Social determinants of health and population health are the two latest buzzwords in the health care community to define a key underlying problem. Simply put, where you live can have a direct link to your health.
The New Jersey Housing and Mortgage Finance Agency recently announced a $12 million innovation partnership program with hospitals, inviting hospitals to match the investment for affordable housing in their communities.
The partnership targets low-income individuals, who are often faced with the decision of paying bills or taking care of their health, and homeless patients, which are frequent visitors in the emergency room.
Both groups become a burden on hospitals for the low or unreimbursed cost of providing care.
The HMFA announcement marks a new way for the state to be involved in helping to curb health care costs.
The HMFA said it anticipates awarding three or four projects throughout the state. Each project would be provided funding of up to $4 million, which will also include the federal 4 percent Low Income Housing Tax Credit program.
A typical project, the HMFA said, would include 60 to 70 housing units — 10 of which would be set aside for low-income families — and commercial space for doctors, clinics or other uses.
New Jersey Hospital Association CEO and President Cathleen Bennett said housing, seen as a stability factor, has become a key focus of patient care in the health care community.
“No one entity can do it all alone,” Bennett said, when asked about why the state was taking this new step.
“Housing conditions affect population health. Supportive housing can … help reduce expensive hospital services.”
This theory of care is one the Camden Coalition of Healthcare Providers has been utilizing for some time.
Since implementing its Housing First program in 2015, the Camden Coalition has seen a 60 percent reduction in emergency room visits from housing enrollees.
The Camden Coalition worked with the state agencies to secure low-income housing vouchers and place homeless patients in them.
The HMFA program also will rely on vouchers, but how they will be applied remains to be seen.
“Housing vouchers accomplish one thing, that gets you into housing, and supportive housing takes it one step further and says, ‘What type of supports do you need around you?’” Bennett said.
Having someone help check health monitoring levels, prescription adherence, counseling services or weigh-ins for chronic conditions — those are all services can happen on-site, Bennett said.
Hudson County currently has a program that relies on a bridge between housing and hospitals, which has also been successful, according to NJHA.
“This isn’t something that a hospital can do on its own or a business can do on its own,” Bennett said.
Greater details will be revealed when the HMFA begins its RFP process, she said. That is when developers and hospitals can collaborate and determine how to implement the program.
Bennett said it is all part of a bigger-picture approach to care.
“If we want to have a strategy that ends homelessness, and we also want a strategy that helps to preserve our health care system today — because we are looking at the cost of those services — we need to work together to create the type of environment where those that need support to maintain them in housing and help maintain their contribution as members of the community that they need to work together,” she said.
Department of Health Commissioner Shereef Elnahal told ROI-NJ he also has been in conversations about the program with the HMFA and is encouraged by the willingness of the state to test the theory.
It remains to be seen if it is a sustainable model, and which hospitals are selected.
“It does cost money,” he said. “So, the ability to prove that it can ultimately yield a return on investment has been difficult up to this point.
“It’s possible that hospitals that just fall off the cliff of being reimbursed at the 96 percent level on charity care and yet see a number of patients that are self-pay because they don’t have insurance would be able to prove a financially-stable model around this.
“But the impetus, so far, has really been one of trying to help the sickest patients in the community and its encouraging to see the hospitals and the finance authority are interested in this.”