A community partnership to house and care for complex patients

Rising homelessness, especially among older adults, has significant ramifications for our health care system. People experiencing homelessness tend to experience worse health and poorer access to needed health care than do people with stable housing. Commonwealth Care Alliance (CCA), a not-for-profit payer and provider that offers health plans to people dually eligible for Medicare and Medicaid, sought to address homelessness among its beneficiaries through a partnership with a local community-based housing organization, Hearth. This partnership led to many CCA beneficiaries gaining access to permanent supportive housing in a setting that allowed CCA and Hearth to monitor and address their medical, social, and behavioral needs. It also provided an opportunity to examine health care utilization and cost trends associated with permanent supportive housing. The authors' experience demonstrates that a community-based partnership can effectively address homelessness among older adults with significant medical needs and that permanent supportive housing may contribute to meaningful reductions in health care expenditures.