Online Program

Using evidence to impact policy change: How transforming healthcare utilization of a chronic homeless population reduces costs, increases the quality of care, and improves patient outcomes

Monday, November 2, 2015

Tom Ludden, PhD, Carolinas HealthCare System, Charlotte, NC
Lori Thomas, PhD, MSW, Department of Social Work, University of North Carolina at Charlotte, Charlotte, NC
Mary Ann Priester, MSW, College of Social Work, University of South Carolina, Columbia, SC
Background: Chronically homeless individuals are frequent users of emergency health services, often using emergency departments (ED) to address non-emergency health needs. Permanent Supportive Housing (PSH) can reduce the ED utilization of chronically homeless adults and potentially increase out-patient utilization while overall lowering healthcare utilization and costs. Policy initiatives to change healthcare utilization for PSH residents funded by Medicaid have been proposed which require evidence-based research to support these changes.

Methods: This study used local hospital billing and medic data to examine healthcare utilization chronically homeless individuals (N=54) living in a PSH program in Charlotte, North Carolina.  Local hospital billing data was collected for the two years prior and two year following each consenting tenant’s move into the PSH program.

Results: In the two years after moving into PSH, the average number of tenant ED visits decreased from 16.1 (SD=39.1) to 3.1 (SD=5.3) visits; t(49)=2.606, p=.012.  The average length of hospitalizations originating from those visits decreased from 9.4 (SD=17.7) to 3.6 (SD=11.6) days; t(49)=2.039, p=.047. The average participant outpatient utilization increased from 7.2 (SD 11.70) to 10.9(SD 8.6) visits; t(53) p=.008.

Discussion: Study findings underscore the effectiveness of PSH in interrupting frequent utilization of EDs and changing healthcare utilization to a lower-cost outpatient setting. The results provide evidence for policy changes for care management in a PSH setting by Medicaid for the chronically homeless population to improve patient outcomes, improve the quality of care, and lower the overall costs of healthcare.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Program planning
Public health administration or related administration

Learning Objectives:
Demonstrate how to reduce healthcare utilization and reduce costs for a chronically homeless population

Keyword(s): Homelessness, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted research around changing healthcare utilization, improving healthcare outcomes, and lowering healthcare costs for Carolina's Healthcare System, the public hospital authority for Mecklenburg County for 7 years. I have worked on grant-funded projects targeting at-risk populations such as the Hispanic/Latino immigrant community around access to healthcare and the chronic homeless.
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.