142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Reducing Costs and Improving Health of Elderly Homeless Women Through a Medical Home Without Walls

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Roseanna Means, MD MSc , Women of Means, Inc., Wellesley, MA
Shaun Austin, MD , Commonwealth Community Care, Boston Medical Center, Boston, MA
Evelyne Malfroy-Camine, A-NP , Commonwealth Community Care, Boston Medical Center, Boston, MA
Valeria Vargas, Community Health Worker , Women of Means, Wellesley, MA
Charlotte Rolle, MD, MPH , Department of Medicine Global Health Equities, Brigham & Women's Hospital, Boston, MA
Ballooning health care costs are taking their toll on US financial health.  Certain situations (care for the elderly and end-of-life care, over-reliance on ERs, bounce-backs after inpatient stays) and the many challenges of access to care for vulnerable populations contribute to these costs. Persons who are homeless can utilize resources 4 times as much as housed individuals because of multiple co-morbid socio-economic factors and medical conditions.  Women of Means is a non-profit organization in Boston comprised of volunteer physicians and a paid nursing staff  that has delivered free walk-in acute, episodic  and de facto primary care to Boston’s homeless women since 1999.  In 2010, we developed targeted services to homeless women over age 55 showing that intensive care and case management can improve health metrics and reduce inappropriate resource utilization.  In 2013, we launched the nation’s first Medical Home Without Walls, an ACO-contracted comprehensive “medical home” within the homeless community that delivers primary care, outreach, care coordination and “gap” services to 50 homeless and marginally housed women over 65 who rely on shelters to meet basic survival needs. Results from the first year show significant reductions in ER and inpatient stays, improvements in housing, safety, health literacy and “milestone events.”  This project is providing data on the cost of care for elderly homeless women and how those costs can be reduced. The model’s components can be applied to other vulnerable populations.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Explain how and why being homeless costs the health system more. Describe the components of a Medical Home and differentiate between the traditional model and a Medical Home Without Walls. Name three ways that the Medical Home Without Walls approach cuts costs and improves health for vulnerable populations.

Keyword(s): Health Care Delivery, Health Care Costs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 30 years of practice in Internal Medicine and 20 years of experience caring for homeless persons. I am the Founder and President of a non-profit health care program that provides improved access to health care and case management for homeless women and families.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.