Speaker Kathleen Stillo, president and chief operating officer of the clinical redesign direct care delivery unit in UnitedHealthcare’s Community & State division, talks to RISE ahead of the September conference about the organization’s mission to provide its most medically and socially complex members with better care at lower cost.
Stillo will present the strategy and impact of leading-edge care models that address the health-related social needs of UnitedHealthcare’s Medicaid members at RISE West, on Tuesday, Sept. 10, the first day of the main conference program for the annual event.
One model, Housing + Health, focuses on providing housing and integrated wraparound care to members who are persistent and frequent users of the health care system and are currently homeless. Housing + Health is modeled after a similar program that Stillo and Jeffrey Brenner, M.D., chief executive officer of clinical redesign at UnitedHealthcare Community & State, ran at the Camden Coalition of Healthcare Providers and the Urban Health Institute at Cooper Health System in Camden, N.J.
“Most models are built around body parts, ours was built around people. The work is similar in many ways, but from the position of payer, the opportunity is significant. We’re impacting vulnerable patients nationwide,” Stillo said.
Indeed, UnitedHealthcare has approximately seven million Medicaid members across 30 states within its system. A small percentage of these members live with a variety of extreme complexities–chronic medical conditions, behavioral health issues, and social disparities, like homelessness, according to Stillo. “They’re utilizing the health care system in many ways–ERs, nursing facilities, and so on. While their cost of care accumulates, they’re not feeling better. They’ve yet to have the root cause of their situations addressed,” she said.
UnitedHealthcare launched its first Housing + Health model in the Phoenix market in 2016. The organization learned that those members who experience homelessness visit the emergency room nine times more frequently than other members who are not homeless. They have six times the amount of inpatient stays and their medical spend is more than three times of those members who aren’t homeless. These insights informed the organization’s strategy in Phoenix and subsequent markets.
How the model works
UnitedHealthcare uses three pipelines to identify members who spend a large amount of time in hospital emergency rooms or as inpatients and who meet the criteria for the housing service. The first approach is an internal health care hotspotting capability that UnitedHealthcare developed based on Brenner’s use of data to reallocate resources to the high-needs, high-cost patients in Camden, N.J. It also relies on staff who are embedded in hospitals as part of the discharge process to identify members who may benefit from the service. Finally, the insurer relies on its state health plans to refer members to the program.
Housing + Health provides immediate housing and, in time, stabilization for members who are experiencing homelessness, so they can address their medical and social needs. “If you are a person with severe diabetes and you are also homeless, you don’t have the ability to take care of yourself properly. You can’t store insulin if you don’t have a refrigerator. Immediate housing is very effective for members like these who have tremendous medical complexity,” she said.
Different housing options, depending on need
The health plan partners with a housing vendor to offer collocated single-site apartments, scattered site apartments, or group housing that has varying levels of staffing and supportive programming. The multiple housing options help meet the needs of members who are in different stages of complexity. For example, one member who lives in Reno, Nev., and has stage 4 colon cancer, was originally in a single-site unit but then was moved to group housing, which provides a family feel and has given her tremendous support and comfort.
“She has a best friend who has become in many ways a significant caregiver for her,” Stillo said. “It’s been rewarding to see supportive relationships forming in our housing units. There isn’t one solution that fits everyone, so we offer different housing options for members experiencing varying states of complexity.”
Plans to expand by end of 2019
UnitedHealthcare pays a monthly charge per member for housing and most programs have wraparound care services to get them stabilized and in a recovery process. These services include purpose-centered case management, patient-centered care coordination (medical and prescription drugs), advocacy for disability benefits, one-on-one weekly health coaching, non-emergent transportation, on-site support groups, and classes for chronic conditions.)
The Housing + Health integrated care model is currently in six states, but Stillo said UnitedHealthcare intends to expand to 15 states by the end of this year.
“We have seen a real reduction in medical spend when this type of wraparound care is available to patients who are in the most complex medical and social situations,” Stillo said.
Editor’s note: Stillo will discuss UnitedHealthcare’s Housing + Health integrated care approach in-depth at RISE West, which will take place Sept. 9-11, at Loews Coronado Bay Resort, San Diego. Click here for the online agenda or to register.