RISE West to take a deep dive into UnitedHealthcare's housing, wraparound care model that tackles social determinants of health

UnitedHealthcare’s Kathleen 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, a premier senior leadership conference that will take place Sept. 9-11 in San Diego. 

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, said Stillo, president and chief operating officer of the clinical redesign direct care delivery unit in UnitedHealthcare’s Community & State division.

“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.

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.

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 the work of Jeffrey Brenner, M.D., chief executive officer of clinical redesign at UnitedHealthcare Community & State division. Brenner, who previously worked at the Camden Coalition of Healthcare Providers and the Urban Health Institute at Cooper Health System in Camden, N.J., used data to reallocate resources to high-needs, high-cost patients in Camden The second approach 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.

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.

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.

Author’s note: Stillo will discuss UnitedHealthcare’s Housing + Health integrated care approach 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.