Next for Camden Coalition: Getting patients to change behavior

Talking Points

By Anjalee Khemlani
Philadelphia | Nov 13, 2017 at 10:55 am

Talking Points is an occasional feature in ROI-NJ that recaps key speakers at business gatherings across the state. Jared Susco, the chief operating officer and interim CEO of the Camden Coalition, spoke about the challenges the group is facing during a recent health care conference in Philadelphia hosted by Virtua Health.

The Camden Coalition of Healthcare Providers has been a success story for the state, but it hasn’t been an easy nearly two decades, according to Chief Operating Officer and interim CEO Jared Susco.

“The Camden Coalition is a solution to Camden’s specific issue,” Susco said.

He spoke to a crowd of about 30 at a recent health care conference in Philadelphia, hosted by Virtua Health.

Susco said that, when founder Jeffrey Brenner first started his work, he wasn’t sure where it would go. Brenner recently left to work with UnitedHealthcare.

“When Jeff Brenner began (17 years ago), he didn’t know we needed to do something about housing,” Susco said.

The Coalition has touted its Housing First program, which focuses on offering housing to the highest 1 percent of utilizers of health care in the state, as a success.

Brenner began the work on social determinants of health care, which focuses on things such as food, housing and employment — things outside the hospital — that affect a person’s health.

By identifying higher utilizers of the health care system, which in some ways increase the costs of health care overall, the Camden Coalition has been able to develop methods over a decade to curb utilization.

The Coalition used to look for referrals for those who needed help, as well as trying to approach people whom it believed needed help.

Rather than separating them in a housing project, providing them with a balanced social structure is important, Susco said.

The Coalition was approved for 50 vouchers last year from the state’s Housing Authority, with an additional 15 this year.

So far, 42 percent of the vouchers have been used. Of those individuals, 88 percent have a mental health diagnosis, 48 percent are battling a mental health or substance abuse problem, and 100 percent of them have a chronic illness, Susco said.

It’s a complex problem.

And the idea of homelessness and housing has often been defined in a rather pernicious way, Susco said.

It relies heavily on the idea of a merit-based system. Staying out of jail, staying drug-free, getting a job — all are requirements for housing assistance.

But the Coalition’s program comes at the problem from the opposite angle: Give them housing, and everything else can be worked out.

And, while there are still hoops and hurdles, and there is trepidation from landlords about accepting the individuals, there is a business case to be made.

“It turns out that I can convince someone solely on an economic reason that giving someone a home makes sense. I don’t need to convince you on the basis of who you are as a person, your social values or anything like that. Because the economics actually play out,” Susco said.

To that point, it has proven to improve not just a person’s health, which decreases costs of health care overall, but also has proven a reduction in jail utilization, he said.

And, unlike traditional housing models, where evictions can occur, there is a high — 80 to 90 percent — retention rate of those being housed, Susco said.

But then the Coalition discovered another obstacle: human nature.

“Patient choice is an essential element of the program,” Susco said. “You can’t tell someone, ‘Be better.’

“It doesn’t work. Think about in any relationship, can you make anyone do anything? No. But, somehow, in medical care, we believe we can make patients do things. It doesn’t work that way. Human beings don’t work that way.”

So, solving the problem of patient choice equates to identifying a need for changing behavior and lifestyle, whatever that need or catalyst may be, and then offering choices, Susco said.

These choices, he said, could be of types of housing, as well as various options for health care services — all of which can help improve the outcome of the patient.

“You have to paradoxically reinforce the other person’s autonomy,” Susco said. “Connect with that person’s reason for change, and reinforce autonomy, then you’re going to get the behavior modification — potentially — that you want.”

Balancing that, and being able to offer options for housing, is a challenge.

For landlords, there needs to be a certain amount of compassion, to allow someone with a housing voucher from the state to live among the regular rent-paying residents, Susco said.

And, once the vouchers run out, there needs to be a way to sustain the successful model at the Coalition.

Susco said the Coalition is turning to potential partners that make sense, like banks, and has turned down grants that could take away from the working model it has developed.

Which is why, at the end of the day, it is still a work in progress.

“There’s a really strong public case for doing this work, but there is a strong political will that needs to be built,” Susco said.

Anjalee Khemlani | | @anjkhem