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This Innovative Philly Medical Program Uses Housing to Save Lives–and Could Become a Model for Other Cities

What does it mean to be healthy? For such a complex question, it is clear that the conditions in which people live have a huge impact on their ability to lead a healthy life. Safe housing, availability of nutritious food and clean water, quality education, access to healthcare, and stable income–or social determinants of health (SDOH)–are foundational needs for every individual to be able to live their healthiest life. When looking at the availability and access to these essentials over generations, it becomes clear how disparities can widen between countries, cities, and even zip codes. And right here in Philadelphia, inequity between neighborhoods is evident with dramatic gaps in life expectancy measured between zip codes.

The Temple Center for Population Health in Philadelphia focuses on developing innovative solutions that bring their patients what they need–the components of a healthy life–rather than treating conditions that have progressed to a dangerous point, with the goal of reducing disparities of social determinants of health within the city and beyond.

And a recent, novel solution led by the Temple Center for Population Health has taken that thinking to a new level–by treating housing, and the healthier life that stable housing supports, as preventative medicine.

Since 2020, more than 49 housing-insecure individuals have been enrolled in the Center’s Housing Smart program, an initiative that identifies patients with health conditions that could benefit from individualized support services. The program–established in collaboration with Resources for Human Development (RHD), Health Partners Plans, and Keystone First–finds patients longer-term temporary housing and then offers medical, behavioral, and other forms of support until the person can financially support themselves in a permanent residence.

Seeing the Pattern

In 2019, Steven Carson, senior vice president of population health at Temple Health and CEO of the Temple Center for Population Health, noticed a troubling pattern while working in partnership with a federally qualified health center, or FQHC, to help at-risk patients.

Temple Health had been measuring patient information as complex as how the socioeconomic conditions in which a patient lives could be the driver of poor health. By asking patients what else is going on in their lives during health screenings, they were recording and detailing correlations between physical health and everything from everyday physical safety to internet access.

Carson was examining this data when he noted recurring emergency room visits among patients who faced challenges as a result of living in poverty. After digging deeper, Carson connected many of them to the same address–the address of the hospital itself.

“Hospitals will sometimes use their own address when the patient is unable to supply one. They actually didn’t have a home,” Carson explains. In other words, many of the patients coming to the emergency room and returning repeatedly had one thing in common–they struggled with homelessness or housing insecurity.

When Carson saw the correlation between poor health and housing insecurity in the data, he saw the potential for an intuitive, if bold, solution. If his team could find a way to provide stable homes where services could reach them, not only would they give that person a safer, more stable environment, but they could get them the necessary support to maximize that person’s chances of living a stable and healthy life–preventing emergency care.

Building an Expert Team

Carson knew that Resources for Human Development (RHD), a national human services nonprofit, had worked on a related project in the past. Carson coordinated with RHD’s CEO Marco Giordano, and began planning how a similar program would be developed between Temple and RHD. Through that work, Temple and RHD were able to bring in Health Partners Plan and Keystone First, two Medicaid managed-care organizations in southeastern Pennsylvania, to develop and assist with funding the program.

The team also had the expertise of Kathleen Mullin, Director of Housing Initiatives at Keystone First. According to Mullin, one major issue they had to account for was the difficulty in contacting and engaging with individuals experiencing homelessness.

Luckily, Resources for Human Development had a team with expertise in homeless outreach and behavioral health services. They understood the patients’ environments and resource systems, identified with the struggles they were facing, and used individualized approaches to connect with each participant.

“RHD had experience and expertise in doing street outreach, and also particularly outreach to folks that have severe behavioral health conditions, including substance-use disorders,” Mullin says.

Plan into Action

This combination of expertise set them up for success. Together, Temple, RHD, Health Partners Plans and Keystone First launched the program in April 2020.

Once individuals had stable homes, the team supported patients in stabilizing their health, through primary care appointments and mental health treatment, and with the development of life skills, among other things.

With this support, individuals work toward reaching a stable point where they are ready to graduate from the program, which Carson says is often about 18 months.

Critical to the program’s success was the team’s ability to develop relationships and trust with patients. By empowering each individual to be an active part of decision making, like in choosing from available apartments, the program cultivated a shared investment between the team and participants, and positioned each person for independence from day one.

This partnership provided insight to the real challenges faced by participants each day, giving the team the opportunity to help deconstruct the barriers participants faced.

“What the team really tries to do is unpack all that built infrastructure, the inequity, and try to point someone in a direction to be successful,” Carson says.

The Housing Smart program shows that with stability and equity in foundational social determinants of health, patients have the ability to thrive in other areas.

Reshaping the City

It’s a program that is not only changing lives for the better but has potential to scale and provide greater insight into how to address the adverse health impacts of individuals experiencing homelessness or housing insecurity on a systemic level. In the first few years of the program, Housing Smart saw a decrease in emergency room visits among participants and an increase in utilization of preventative services like behavioral healthcare and PCP visits.

“The Housing Smart team works with a participant to address quality measures, like care gaps, which could include helping someone get their vaccines or schedule an overdue breast cancer screening with their provider,” Mullin says.

Carson points out that the prescription for addressing adverse health outcomes in populations facing barriers of social determinants is housing and services, and Housing Smart and other programs like it are beginning to prove that to larger governmental and private organizations.

“More and more regulatory bodies, either at the federal and the state level, are beginning to recognize the fact that this is a solid solution for individuals, and it improves health outcomes,” Carson says. “It’s a better situation for the individual, and actually it’s more sustainable to do this than have that person keep coming and going in and out of emergency care.”

He maintains that, though it’s a small program, it’s a scalable solution that could combat the

public health impacts of homelessness and housing insecurity in Philadelphia more broadly.  What’s novel about Housing Smart is its focus on strategically aligning housing resources and health services to create the best environment for long-term health. That innovation is critical.

“There’s such a deep need for affordable housing that it is difficult to completely solve for that,” Mullin says. “But we can marry up these care coordination services with other existing housing programs – providing another route for it to scale.”

For Carson, the critical element is that they’ve proven that they can transform lives if people are willing to support the effort.

“When you look at where the most money is spent in health care, it’s after a problem has occurred: surgeries and procedures. But health care can be more than just the pill, or hospitalization, or treatment. It’s also social programming,” Carson says. “In this microcosm of this housing program, we’ve been able to prove that if you provide services upfront, a person can be healthy and successful, and everyone benefits.”