As an emergency department (ED) physician at the University of Vermont Medical Center in Burlington, Steven Leffler, M.D., saw firsthand how chronically homeless patients returned again and again to his crowded ED for care.
“We had a hard time discharging people because they didn’t have a place to go,” says Leffler, who is the medical center’s chief medical officer. When it did, they were pushed back into homelessness, where their symptoms would return and often worsen until they were right back in the ED.
Recognizing chronic homelessness as a major health care issue, the medical center two years ago reached out to other community groups to come up with a possible solution. It agreed to fund transitional and permanent supportive housing for homeless patients who are discharged from the hospital and to provide services that can help get them back on their feet. Other partners in the initiative include the Champlain Housing Trust – a nonprofit organization which creates and preserves affordable housing in northwest Vermont – and the United Way of Northwest Vermont.
The medical center first invested in the Champlain Housing Trust’s Harbor Place in Shelburne. It provides temporary housing to patients recently discharged from the hospital and connects them to a range of “wraparound” social, community and health care services.
The medical center compared hospital use and costs for these former patients before and after they stayed at Harbor Place. The year before their time at Harbor Place, the patients required 95 inpatient admissions at an average cost of $13,000 – a total cost of more than $1.2 million, according to Leffler.
After leaving Harbor Place, the same patients required 30 inpatient admissions at an average cost of $7,000. The total cost was $22,000. Leffler says ED use dropped from 161 visits to 94.
He says the experience at Harbor Place “was like a magic wand” that not only improved the patients’ health and allowed most to lead a more productive life in the community, but also lowered health care costs.
“A few years ago if you came to the medical center and said we should invest in housing for people who are chronically homeless, we would have said it really is not our business,” Leffler says. “Once we knew we had good results at Harbor Place, then we said we could make a difference. The power of the collaboration and the results made us want to invest in a bigger project of permanent housing for the homeless.”
That led the medical center last year to help fund Beacon Place, another housing project administered by the Champlain Housing Trust. The project in South Burlington has converted a motel into 20 single apartments for homeless patients. Other efforts are underway.
“Without stable housing you can’t get healthy,” says Michael Monte, the Champlain Housing Trust’s chief operating officer and chief financial officer. “If we can show that this sort of approach of bringing safe, affordable housing to people leads to better health care results and is more cost effective, then why wouldn’t we do it?”
Leffler notes that the medical center recently renamed its community benefits committee the community health investment committee, “because we expect a return on our investment in programs that try to make our community healthier, and measure if we are doing the right things.”
Leffler chairs the 12-member committee, which invests up to $800,000 annually in programs – like the housing-for-the-homeless initiatives – that address priorities identified in the medical center’s community health needs assessment.
The medical center’s focus on housing needs to improve health care is part of its investment in “upstream social determinants” of health – the things that keep people healthy in the communities and out of the hospital, observes Martha Maksym, executive director of the United Way of Northwest Vermont, and a member of Leffler’s community health investment committee.
“The hospital saw this as a better investment than having a wing of people who couldn’t be discharged because there was no fit place for them to be,” she says. “Now, they see partnering to end homelessness as part of their job.”
Addressing issues like chronic homelessness in their communities is a “survival imperative” for the hospital and health system field as health care shifts to a model where reimbursement comes from keeping the population healthy, says the medical center’s Leffler. “If you ignore the social determinants of health, I don’t see how you can possibly succeed,” he says.
Watch a video on the collaboration to reduce homelessness and health care spending.