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In this report, the authors present the final evaluation of the Pima County Housing First (PCHF) Initiative, which offers permanent supportive housing (PSH) and case management for individuals who are involved with the criminal justice system and have experienced homelessness. Those who have been placed in detention, including jail or prison systems, encounter significant barriers to reentry and reintegration, and individuals with complex physical and behavioral health conditions are at heightened risk of homelessness. This study is one of the first to examine the impact of PSH on such individuals. In its first two years, the PCHF Initiative enrolled 314 adult clients. Over 70 percent of these individuals were provided with a housing voucher, and close to 60 percent were provided with supportive housing. Among those tracked for 12 or more months from program enrollment, criminal justice system service utilization declined by over 50 percent and hospital-based health care utilization declined by more than 40 percent. These reductions in services offset the programmatic costs of housing and social services attributable to the PCHF Initiative. However, to determine whether the relationship between program participation and shifts in service utilization are causal, a more rigorous study design would be needed.
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In the United States, low levels of price transparency make it hard for employers and other purchasers of health care to assess the prices that they pay for health care services. Using data from 2016 to 2018, the authors document variation in facility prices for the commercially insured population, reporting differences in standardized negotiated prices and prices relative to Medicare reimbursement rates for the same procedures and facilities. The data come from all but one state in the United States and cover
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Although rates of homelessness have remained fairly steady in the United States over the past decade, the number of people experiencing homelessness in California has continued to grow. California now has an estimated 151,000 people experiencing homelessness, more than any state in the nation. Permanent supportive housing (PSH) has been recently adopted by health plans, hospitals, and large health systems as a way to address one of the key social determinants of health: stable housing. This report represents a second examination of a PSH program operated by a large not-for-profit Medicaid and Medicare managed care plan in Southern California. This PSH program combines a long-term housing subsidy with intensive case management services for adult plan members experiencing homelessness who have one or more chronic physical or behavioral health conditions and represent high utilizers of inpatient health care. In this report, the authors provide an overview of implementation to date, including information about referrals and enrollment into the program, housing placements, and participant characteristics. The authors also assess the short-term impact of the program by examining health care service utilization and associated costs in the six months prior to and six months following enrollment in PSH in comparison with an observational control group of adult plan members who did not receive PSH. The authors also examine the PSH program costs during this period.
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Because employer-sponsored spending comes from employee wages and benefits, employers have a fiduciary responsibility to administer benefits in the interest of participants. The lack of transparency of prices in the health care market limits the ability of employers to knowledgeably develop or implement benefit design decisions. This study uses medical claims data from a large population of privately insured individuals, including hospitals and other facilities from across the United States, and allows an easy comparison of hospital prices using a single metric. An important innovation of this study is that our data use agreements allow reporting on prices paid to hospitals and hospital systems (hospitals under joint ownership) identified by name.
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Homelessness, which refers to the lack of a fixed, regular, and adequate nighttime residence, is a pervasive public health issue. This report presents results from an implementation and outcome study of an ongoing permanent supportive housing (PSH) program—including service utilization and associated costs review—operated by a large not-for-profit Medicaid and Medicare managed care plan serving more than 1 million members in the Inland Empire area of Southern California. This PSH program combines a long-term housing subsidy with intensive case management services for adult plan members experiencing homelessness who have one or more chronic physical or behavioral health conditions and represent high utilizers of inpatient health care. The aim of this report was to determine whether programmatic costs incurred by the health plan supporting the PSH program were partially or fully offset by decreased costs attributable to health care utilization within the health system. The evaluation used a quasi-experimental research design with an observational control group. The authors differentiated the program's effect during the transitional period—that is, after program enrollment and prior to housing placement—from its effect during the period after members were housed. In addition, the authors present participant flow through the key program milestones (e.g., referral, enrollment, housing placement, program exit) and describe health care utilization and associated costs for members who exited the program. Finally, they report the PSH programmatic expenditures relative to the changes in health care costs to provide an overall picture of the intervention's benefits and costs to the health plan.
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Like the United States as a whole, Virginia faces a significant shortage of health care workers in nursing, primary care, and behavioral health. If current trends persist, these shortages will increase across Virginia. The authors of this report identify interventions that can help the Virginia Health Workforce Development Authority (VHWDA) address these health care workforce shortages. To accomplish this goal, they applied an analytic framework to existing or potential interventions for retaining, recruiting, and improving the structural efficiency of the nursing, primary care, and behavioral health workforces in Virginia. In this report, they highlight which interventions VHWDA should prioritize based on its desired outcomes and policy goals.
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