Oral Health America Webinar Series
Leveraging Service-Enriched Housing to Improve the Health of Vulnerable Populations
July 25, 2017
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HOUSEKEEPING INFORMATION • •
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CE Credit Available
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CAMPAIGN FOR ORAL HEALTH EQUITY Addresses oral health inequities in our society and identifies possibilities for closing the oral health divide in America. The campaign strives to:
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Kamillah Wood, MD, MPH, FAAP Senior Vice President of Health and Housing at Stewards of Affordable Housing for the Future (SAFH) Community Pediatrician at the Children’s Health Center at THEARC, Children’s National Health System in Washington, D.C.
Leveraging Service-Enriched Housing to Improve the Health of Vulnerable Populations Kamillah Wood, MD, MPH, FAAP
Senior Vice President, Health and Housing Stewards of Affordable Housing for the Future
contact@sahfnet.org contact@sahfnet.org
Objectives • Understand the role of service-enriched housing as a social determinant of health • Discuss the use of data in the evaluation of health outcomes from a housing perspective • Provide examples of cross-sector engagement between health and housing • Validate the importance of cross-sector engagement to address opportunity, equity and health
contact@sahfnet.org
Outline • Background on Stewards of Affordable Housing for the Future (SAHF) • Public health theories of intervention and population health • Landscape and momentum around addressing the social determinants of health • SAHF’s health and housing work • Impact of current policy landscape
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Health beyond healthcare – Moving Upstream
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Health beyond healthcare – Moving Upstream Social and Structural Determinants
Prevention and health education
Healthcare
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Social and Structural Determinants of Health
10-20%
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
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Place Matters
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Health and Housing
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Growing Acknowledgement on Federal Level • Public Health 3.0
• OMB interest
• Accountable Health Communities http://www.slideshare.net/CMSgov/webinar-accountable-health-comunities-model-overview-applicationrequirements
contact@sahfnet.org
Cross-sector interest burgeoning • White House Fellows Foundation and Association – special convening on the social determinants of health • George Washington University Rodham Institute session on health and housing • Center for Budget and Policy Priorities meeting on Housing and Healthcare • CDC-HUD-ASTHO Convening on Health and Housing
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Source: https://www.youtube.com/watch?v=lrKRm6KAzfU
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Source: http://www.communichi.org/racial-equity-diversity-awareness/
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SAHF Portfolio: By the Numbers Mercy
CHP Common Bond
ELGSS
HFA
13
POAH
RHF
Non-Profit Housing Providers
NHTE
BRIDGE
NHPF
VOA TCB
NCR
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SAHF’s mission is to lead policy innovation and support the delivery of affordable rental homes that expand opportunity and promote dignity for residents
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Housing as a Platform for Success
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SAHF Outcomes Initiative SAHF began the Outcomes Initiative to create a common framework for members to demonstrate the impact on residents of providing safe, quality affordable housing and other services in five areas: Youth & Education
Community Engagement
Financial Health & Capability
Housing Stability
Health & Wellness
Resident service coordinators well positioned to impact health outcomes: • Direct connection with residents who are considered a vulnerable population (seniors, low income families, those with disabilities, formally homeless) • Understand issues that directly impact residents • Can create unique community partnerships • Validate value proposition to health providers who are looking to improve outcomes, reduce healthcare costs and focus on population health
contact@sahfnet.org
SAHF Outcomes Initiative • Culture shift and systems change ➢ To create and validate a persuasive and data-based narrative that affordable housing with services helps low-income residents achieve important social outcomes beyond providing basic shelter, including improving health ➢ Value Proposition/business case
• Moving from individual programs to systems level evidenced-based interventions • First network collaborating around data and best practices on consistent outcomes (rather than activities and outputs)
contact@sahfnet.org
Outcomes Initiative Data Submitted to SAHF 2 years of data from
6 organizations for
40,000+ residents living in
820 properties across the U.S. *Submitted data only for 2016-17 round (1 year of data)
BRIDGE Housing Mercy Housing NHP Foundation* NHT-Enterprise* The Community Builders Volunteers of America National Church Residences Preservation of Affordable Housing
contact@sahfnet.org
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SAHF Health Indicators Collected • SAHF has collected data for the following six health-related indicators from our member organizations for two years. Health data was submitted for approx. 44,000 affordable housing residents in total.
• Number of ED visits in the past year • Number of times admitted to the hospital in the past year • Resident has a personal doctor/health provider/usual place of care (Yes/No)
• Resident has visited a doctor for a routine check-up in the past year (Yes/No) • Resident is covered by health insurance (Yes/No) • Type of health insurance (Medicare/Medicaid/Private/CHIP/VA/Other) • SAHF members collected data using a variety of methods
contact@sahfnet.org
Health Care Utilization Data Analysis % people with one or more hospitalization in past year
% people with usual place of care
30%
100%
97%
96%
Largest difference: 90% +24 pct. points
90% 25%
21%
78%
76%
80%
Largest difference: +9 pct. points
93%
76%
70% 70%
20%
56%
60%
17%
54%
15% 15%
50% 40%
10%
8% 6%
5%
6%
8%
30%
6% 20%
5%
2%
10%
0%
0%
1-17
18-24 U.S. population
25-44
45-64
SAHF population
65+
0-17
18-24
25-44
U.S. population
45-64
65+
SAHF population
SAHF N = 44,115 residents. Figures only include residents for whom a number was reported, not all residents in files. U.S. population data source is the U.S. Department of Health and Human Services, Center for Disease Control, National Center for Health Statistics, report titled "Health, United States, 2014" (page 276) found at http://www.cdc.gov/nchs/data/hus/hus14.pdf#089.
contact@sahfnet.org
Health Insurance Rates by Income Rates of Health Insurance by Income Bracket 98%
96%
96%
96%
96%
96%
97%
95%
94% 94%
92%
90%
88% 88%
86%
84%
contact@sahfnet.org
SAHF’s Role in Health and Housing • Matchmaking activities between SAHF members and Medicaid Manage Care Organizations ➢Imbedded case manager initiative- VOA and Mercy with Colorado Access in Denver ➢Telemedicine project - Mercy Southeast and Amerigroup ➢Community garden - Mercy Southeast and PeachState health plan of Georgia
contact@sahfnet.org
SAHF Member Work • Mercy Northwest –
➢Regional Health Innovation Project in King County ➢Washington State recently received 1115 Medicaid Waiver
• National Church Residences –
➢Working with regional Accountable Care Organization in rural Ohio
• Mercy California –
➢Health and Wellness center established in Sunnydale neighborhood in San Francisco
• Preservation of Affordable Housing (POAH) – ➢Potential oral health collaboration
contact@sahfnet.org
2017 SAHF Initiatives • Medicaid and Affordable Housing Roundtable • Regional Health and Housing Roundtables • • • • • •
Oral Health Food insecurity Technology Toxic stress Mental and behavioral health Obesity
• Continue to elevate work in member organizations, explore areas for new collaboration and peer sharing contact@sahfnet.org
SAHF Health and Housing 2.0 • Community Benefit • Data Sharing • Academic Partnerships • Working across multiple social determinants
• Reframing conversation – change in vernacular? contact@sahfnet.org
PROPOSED POLICY CHANGE
• Medicaid – per capita caps/block granting • Elimination of the Prevention and Public Health Fund • Cuts to Community Development Block Grant program and Choice Neighborhoods • Cuts to rental assistance programs – increase in tenant contributions • Work requirements • Tax reform • Infrastructure investment
INTERVENTIONS
• New approach to conversation? • Cost-savings from
initiatives/interventions • Focus on state and local level • Creativity and innovation in partnerships/exploring opportunities more crosssector engagement regionally and locally (collective impact and coalition building)
contact@sahfnet.org
Questions? Comments? kwood@sahfnet.org
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Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
CE Credit Available
Contact Information • Kamillah Wood, MD, MPH, FAAP • kwood@sahfnet.org
• Eamari Bell • eamari.bell@oralhealthamerica.org