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Health as Housing
- 2. Housing as Health Panel Pam Hester Health and Housing Manager Community Health Innovation Program November 16, 2016
- 3. CareOregon Serves 230,000 Oregonians in 9 counties • 80% in Portland metro area • 53% female • 41% 19 and younger • 10% 4 and younger • 32% do not speak English as their first language • 45% self-identify as non-Caucasian
- 4. CareOregon History Founded in 1993, began as a health plan in 1994 9,500 members in 14 Oregon Counties 1997 - became an independent non-profit 2012 – Oregon moved to Coordinated Care Organizations 2014 – Population Health Partnerships department created
- 5. Social Determinants of Health The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. -The World Health Organization
- 6. Reallocate Health Care $$$$ Infographic from bipartisanpolicy.org http://bipartisanpolicy.org/sites/default/files/5023_BPC_NutritionReport_FNL_Web.pdf Data from: McGinnis et al 2002. The Case for More Active Policy Attention to Health Promotion. HealthAffairs
- 7. Health Care Reform & Homelessness in Multnomah County – City Club or Portland Bulletin, Vol. 97, No. 10, January 6, 2015 The Health Burdens Associated with Homelessness
- 8. Health Care Reform & Homelessness in Multnomah County – City Club or Portland Bulletin, Vol. 97, No. 10, January 6, 2015 The Health Burdens Associated with Homelessness
- 9. Before Move-in After Move-in % Change # Primary Care Visits* 2.8 3.4 +20% # ED Visits* 1.1 0.9 -18% # In-Patient Non-OB Visits 0.08 0.07 -15% ≥ 1 Primary Care Visit* 0.57 0.67 +18% ≥ 1 ED Visit* 0.40 0.36 -11% ≥ 1 In-Patient Non-OB Visit 0.08 0.07 -11% Total Cost* $386.3 $338.3 -12 % KEY FINDINGS: Housing increases primary care visits Housing decreases ED utilization and total cost Healthcare supports in affordable housing N = 1,625 * Findings are significant
- 10. More healthcare and housing data • A 2006 study of CCC’s Chronic Homeless Housing First team: Annual cost for health care and incarceration per client was reduced from an estimated $42,000 per year to $17,199 per year. Once the cost for supported housing was accounted for, the program reduced total annualized costs by 36%. • A 2006 study of Denver Housing First Collaborative: ER visits reduced by 34%, inpatient costs were reduced by 66%, Detox visits were reduced by 82 %, incarceration days reduced by 76 % and the total average cost saving per person was $31,545. • A 2002 study by Dennis P. Culhane, et al.: 4,679 homeless people with serious mental illnesses placed in supportive housing in NYC between 1989 and 1997 resulted in reduction in services use of $16,282 per housing unit per year.
- 11. Health Plan Alignment Goals Decrease measurable medical cost Increase quality metrics Increase member & provider satisfaction Data driven Claims: Individual high risk/high utilizers Claims/HEDIS: Population focus HEDIS/CCO incentives: Targeted individual outreach
- 12. Population Health Department • Health Resilience Specialists – Trauma-informed clinical program – Non-traditional healthcare workers support high-risk, high- cost patients • Exceptional Needs Care Coordination – Care coordination to members with complex medical needs • Advanced Illness Care – Partner with community hospices to provide palliative care • Transitional Care and Outreach – Coordinated discharge planning, patient education, care coordination
- 13. Social Determinants of Health Team Team functions…. Support the PHP department and CareOregon members by: - Providing direct services to prioritized members - Ensuring resources and partnerships are in place to support PHP members’ work - Developing partnerships that align community resources and reduce duplication Housing service domains… • Homelessness prevention and transitions of care • Housing transition service • Tenancy sustaining services
- 14. Housing Programs, Partnerships & Investments • Housing with Services – LLC model involving 9 agencies – Provide health care coordination and services to the 1,400 residents of 11 affordable housing communities – Includes food and social support programming – 644 residents served so far this year – 4,785 services • Housing case management – Annually place approximately 50 people in permanent housing – Provide eviction prevention to approximately 20 annually – Coordination with medical care team and assistance with housing transition (housing search, move in assistance, security deposits, etc. – On-going care coordination
- 15. Housing Programs, Partnerships & Investments • Community Service Provider Network – Network of providers that PHP team can deploy to meet member needs – Food, housing-related services, transportation • $4 million investment in CCC’s Health is Housing • Pilot projects, participation in workgroups and community-led councils
- 18. Neighborhood Partnerships Panel November 16, 2016 PacificSource Community Solutions, Central Oregon CCO
- 19. Central Oregon CCO 101 • PacificSource is the Coordinated Care Organization (CCO) for Central Oregon (Crook, Deschutes, Jefferson, and Northern Klamath Counties) and holds the Medicaid contract with the Oregon Health Authority (OHA). • During the formation of the CCOs, Central Oregon wanted a governance structure that included additional community oversight, involvement, and transparency. • Senate Bill 204 was created which allows the Central Oregon Health Council (COHC) to be the CCO governing entity in Central Oregon. • The CCO and the COHC have a Joint Management Agreement which outlines roles/responsibilities, deliverables, and funding streams.
- 20. Central Oregon Population USCensus estimatesJuly2014 CentralOregon Population Crook: 20,978 Jefferson: 21,720 Deschutes: 157,733 Medianhousehold income Crook: $36,158 Jefferson: $46,588 Deschutes: $49,584 Medianhomevalue Crook: $159,800 Jefferson: $158,100 Deschutes: $243,400 Medianmonthlyrent Crook: $724 Jefferson: $753 Deschutes: $931 Personsinpoverty Crook: 18.3% Jefferson: 21.2% Deschutes: 13.2% Foreignbornpersons Crook: 2.3% Jefferson: 7.3% Deschutes: 4.5% Latino Crook: 7.4% Jefferson: 19.6% Deschutes: 7.8% NativeAmerican Crook: 1.6% Jefferson: 19.0% Deschutes: 1.1% White,non-latino Crook: 88.6% Jefferson: 60.2% Deschutes: 87.9% Populationpersquare mile Crook: 7 Jefferson: 12.2 Deschutes: 52.3 Landareainsquare miles Crook: 2,979 Jefferson: 1,781 Deschutes: 3,019 Central Oregon CCO Enrollment (OHA, December 2015) Crook: 6,002 Jefferson: 5,074 Deschutes: 39,702 Population on Oregon Health Plan Crook: 29% Jefferson: 23% Deschutes: 25% Uninsured rate (OHA, February 2015) Crook: 1% Jefferson: 4.5% Deschutes: 2.6% *Approximately 2,000 individuals are homeless in Central Oregon *There is currently a <1% vacancy rate in the region
- 21. Regional Health Improvement Plan (RHIP) • Earlier this year the CCO and the COHC completed the four- year RHIP which includes housing as a subsection of Social Determinants of Health. • The housing language was derived from the CCO’s two-year Transformation Plan with the OHA. • The RHIP workgroup that is focused on the housing subsection is developing a work plan to begin bridging housing solutions with the health system. The upcoming waiver, new rules, and existing restrictions from the Centers for Medicare and Medicaid Services may influence this work.
- 22. Community Impact • Under the CCO/COHC Joint Management Agreement the CCO has a 2% profit cap; any surplus is paid to the COHC for community reinvestments related to the RHIP. • 34% of the 2016 RHIP funds (>$1M) have been allocated to housing proposals
- 23. Community Housing Investments Pfeifer and Associates Duplexes purchased in Bend and La Pine to house homeless individuals with Substance Use Disorders. Pacific Crest 50 affordable housing units in a multi-family complex rented to low-income households. Includes resident services that focus on health and access to healthcare. Bethlehem Inn Existing temporary housing for homeless individuals/families that will be constructing a new building to double the number of family units and add a commercial kitchen and administrative space.
- 24. Questions? Leslie Neugebauer Central Oregon CCO Director Leslie.Neugebauer@pacificsource.co m 541-330-8116
- 26. Creating Opportunity through Housing: Housing as Health Josh Balloch Wednesday, November 16, 2016
- 28. About AllCare Health •AllCare Health serves: •49,000 Medicaid Members •1,900 Medicare Advantage Members •2,000 PEBB Members 12/12/201628
- 29. About AllCare Health •Our company is owned by 85 independent providers in the Rogue Valley •Our mission, since we were founded in 1994, has been: Working together to provide quality, cost-effective healthcare for our communities. •And just this year AllCare Health became a Benefit Company or B-Corp - Both our CCO and holding company are B-Corps - We should have B-Lab certification within the next few months - Did this to help protect the board in their investment in the social determinants and codify our current direction for future boards 12/12/201629
- 30. How we see Transformation 2.0 12/12/201630
- 31. Housing Investments in 2015-6 Rogue Valley: - Sobering Center -Hearts with a Mission -Purchase of a 15-unit transitional housing complex for families and its needed repairs Curry County: -$100,000 Grant; $20,000 used for crisis housing in Gold Beach 12/12/201631
- 32. What the CCOs board goals will be 2017 and beyond The CCO board has agreed to focus on three areas going forward: -Housing -Education -Community Partner Building We believe we will need all three to in order to truly improve the health of the communities we serve 12/12/201632
- 33. Thank you!
- 35. Housing + Health Care for the Whole Person November 16, 2016
- 36. CENTRAL CITY CONCERN’S SCOPE Housing + Health Care for the Whole Person 2015
- 37. Supportive Housing... Saves lives Reduces emergency room visits Reduces repeat hospitalizations Reduces burden on public safety Stabilizes lives and creates an environment for health and opportunity Housing + Health Care for the Whole Person
- 38. Housing + Health Care for the Whole Person HOUSING IS HEALTH COLLABORATIVE Portland health care organizations are investing $21,500,000 allowing CCC to build 382 new housing units across three locations and a new health center in Southeast Portland. The health organizations supporting the initiative are: Adventist Health Portland, CareOregon, Kaiser Permanente Northwest, Legacy Health, OHSU, Providence Health & Services – Oregon
- 39. CCC HEALTH SERVICES – BY THE NUMBERS In 2015, CCC served 8,000 patients: 23,000 medical care visits, 54,000 mental health visits, 73,000 substance use disorder visits, 165,000 prescriptions filled at our Old Town pharmacy. Eastside Integrated Housing and Services will serve 3,000 patients annually through 15,000 medical care visits, 14,000 mental health visits, 36,000 substance use disorder visits, and 49,000 prescriptions. The clinic will include Urgent Care and the housing will include Recuperative Care Program units for hospital step down and palliative care. Housing + Health Care for the Whole Person
- 40. Connecting the dots • CCC operates the Old Town Clinic, a Federally Qualified Health Center serving the sickest OHA members in the state. OTC is a National Committee for Quality Assurance Tier-3 recognized Patient Centered Medical Home. • In 2012, OTC was recognized by RWJ as one of the top 30 exemplary primary care practices nationwide. • We have operated affordable supported housing for 40 years. • Ed Blackburn, the Executive Director is a founding member of HSO with the CEOs of each of the hospital and health systems that invested in this new project. • CCC has a proven track record in the Recuperative Care Program hospital partnerships. • CCC in the nexus of healthcare and housing, recognized nationally by HUD, HRSA, SAMHSA, NAEH, NHCH, NCBH, DOL and the United States Interagency Council on Homelessness. • This partnership is the result in the confidence in CCC and the quality of services we provide.
- 42. Oregon’s Proposal for Coordinated Health Partnerships
- 43. Introduction • The Challenges and Opportunities in Oregon • 1115 Waiver Proposal for Coordinated Health Partnerships (CHPs) • CHP Advisory Council
- 44. The Challenge in Oregon • Unprecedented housing crisis: Oregon’s homeless population increased by 9 percent in 2015 and on a single night there were 13,176 homeless individuals • Complex needs among homeless: a large portion of the homeless population suffers from chronic illnesses and one or more physical, mental, or substance use related conditions • Lack of coordination and gaps in existing services: Federal, state and local programs that target homeless individuals, or those at risk of becoming homeless are often: – Siloed with each program having its own objectives and client base, – Lacking connections to other federal, state and locally funded programs serving similar populations.
- 45. Opportunity in Oregon • A significant number of Oregon’s chronically homeless and individuals at-risk of homelessness are now eligible and enrolled in Medicaid • Leverage Oregon’s health system transformation and our 16 coordinated care organizations (CCOs) • Oregon’s Legislature and local municipalities have invested millions in expanding affordable housing (2015 and 2016) • Existing US Department of Justice Agreement with Oregon and the Oregon State Hospital to improve community mental health treatment and programs.
- 47. Coordinated Health Partnerships (CHPs) CHPs are five-year pilots to increase supportive housing integration among target populations and develop infrastructure to ensure ongoing collaboration among the participating entities • Form local collaborations to enhance local coordination and integration of health and housing-related services and transitions of care • Support and enhance access to flexible services delivered by CCOs and providers serving the target population • Develop a menu of supportive services that focus on homelessness prevention and care coordination, transitional supports, and tenancy sustainability
- 48. Target Populations for CHPs • High-risk, high needs individuals o With repeated incidents of avoidable emergency use or hospital admissions; o With two or more chronic conditions; o With mental health and/or substance use disorders; o Who are currently experiencing homelessness; and/or o Individuals who are at risk of homelessness, including dual eligibles, and IHS, Tribal, and Urban Indian program constituents, and those that will experience homelessness upon release from institutions • CHPs may choose to limit the population served within their pilot application • OHA will work with CHPs to determine the number and focus of target population
- 49. CHP Participating Entities CHPs will test new models to increase collaboration, coordination, and integration of services among community partners, including: • CCOs (lead entity) • County agencies • Corrections • Tribes (lead entity) • Health providers • Housing entities • Local hospitals • Other entities serving or advocating for the targeted population
- 50. CHP Goals and Objectives Pilots will seek to address local supportive housing needs and develop solutions that fit local communities in Oregon; pilot objectives include: • Increasing awareness of and access to housing supportive services • Increasing coordination of housing supportive services for a target at-risk population. – Local CHPs may identify specific sub-populations to include in pilot program based on community needs • Reducing inappropriate emergency, inpatient and residential treatment facility utilization • Increasing access to and use of primary care • Improving data collection and sharing among local entities to support ongoing case management, monitoring, and improvements
- 51. Proposed CHP Program Design • CHPs must provide services across three domains: homelessness prevention/transitions of care, housing transition services, and tenancy sustaining services – At a minimum, CHP pilots will be expected to implement one program per domain area • Medicaid enrolled can decide to participate in a CHP pilot and opt in and opt out at any time • Each grantee will be required to develop their own payment methodology and strategies for financing services (consistent with federal guidelines) • Initially, payments to grantees will be based on meeting process measure targets and will move towards outcomes based payments
- 52. CHP Pilot Domains Example: Potential Types of Services Homelessness Prevention/ Transitions of Care Support to ensure care coordination among non- medical settings; fund services to support an individual’s ability to move from institutional settings to less costly community-based care settings Ensuring that CCO members obtain health services necessary to maintain physical, mental, and emotional development and oral health Ongoing assessment of medical, mental health, substance use disorder or dental needs Case management and coordinating the access to and provision of services from multiple agencies Establishing service linkages with community providers CHP Pilot Domains
- 53. CHP Pilot Domains Example: Potential Types of Services Housing Transition Services Invest in pre-tenancy services to decrease health care costs and reduce use of high-cost health care services Tenant screening and assessment Assistance with housing searches and applications, move-in assistance, short-term expenses such as security deposits, other landlord-required rental or lease costs Moving costs, basic furnishings, food and grocery supports Adaptive aids and environmental modifications Housing support crisis plan and intervention services Care coordination services with medical homes, behavioral health and SUD providers CHP Pilot Domains (cont.)
- 54. CHP Pilot Domains Example: Potential Types of Services Tenancy Sustaining Services Invest in services that support the individual in being a successful tenant in his/her housing arrangement Tenancy rights/responsibilities education; coaching and maintaining relationships with landlords Eviction prevention (paying rent on time, conflict resolution, lease behavior requirements) Utilities assistance/management (energy/gas) Landlord relationship/maintenance Crisis interventions and linkages with community resources to prevent eviction when housing is jeopardized Linkages to education/job training, employment Care coordination services with medical homes, behavioral health and SUD providers CHP Pilot Domains (cont.)
- 55. Proposed CHP Timeline Oregon is proposing a multi-faceted, incremental approach to the state’s integration of health care and supportive housing for the 2017-2022, 1115 Demonstration renewal: • Year 1: Convening and planning initiatives, regionally and statewide • Years 1-5: Statewide investment in infrastructure development and creation of CHPs • Years 2-5: Pilot and test new models of housing supportive programs among CHPs • Years 2-5: Transition to paying for outcomes based on evidence-based practices • Years 2-5: Dissemination and spread of best practices
- 56. Preliminary Evaluation Considerations • Reductions in ED use and psychiatric acute care hospitalizations • Increases in primary care and behavioral health care use, including medication adherence • Decreased discharges to secure residential treatment facilities • Increase in transitions from recovery to permanent housing settings • Increase in access to care and quality of care after moving into housing • Retention in housing unit for 12 months or longer • Increase in percentage of adults accessing employment and benefits services • Increase in the percentage of individuals that transition to affordable housing (market rate housing/community housing placement) • Increase in self-sufficiency among those served
- 57. CHP Advisory Council • OHA has finalized member selections for the Coordinated Health Partnerships (CHP) Advisory Council o Jerome Brooks, Oregon Opportunity Network o Ryan Fisher, Northwest Public Affairs o Karen Gaffney, Lane County Health and Human Services o David Geels, Coos Health & Wellness o Chris Hoy, Clackamas County Sheriff’s Office o Eric Hunter, CareOregon o Sean Kolmer, Oregon Association of Hospitals and Health Systems o Leslie Neugebauer, Central Oregon CCO o Rachel Post, Central City Concern o Paul Solomon, Sponsors, Inc. o Brandon Tupper, Klamath Tribal Health and Wellness Center o Mellani Calvin, A.S.S.I.S.T Program
- 58. CHP Advisory Council (cont.) • CHP Advisory Council will be initially convened in November 2016 • CHP Advisory Council will provide an opportunity for public input and will be tasked with informing the final design and implementation work plan • Additional opportunities for involvement: OHA is seeking interested stakeholders willing to provide rapid feedback through online surveys, phone calls, technical advisory groups and other similar activities
- 59. Questions • More information on Oregon’s 1115 Waiver renewal or CHP Advisory Council: – https://www.oregon.gov/oha/OHPB/Pages/health-reform/cms- waiver.aspx
- 60. Questions • More information on Oregon’s 1115 Waiver renewal or CHP Advisory Council: – https://www.oregon.gov/oha/OHPB/Pages/health-reform/cms- waiver.aspx
Notes de l'éditeur
- Founded by partnership of safety-net providers including Mult Co Health Dept, OR Primary Care Association and OSHU with idea that health care should be available to everyone Health plan opened 1994 with 9,500 members in 14 Oregon Counties PHP department created as a rethinking of care management strategies to meet CareOregon members’ needs in the context of a rapidly changing financial, clinical and regulatory environment. It’s a community facing strategy with embedded clinicians and service providers to better address population specifics in areas of behavioral health, advanced illness and housing I’ll talk more about our programs in a minute. First some of the background that led us into housing.
- The PHP reallocates health dollars to address those conditions and contexts that make people healthy.
- Poverty is the single-most important structural social determinant of health. Within the social determinants associated with poverty, housing has a significant impact on health.
- - There is a growing body of evidence to suggest investing in housing has a positive impact on healthcare costs - A study by CORE Team at Providence
- CORE evaluated claims of OHP residents who moved into one of 145 different affordable housing properties. Overall there was an increase in primary care visits and decrease in ED and inpatient utilization The greatest decrease in expenditures were within buildings with integrated health services – an average reduction of $115 per member, per month. The sicker the clients at move-in, the more the housing helped.
- -HRSs---social workers who “walk alongside” members to help them learn how to meet their own needs and foster resilience ENCC – team of RNs and Behavioral health specialists, referrals to supports, targeted interventions Transitions- Team of mobile RNs reduce hospital readmissions by providing coordinated discharge planning
- Our housing staff Develop and provide a range of services and partnerships across these domains:
- Services that partner with other agencies to provide homelessness prevention and transitions of are, housing transition services and tenancy sustaining services. LLC model that brings healthcare coordination services to residents in
- Supporting and aligning with the work that the community is already doing…
- 170,000 visits per year including primary care, mental health and addiction treatment
- The opportunity in Oregon with respect to addressing the social determinants related to health and housing are: Our state is facing an unprecedented housing crisis – in 2015, Oregon’s homeless population increased by 9% (from 2014), and on a single night there were 13,176 homeless individuals of which 3,991 were chronically homeless. In Oregon’s most populated region, Multnomah County, more than half of those counted as homeless in 2013 suffered from one or more serious physical, mental or substance use-related conditions. The challenge, however, is limited services exist to address homelessness, and often available care coordination and supportive housing services contain gaps, lack coordination and education to ensure services are available and used. Coinciding with Oregon’s housing crisis was the state’s Medicaid expansion. In the first two years, From 2014-15, 436,000 low-income adults became newly enrolled in the Oregon Health Plan (OHP) through the Affordable Care Act (ACA). Expansion dramatically altered the age and gender distribution of Medicaid members – adults now outnumber children on OHP and there are significantly more adult male members.
- The opportunity in Oregon with respect to addressing the social determinants related to health and housing are: A significant number of Oregon’s chronically homeless and individuals at-risk of homelessness are now eligible and enrolled in Medicaid; Leverage Oregon’s successful health system transformation and our 16 coordinated care organizations (CCOs); Oregon’s Legislature and local municipalities have invested millions in expanding affordable housing (2015 and 2016). Existing US Department of Justice Agreement with Oregon and the Oregon State Hospital to improve community mental health treatment and programs.
- This is a visual to help illustrate the changes Oregon is proposing through the state’s 1115 waiver proposal to the federal Centers for Medicare and Medicaid Services (CMS). Essentially a federal waiver allows a state to test new approaches to financing and delivering Medicaid-funded services. Our most current 1115 waiver helped created the state’s 16 Coordinated Care Organizations (CCOs). The current waiver expires in July 2017 and Oregon has submitted an application to renew our waiver for 5 years (2017-2022). The waiver renewal application will build on Oregon’s successes with CCOs, help further address social determinants of health, and test community-based models to prevent homelessness and increase care integration and coordination for targeted populations
- Now I would like to share some of the strategies and details of how the state plans to address supportive housing through Medicaid. For CMS, Oregon has proposed three critical strategies: First, Form local collaborations – With five-year grants, Oregon plans to support a statewide pilot program of community-based Coordinated Health Partnerships (CHPs) to enhance local coordination and integration of health and housing-related services and transitions of care. Second, Support and enhance flexible services - This entails providing CCOs the flexibility to spend federal and state Medicaid dollars in innovative ways and on non-traditional health related services. Several examples could include: Tenant screening and assessment, assistance with housing searches and applications, move-in assistance, short-term expenses such as security deposits, other landlord-required rental or lease costs, or moving costs, basic furnishings, food and grocery supports. The state needs permission from CMS to use federal Medicaid dollars to pay for non-medical related services. The 3rd strategy is to develop a menu of supportive services for targeted populations – create a list of supportive services that focus on domains of homelessness prevention and care coordination, transitional supports, and tenancy sustainability
- Target populations may include but are not limited to high-risk, high needs individuals The CHP pilots will have the ability to define the populations they would like to target based on regional needs and the broad criteria for the population as listed in the slide. OHA anticipates that individuals not currently enrolled in CCOs but are served through fee-for-service will be eligible for the CHP pilot program. Individuals enrolled in Medicaid and that are eligible for housing supportive services through existing federal waivers, largely Oregon’s 1915 waivers and state plans will not be eligible for enrollment in the CHP pilots where services may be duplicated.
- The CHPs will test new models to increase collaboration and coordination among CCOs, local hospitals, community-based organizations, housing authorities, county government and public health agencies, affordable housing providers, behavioral health and substance use disorder (SUD) providers. The program will provide funding to local CHPs to increase integration of services and build infrastructure among the participating entities. The CHPs will be comprised of key community partnerships led by CCOs or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (I/T/Us. CHP lead entities will be responsible for coordination with all partner entities participating in the CHP. Furthermore, lead entities for the CHP will be expected to partner with local housing entities to help build an understanding of the housing situation in the region.
- The CHP pilot program will achieve the following: Support care coordination among non-medical settings and promote transitions from institutional settings to less costly community-based care settings; Reduce inappropriate emergency, inpatient and residential treatment facility utilization; Increase access to and use of primary, behavioral and substance use disorder services; Increase coordination of housing supportive services for targeted at-risk populations; and Invest in health IT infrastructure among non-traditional providers to improve data collection and sharing among local entities to support ongoing case management, monitoring, and sustainability for CHP pilots.
- The CHP program consists of three foundational elements, referred to as domains. Taken as a whole, the domains create a continuum of services available within a community to the defined target population. Each CHP pilot will be expected to provide services in all three domains. Through the CHP pilot program and the proposed domains, Oregon’s goal is to improve care transitions and coordination with a focus on ensuring effective care transitions from institutional to community-based settings, particularly among county correctional facilities, the Oregon State Hospital and acute care facilities.
- Homelessness Prevention/Transitions of Care: support to ensure care coordination among non-medical settings; fund services to support an individual’s ability to move from institutional settings to less costly community-based care settings.
- Housing Transition Services: invest in pre-tenancy services to decrease health care costs and reduce use of high-cost health care services.
- Tenancy Sustaining Services: invest in services that support the individual in being a successful tenant in his/her housing arrangement.
- Oregon is proposing a multi-faceted, incremental approach to the state’s integration of health care and supportive housing for the 2017-2022, 1115 demonstration renewal: Year 1: Convening and planning initiatives, regionally and statewide. Select proposals and create CHPs. Years 1-5: Statewide investment in infrastructure development and creation of CHPs Years 2-5: Pilot and test new models of housing supportive programs among CHPs Years 2-5: Transition from paying for process to paying for outcomes based on evidence-based practices
- OHA, DHS and other appropriate state agency employees (e.g., Oregon Housing and Community Services, Department of Corrections) will serve as subject matter experts and staff the Council during meetings and other activities. OHA would like to ensure broader participation, input and feedback from stakeholders and the public and will host roundtables and panels on specific topics identified by the Council as requiring further stakeholder engagement.
- The final design and implementation details will be based on extensive public input and involve robust collaboration among Indian Tribal leaders, CCOs, housing authorities, affordable housing providers, health care providers (including behavioral and substance use disorder providers), counties and local public health agencies, corrections and organizations serving Oregon’s homeless population. The CHP council will consist of a broad range of stakeholders and initially will be tasked with informing the final design of the program and the implementation work plan. The committee will continue to meet throughout the duration of five-year demonstration and will advise OHA on a range of potential issues that may include: Refining the definition of the target population. Advising on the structure of CHPs when there are multiple CCOs in a single region. Addressing differences between rural and urban CHPs, including availability of affordable housing units and local area housing supportive service providers (i.e. workforce). Recommending process and outcome requirements for payment to CHPs.