Managed care plans, accountable care organizations (ACO) or federally qualified health centers (FQHC) could help providers of affordable housing bring an integrated package of health care services into their housing properties.
But selling these health care organizations on the Housing Plus Services model won’t be a slam-dunk.
Instead, forging successful partnerships will take hard data, a clear business plan and an assurance that both parties will benefit from the arrangement, say 3 health experts who conferred recently with the LeadingAge Housing Plus Services Learning Collaborative.
Accountable Care Organizations
Housing providers have a great story to tell their potential ACO partners, admits Mark Lamos, M.D., president and medical director of a Maryland-based ACO called the Greater Baltimore Health Alliance.
"You have a group of residents who have defined needs," he says. "That fits with the long-term goals of the Affordable Care Act (ACA). You want to keep people at home in their apartments. You want to give them the best possible care so they don't bounce in and out of emergency rooms. If I had that story to sell to my board of directors, I'd hit a home run."
But having a good story doesn't necessarily mean that an ACO will want to partner with you, says Lamos.
"You have to be innovative," he says. "You need to think outside the box. And then you need to show me your value. You have to show me why I should pay you."
Lamos' organization has its own story to tell. Now in its second year of the Medicare Shared Savings Program, the Greater Baltimore Health Alliance has reduced the cost of care by over $1,000 per patient per year. It has done that through deliberate steps to lower the rate at which patients enter the hospital or use the emergency room, says Lamos.
In short, the ACO's physicians have reinvented themselves, he says. And housing providers need to do the same thing.
Managed Care Plans
Sharon Williams, a consultant and former managed care executive, watched carefully when her home state of Michigan began participating in an ACA-authorized demonstration program designed to move older adults who are eligible for both Medicare and Medicaid into managed care plans.
She believes that the growing interest in the so-called "dual eligibles" could offer providers of affordable housing an unprecedented opportunity to partner with managed care plans to keep their residents healthy and independent.
These plans have not traditionally been engaged with local housing organizations, says Williams. But that is bound to change as health reform initiatives focus on keeping dual eligibles out of expensive care settings like nursing homes and encourage states to enhance their community-based housing options.
For the first time, says Williams, managed care executives must think about where health care consumers live. That’s good news for housing providers, she says.
"This creates a real need to establish the value of the housing system, including your deliverables and how your deliverables align with the objectives that the managed care plans have," she says.
Federally Qualified Health Centers
The dual-eligible population is also of growing interest to FQHCs, which use federal grant funds and enhanced Medicare and Medicaid rates to provide a package of integrated health and social services to low-income individuals.
While FQHCs have traditionally targeted their services to families and children, about 7%-8% of FQHC clients—or 1.4 million people—are over age 65. That figure is expected to increase dramatically over the next decade as the baby boomers age.
That makes FQHCs a perfect partner for affordable housing properties, says Marty Lynch, Ph.D., executive director and chief executive officer of Lifelong Medical Care, an FQHC in Berkeley, CA. But that doesn't mean the partnerships will be easy to implement.
"For many FQHCs, partnering with subsidized housing isn't number one on their list of things to do," says Lynch. "They are just trying to survive."
However, says Lynch, the ACA may give housing providers the leverage they need to convince FQHCs to offer health services in their properties.
Several ACA initiatives encourage FQHCs to increase their outreach to the dual-eligible population, which is expected to grow in states where Medicaid programs are expanding. Housing properties may be able to develop partnerships with FQHCs if they can offer the health centers new opportunities to serve the dual-eligible population, says Lynch.
"The dual eligible population is familiar to many health centers and (this population) provides the best reimbursement in the health center environment," he says.
Partnership Advice for Housing Providers
Lamos, Williams and Lynch offered this advice to housing providers interested in creating partnerships with ACOs, managed care plans and FQHCs:
- Stay informed. "Medicaid is going to be the driver of all this change," says Williams. "So it's important for housing providers to stay informed and engaged at the state level."
- Start a conversation with your potential partner. "This may sound obvious," says Lynch. "But how often do I talk to people who run housing organizations? Not very often."
- Work with other service providers. "Managed care plans will want to contract with a one-stop shop for the services and supports their members need," says Williams. "So figure out how you can work with local service organizations to provide a package of services to the managed care industry."
- Collect hard data. Document the value you bring to health care partners with hard numbers about your residents, the services they use and the services they need. "The health care partner wants to know what people are doing now for care and what their coverage is,” says Lynch.
- Be ready. "Make sure your organization has the financial, operational and cultural wherewithal to be a good partner," says Williams. “Do you have someone who can do contract negotiations? Do you need to start thinking about hiring nurses and social workers to help you design care management programs? Do you have the capacity to share resident health data with hospitals, health plans and other providers?"
- Don’t go it alone. Collaboration may come easier to larger housing providers that have the resources and the resident census to make them attractive to health care partners. But that doesn’t mean smaller housing providers must forego partnerships. They just have to be more creative. For example, 3 or 4 small housing properties in one region could agree to share a nurse practitioner among multiple sites, says Lamos. By the same token, a group of housing properties might share the cost of a health information technology system that none could afford on their own, says Williams.
The Importance of Creating Mutual Benefit
Finally, says Lamos, identify how the partnership will benefit both parties.
"Don't look at me as an ACO and ask, 'How much will you pay us?'" says Lamos. "Instead, spend some time really identifying exactly what it is you want to do and how we can work together to meet common goals."
If you want to co-locate a health care practice at your housing property, for example, be clear about what you are bringing to the deal, says Lamos. Offer to provide a fully-equipped examining area or to contribute a portion of the nurse practitioner's salary, he says.
"You've got to make it real," says Lamos. "Then we can find common ground where there is some potential. You share some facilities. I share some money. We both win."