In January 2011, surgeon Atul Gawande wrote an article in The New Yorker magazine that helped change the way many of us look at the quality and cost of health care delivery.
Gawande's article, called "The Hot Spotters," suggested that we might be able to lower medical costs "by giving the neediest patients better care."
Change "patients" to "residents" and Gawande's article holds a valuable lesson for those of us who care about the health and wellbeing of low-income older adults living in publically subsidized housing.
Gawande tells the story of a young doctor in Camden, NJ, who championed a "Compstat approach" to evaluating how his city handled its health care delivery. Using a database he created, Dr. Jeffrey Brenner literally mapped the City of Camden to find out which blocks generated the highest health care costs. Two blocks stood out. A nursing home was on one block. An affordable housing property stood on the other.
Together, the two buildings sent 900 people to the hospital over two years -- all to the tune of about $200 million.
Pouring over his data, Brenner came to a startling conclusion. Only 1 percent of the people using Camden's medical facilities accounted for 30 percent of health care costs in those facilities. He used that knowledge to develop a highly coordinated care delivery model to serve a targeted group of health care "super-utilizers." In the process, he helped reduce hospitalizations by 40 percent and hospital bills by 56 percent for his first group of 36 patients.
And to think it all started with data.
Hot Spotting HUD-Assisted Housing Properties
The LeadingAge Center for Applied Research has been involved in analyzing similarly exciting data over the past few years. We did this while working as a subcontractor to the Lewin Group on a study funded by the U.S. Departments of Health and Human Services (HHS) and Housing and Urban Development (HUD).
The researchers who collaborated on this study were able, for the first time, to successfully link administrative data from HUD and HHS. The new, merged data provide important insights into the health and health care utilization of low-income older residents of HUD-subsidized housing in 12 geographic areas.
An initial analysis of this data has led us to many of the same general conclusions that Jeffrey Brenner reached after mapping Camden's health care data. Like Brenner, we found evidence that subsidized housing properties are the "hotspots" of health care need.
Our report, Picture of Housing and Health: Medicare and Medicaid Use Among Older Adults in HUD-Assisted Housing, affirms that older people living in subsidized housing:
- Have more chronic conditions than their peers in the community who do not receive HUD assistance.
- Are highly likely to be eligible for Medicaid, in addition to Medicare.
- Run a higher risk of being hospitalized or using the emergency department than their peers in the community who do not receive HUD assistance.
- Have higher health care costs than the average older person--and even higher costs than community-dwelling elders not receiving HUD assistance who are also eligible for both Medicare and Medicaid.
The Message Behind the Data
You could view our analysis as a depressing statement on the challenges facing low-income older people in this country. But, influenced by Jeffrey Brenner's experience, I choose to see a much more hopeful message here. It's a message about the dramatic difference that affordable senior housing properties could make in the lives of low-income older adults.
Imagine the good work we could do if we used those housing properties as platforms for delivering health and social services that would help low-income residents manage their health and improve their functional status--all while saving health care dollars.
At the Center for Applied Research, we have recognized this potential for many years. That's why we established the Center for Housing Plus Services and why we facilitate a Housing Plus Services Learning Collaborative to help affordable senior housing providers develop and test models for bringing health and supportive services into their housing properties.
Next Steps for Housing Providers
The merged HUD-HHS data make it hard to ignore the great need that exists in publically subsidized housing properties and the great potential that those properties hold for filling that need.
These data give advocates for low-income older adults some great information about how we can intervene to improve health among low-income seniors and where we should target our resources for the greatest return. They also give housing providers the evidence they need to expand their role in meeting the needs of the "super-utilizers" of health care -- and in garnering the support they need to be successful.
Becoming a platform to alleviate our health care hotspots means nothing less than reinventing affordable senior housing. We can no longer be the kind of housing providers who collect the rent and leave residents to fend for themselves.
Instead, we need to envision a new kind of housing provider that recognizes how prevalent aging in community is becoming, understands the challenges facing low-income older adults, and wants to be part of the solution.