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By Geralyn Magan

The LeadingAge LTSS Center @UMass Boston (formerly the LeadingAge Center for Applied Research) will evaluate the Housing and Health Pilot when the 2-year project ends.

LeadingAge Massachusetts and the Long-Term Quality Alliance (LTQA) are designing a pilot project that will bring housing providers and health plans together to deliver coordinated services and supports to residents of affordable senior housing communities in Massachusetts.

Using a grant from the West Health Policy Center, the partners are also planning to design and test what they hope will become a sustainable model for financing housing plus services models around the country.

The LeadingAge LTSS Center @UMass Boston (formerly the LeadingAge Center for Applied Research) will evaluate the Housing and Health Pilot when the 2-year project ends.

The Pilot Design

At the heart of the Massachusetts Housing and Health Pilot are onsite teams, consisting of an enhanced resident service coordinator and a wellness nurse, which will work at housing communities in coordination with participating health plans. The pilot builds on the Support and Services at Home (SASH) program, the Portland Housing with Services program, and other housing plus services demonstrations.

“The onsite team would serve as the eyes and ears for the health plans, with the ultimate goal of reducing hospitalizations and Emergency Department (ED) visits, delaying nursing home placement, and bringing about other positive outcomes that we think can result from better integration and better communication between housing and health care,” says Elissa Sherman, president of LeadingAge Massachusetts.

A key feature of the proposed pilot is the creation of a separate entity that will pool funds contributed by health plans to finance the onsite teams across the pilot sites. This concept would inform a more sustainable and scalable funding mechanism than previous housing and health models, which have generally depended on grants or other ad-hoc funding solutions to pay for onsite services, says Sherman.

Several health plans, including Senior Care Options (SCO) programs and Programs of All-Inclusive Care for the Elderly (PACE), are playing an active role in designing the Housing and Health Pilot. SCOs are Medicare Special Needs Plans enrolling individuals who are dually eligible for both Medicare and Medicaid.

The expectation is that these plans will also participate in the pilot’s implementation phase, says Sherman.

“Our greatest hope is that we are going to be able to show that tighter coordination and use of onsite services did have impacts on measures that the SCOs and the other health plans care about, and that the health plans will decide these services are worth paying for,” she says.

Work Groups

LeadingAge Massachusetts members and staff, as well as representatives from LTQA, the LTSS Center, SCOs, PACE organizations, aging and social service providers, and housing providers have been working together since January 2016 to design the Housing and Health Pilot. The design work is currently taking place within 3 work groups:

• A “Residence Staffing” work group is creating standardized roles for members of the onsite teams to ensure that those teams will operate in the same manner across all intervention sites. Initial plans call for the teams to provide wellness-related programming to all residents in a housing community, and to offer a second tier of enhanced services, including care coordination, to residents enrolled in participating health plans.
• An “Integration” work group is envisioning how the onsite teams will go about supporting the care management function of the participating health plans. “This could be challenging because each housing-based team will be working with care managers from multiple health plans,” says Sherman. “But, if done well, it has the potential to create tremendous value for the plans and, of course, for the residents themselves.”
• A “Measurement” work group is designing the evaluation that the LTSS Center will conduct at the end of the pilot. That evaluation is likely to examine whether the Housing and Health Pilot succeeded in reducing hospital stays or ED visits, and how well it performed on quality measures related to wellness and chronic disease management. Evaluators are expected to compare outcomes for health plan members living in the intervention sites to outcomes experienced by health plan members living in housing communities that do not offer onsite services.

A fourth work group, tasked with designing the pilot’s funding mechanism, will begin its work after the pilot’s basic design is complete.

Part of an Ongoing Effort

LeadingAge Massachusetts and its members have been working for about 18 months to explore opportunities for integrating housing and health care. Last fall, the association’s Housing and Health Care Task Force hosted a forum on housing and health partnerships that attracted about 75 of the state’s housing, aging and health care stakeholders.

“We wanted everyone in the room to hear about initiatives around the country that were already bringing housing and health care together,” says Sherman. “We also wanted to explore the challenges and opportunities associated with doing something here in Massachusetts.”

The West Health Policy Center grant helped take that exploration to the next level, says Sherman.

“This has been a great opportunity to bring together the expertise that LTQA has with integrated care and our desire to test a new way to coordinate and pay for housing with services, and not just in Massachusetts,” says Sherman. “Hopefully, this will become a model that other health plans in other states will want to implement.”

Other Housing Plus Services Projects in Massachusetts