Health Care Spending And Use Among People Experiencing Unstable Housing In The Era Of Accountable Care Organizations

Abstract

Provider organizations are increasingly held accountable for health care spending in vulnerable populations. Longitudinal data on health care spending and use among people experiencing episodes of homelessness could inform the design of alternative payment models. We used Medicaid claims data to analyze spending and use among 402 people who were continuously enrolled in the Boston Health Care for the Homeless Program (BHCHP) from 2013 through 2015, compared to spending and use among 18,638 people who were continuously enrolled in Massachusetts Medicaid with no evidence of experiencing homelessness. The BHCHP population averaged $18,764 per person per year in spending-2.5 times more than spending among the comparison Medicaid population ($7,561). In unadjusted analyses this difference was explained by greater spending in the BHCHP population on outpatient care, including emergency department care, as well as on inpatient care and prescription drugs. After adjustment for covariates and multiple hypothesis testing, the difference was largely driven by outpatient spending. Differences were sensitive to adjustments for risk score, which suggests that housing instability and health risk are meaningfully correlated. This longitudinal analysis improves understanding of health care use and resource needs among people who are homeless or have unstable housing, and it could inform the design of alternative payment models for vulnerable populations.

Pandemic Pause: Systematic Review of Cost Variables for Ambulatory Care Organizations Participating in Accountable Care Organizations

“…Specifically, a program developed to identify those patients with the ability to provide their own self-care at home was initiated to support overall value-based care [ 12 ]. This initiative was also commonly identified in the literature as a contributing variable for outpatient ACO cost reductions with advanced telehealth treatment expansion initiatives [ 17 , 28 ].…”

“…Keeping with past trends, ACOs led by physician groups saw higher levels of savings in the MSSP than those led by hospital systems, saving an average of $114 per beneficiary compared to just $61 for hospital led ACOs in Performance Year 2019 [ 34 ]. Physician-led ACO success is also seen in the Medicaid program which lends verifiability across different population types in promoting value-based care [ 17 , 20 , 26 , 30 ].…”

Addressing Major Health Disparities Related to Coronavirus for People With Behavioral Health Conditions Requires Strength‐Based Capacity Building and Intentional Community Partnership

“…Smoking and vaping are more common among lower‐income communities and people with mental health conditions (Al‐Hamdani, Hopkins, & Park, 2020; Glover, Patwardhan, & Selket, 2020). People who are homeless already face higher risk of mortality (O'Connell, 2005), chronic medical conditions (Koh et al, 2020), mental health and substance use problems (Lebrun‐Harris et al, 2013), and poor health care access (Moore & Rosenheck, 2016). All these factors and comorbidities increase the risk of exposure of severe complications from coronavirus (Lewis, 2020) for people living with behavioral health conditions.…”

Comparison of Childbirth Delivery Outcomes and Costs of Care Between Women Experiencing vs Not Experiencing Homelessness

“…3 , 4 Individuals who are experiencing unstable housing or homelessness have higher disease burdens and mortality rates and 2.5-fold higher health care spending vs a comparable housed population. 5 , 6 , 7 , 8 , 9 , 10 …”

“…3,4 Individuals who are experiencing unstable housing or homelessness have higher disease burdens and mortality rates and 2.5-fold higher health care spending vs a comparable housed population. [5][6][7][8][9][10] While most people experiencing homelessness are men, approximately 1 in 4 individuals experiencing homelessness are women or girls. 1 More importantly, women and families constitute the fastest-growing segment of the homeless population.…”