A new JAMA study that looked into social determinants of health (SDOH) found that nearly half (43.6%) of community health center (CHC) patients reported having a history of housing problems.
A total of 1.2% CHC patients reported being homeless, much higher than the percentage of homeless people in the total U.S. population, which is 0.18%.
Of the nearly 3,200 patients surveyed, 9% reported “doubling-up,” 27% reported unstable housing and 7% reported having stable housing, but previously being homeless.
Housing problems are often linked to poor health outcomes. Like other social determinants of health, people who can’t rely on steady housing will likely have difficulties staying on top of their health, adhering to medication and making appointments. In their conclusion, the study authors suggested CHCs consider universal screening of housing status for patients.
The Health Resources and Services Administration (HRSA) Health Center Program offered primary care to more than 25 million “medically underserved patients” in 2016. They provided care in CHCs, migrant health centers, public housing primary care clinics and healthcare for the homeless programs.
The study authors used data from a survey of center patients between September 2014 and April 2015. In addition to housing problems, survey recipients reported other areas of concern like emergency department use and delays in care.
Payers and providers both understand this issue. More than 80% of payers said they are integrating SDOH into member programs, according to the 8th annual Industry Pulse survey. Meanwhile, the American Hospital Association published a guide last year that highlighted how housing affects a community’s health with recommendations on how hospitals can assist.
Payers, providers and community programs are the three-legged stool for population health, particularly when it comes to SDOH. Providers give the care to patients, payers use analytics to coordinate care and provide value-based payments and community programs are a safety net for when patients are outside of a physician’s office.
“Population health management efforts are most successful when they are tied to efforts to address social determinants of health issues, since the challenges that patients face around housing, food and transportation, for example, are completely tied to their ability to engage in the healthcare system, manage their chronic conditions and stay well,” Dr. Amy Flaster, an assistant medical director for the Center for Population Health at Partners HealthCare in Boston, recently told Healthcare Dive.
Public programs, such as Medicaid, are seen as key to helping people who struggle with food insecurity and housing instability. A recent report by the National Quality Forum developed a framework for how Medicaid can address social determinants.The NQF plan would make state Medicaid programs the hubs to support the healthcare system in addressing SDOH. The report’s recommendations would allow state Medicaid programs to “better assess and address social needs in healthcare,” NQF said.