NEW YORK, NEW YORK July 26, 2018—In a report released today, United Hospital Fund (UHF) identifies neighborhoods throughout New York City where Medicaid might improve access to health care, and health outcomes, for thousands of its members by moving beyond medical care to address their need for safe, secure housing.
There is increasing awareness that economic and environmental factors such as poverty, inadequate nutrition, and exposure to violence—often called social determinants of health—can have a greater impact on health outcomes than medical treatments. Stable housing is a key social determinant, and research consistently shows that insecure housing and homelessness correlate with higher rates of emergency department (ED) use, more frequent hospital admissions, and adverse health outcomes.
The New York State Department of Health (NYSDOH) is encouraging Medicaid providers to address social determinants of health through requirements and incentives under its value-based payment initiative. The UHF HealthWatch report, Stable Housing, Stable Health: Addressing Housing Insecurity Through Medicaid Value-Based Payment, identifies neighborhoods throughout New York City with high levels of housing insecurity, health care use, and Medicaid enrollment, including 16 communities that rank at the top on housing need and ED use, making them particularly good targets for housing interventions. The report also looks at programs around the country with innovative strategies to help patients with their housing needs.
Using recently released neighborhood-level data from the New York City Department of Health and Mental Hygiene, the report shows that city neighborhoods with the greatest need for housing interventions are often clustered near each other, such as those in the Mount Hope area of the southwest Bronx. Other high-need neighborhoods include East New York in Brooklyn and Jamaica in Queens.
“Many ED visits are potentially driven by unstable housing, which can reduce access to care, complicate management of chronic conditions, and make it difficult to perform such tasks as refilling or storing medication,” said Misha Sharp, research analyst at UHF and lead author of the report. “Neighborhoods with combinations of housing need and high ED utilization rates offer good opportunities for developing housing interventions, which in turn could contribute to reducing emergency room visits and hospitalizations.”
The report noted several obstacles, however, including financing restrictions. Currently, federal law prohibits federal reimbursement of direct Medicaid spending on housing (e.g., rent), leaving New York to finance such initiatives with State-only dollars, or focus on federally reimbursable housing-related services. Medicaid providers and managed care plans must also negotiate several complex decisions when determining how best to offer housing interventions in a way that balances cost-effectiveness and patient outcomes.
Underlying all these issues is the long-standing scarcity of affordable housing in New York City, which both drives housing insecurity and obstructs potential solutions. New York Medicaid's value-based payment initiative has the potential to promote cross-sector partnerships between Medicaid plans, providers, and housing and human services organizations that can best address these issues together.
“The success of such partnerships will depend on adequately balancing each sector's goals and share of investment, and returns,” said Nathan Myers, assistant director of UHF's Medicaid Institute and co-author of the report. “But cost savings alone may be an insufficient measure of success. The clearest value may come from addressing the health consequences of current and future homelessness.”
The report can be downloaded from UHF's website here. Accompanying the report is an Excel file, organized by New York City borough, showing neighborhoods with the highest housing need and emergency department utilization.
About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at www.uhfnyc.org and follow us on Twitter.