Ep 86 – Investments in Housing for Health and Equity Through Partnership, with Ruth Ann Norton and Rachel Krausman

We must remain steadfast in our desire as healthcare professionals to ensure that patients who lack access to safe and stable housing are not forgotten. In this special bonus episode of the Race to Value, you will learn how organizations can build alliances to serve the public good and build hope in marginalized communities through investments in housing.  There is strong evidence characterizing housing’s relationship to health. Housing stability, quality, safety, and affordability all affect health outcomes, as do physical and social characteristics of neighborhoods.  Lack of housing security leads to increased mortality (lower life expectancy); physical traumas, crime, and gun violence; long-standing impacts on psychological well-being (depression, anxiety, suicide); increased ED and inpatient hospital utilization; increased pediatric asthma and chronic disease burden; and substance use disorder.  The impact of housing on health is now being widely considered by policy makers as it is one of the most researched social determinants of health.  Needless to say, housing interventions by healthcare organizations and community partners is the future of value-based care!

In this episode, you will learn about how ProMedica (a non-profit health and wellness organization of 11 hospitals and a physician network of 2,600 physicians) formed a community-based housing investment partnership with the Green & Healthy Homes Initiative (GHHI). Their comprehensive, flexible approach to addressing unhealthy housing is being shown to improve health, academic success, job retention, neighborhood safety, and intergenerational wealth transfer all for a relatively low per-person cost. Joining us in this interview is Ruth Ann Norton (President & CEO, GHHI) and Rachel Krausman (Vice President, National Strategy and Partnerships, ProMedica). We invite every value-minded professional listening to this conversation to join in your own community effort to care for your most vulnerable patients. A healthy home leads to a healthy life!

This bonus episode comes from an ACLC Peer Learning Session – click here to watch the video with slides and download the Case Study: https://www.accountablecarelc.org/publications/investments-housing-health-and-equity-through-partnership-promedica-and-green-healthy

Episode Bookmarks:

02:00 How does value-based care and housing intervention go together?

04:00 Introduction to the Accountable Care Learning Collaborative

05:50 Introduction to Rachel Krausman and Ruth Ann Norton

06:45 Background on ProMedica, a non-profit health and wellness organization of 11 hospitals and physician network of 2,600 physicians

08:35 The ProMedica National Social Determinants of Health Institute and its focus on SDOH interventions (e.g. food insecurity, housing)

10:00 The ProMedica Impact Fund that has raised $1B over 8 years to drive innovation and scale in SDOH interventions that have a measurable impact on health

11:30 ProMedica’s Partnership with the Green & Healthy Homes Initiative (GHHI) to test ROI and clinical outcomes improvement associated with SDOH investments

12:20 The founding of GHHI in 1986 through a grassroots effort to end childhood lead poisoning due to unhealthy homes

13:30 Ruth Ann explains GHHI’s accomplishments in reduction of lead poisoning and how that led them to view health and housing more holistically

14:00 Elimination of fall risk injuries in senior population can save Medicare over $20k per beneficiary

14:15 Energy efficiency and weatherization services to reduce energy burden and improve air quality

14:45 Building a future for “intergenerational wealth transfer” through improved health outcomes

15:15 Influencing Medicaid payment policy in the states of New York and California to invest in healthy homes programs

16:40 30M families with housing-related health conditions (e.g. pediatric asthma, brain damage due to lead poisoning, injury) at a cost of $150B in avoidable healthcare services

18:20 The ROI evidence for healthy homes interventions

19:45 Raising $100M for Healthy Homes in 7 Cities (Baltimore, Chicago, Cleveland, Philadelphia, Pittsburgh, Toledo) to return $545M in economic benefit!

21:00 Leveraging other funding sources and community partners as a multi-partner strategy outside the core health system

22:00 Effective project implementation and workforce training needed for long-term financial sustainability

23:00 Maximizing interventions impacts at the neighborhood-level

23:45 The importance of family engagement, housing risk assessments, and an equitable referral system

25:20 Hiring employees from impacted communities to address long-term SDOH and the use of evidence-based impact measures

26:20 Building trust with SDOH interventions leads to improved health plan retention, care plan adherence, and wellness activities

27:30 The Evidence: How reducing fall-related injuries creates intergenerational wealth transfer, reducing lead exposure improves educational outcomes, etc.

29:00 The impact of stable housing on Health Equity (“a better baseline to which to thrive”)

30:00 Reduction in crime and creation of jobs through housing interventions

31:00 Evaluation and Impact Analysis (rigorous evaluation of services delivered, biometric data, social risk factors, care utilization, survey results to assess program impacts on health)

33:30 ROI through reduced Emergency Department Utilization associated with pediatric asthma

36:00 Rachel explains why healthcare organizations need to think differently about investments in community-based SDOH interventions

37:00 Rachel discusses why SDOH interventions (e.g. grab bars in the home, repairing a porch) should be incorporated into a clinical workflow because of implications on health.

38:30 Effective community-based interventions are based on partnerships (not the health system alone) and investments are shared and aligned

39:30 “40% of hospitalizations and ED visits come from lousy housing conditions.”

41:00 Small interventions in the home (e.g. stair tread, leaky roof) can improve health outcomes too – not all have to be major investments!

42:00 Assessing the effectiveness of service providers (e.g. translation capabilities, data capture)

43:00 Emphasis on health equity in redesigning payment models (e.g. CMMI – Liz Fowler) and how we can create scalable SDOH solutions in marginalized communities

47:00 How to develop an effective, equitable, and data-driven referral system to identify appropriate patients for housing interventions

50:00 The positive impact of housing interventions on emotional health and wellbeing