Steve Leffler, MD, is Chief Medical Officer at the University of Vermont Medical Center.

Steve Leffler, MD, is Chief Population Health Officer at the University of Vermont Health Network.

A new study published in the Journal of the American Medical Association describes the importance of hospitals and health systems working with community partners to provide stable, affordable housing to people experiencing homelessness. Watch a video about John, who now has a home as a result of one such partnership.

Why would a hospital invest in housing or a bike path or even community gardens?

An important part of at the UVM Medical Center is to use our resources to benefit our community. Today, doing the right thing also happens to be an increasingly smart investment as the health care system moves away from a model that pays hospitals and physicians for the number of procedures they perform to a model that rewards keeping people as healthy as possible.

Over the past two years, we have invested in two housing-focused programs with our community partners.

This investment is part of the more than $100 million in community benefits provided by the UVM Medical Center each year, including charity care. We have been making grants of this type since the 1980s. We use our Community Health Needs Assessment, a report that we create every three years with extensive community input, as a guide for how and where we put our resources to work in our community.  In our most recent Community Health Needs Assessment, “affordable housing” was one of 10 priorities identified.

Evidence shows that people who are homeless, or poorly housed, require significant health care resources.

Many health issues could be avoided if patients had adequate housing. Often, the issues they face are worsened by their living situations. It’s a reality I see all too often when I work in the Emergency Department.

Our first investment was in Shelburne’s Harbor Place, which houses patients recently discharged from the hospital. Harbor Place provides temporary, emergency housing to guests who lack stable housing. It also connects them with strong “wrap-around” social and health care services. This is necessary for them to be successful in the community. We worked with multiple community partners, including the Champlain Housing Trust, Community Health Centers of Burlington, United Way, and Howard Center. Since we began our partnership at Harbor Place, approximately 100 patients have been discharged there from the hospital.

Supporting success saves lives, money

We compared hospital use and costs for the group before and after they stayed at Harbor Place.

  • Before their time at Harbor Place, this group of patients required 95 inpatient admissions at an average cost of $13,000. The total cost was more than $1.2 million.
  • After leaving Harbor Place, the same patients required 30 inpatient admissions at an average cost of $7,000. The total cost was $220,000.
  • Emergency Department use dropped from 161 visits to 94.

This project improved the health of these patients and allowed them to be more successful in the community. It also lowered overall health care costs in our community.

We then worked with the same partners to focus on Chittenden County’s chronically homeless population, locating as many homeless people and families as possible over two nights in October 2015. We gathered information from each person to determine who was at highest risk of dying or experiencing adverse health issues based on their living situation.

Working collectively, we permanently housed the 32 people with the highest health risks. Once again we followed their progress.

  • In the year before receiving housing, these 32 patients required health care that cost $736,826.
  • In the year after they were housed, their health care costs were $278,075. That’s nearly $500,000 less.

They were also healthier, happier, and more productive.

Watch John’s story

The video below tells the story of John, a gentleman who, in his own words, fell through the cracks, became homeless and has struggled to pick himself back up ever since. It is important that we look to national studies and measure the impact of our investments on the overall health – and cost of health care services – of the people we serve. But you really don’t need to look any further than John to understand how life-changing this focus is.

Having adequate housing, good nutrition and safe, convenient areas to exercise will keep our communities healthy. This will lower overall health care costs. Most of our health is determined outside of the walls of our health system. Using our resources to keep people as healthy as possible is not only the right thing to do – it’s a smart investment in our future.

Steve Leffler, MD, is Chief Population Health Officer at the University of Vermont Health Network. 

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