Delaware Healthy Homes Summit
Child
Children’s
’ H
Health
lth and
d IIndoor
d
E
Environment
i
t
March 12,
12 2014
Newark, DE
0
Collective Financial Burden
 Nearly 9 million families in substandard, unhealthy homes
 Billions of taxpayer dollars lost annually due to inefficient & unhealthy
housing – 3% of US healthcare costs
•
$43.4 billion due to lead poisoning
•
$20 billion annually due to asthma-related illness
•
14 million missed school days (#1 reason for absenteeism = asthma)
•
$19 billion for trip and fall injuries for seniors (projected at $30B by 2020)
 Low-income households spend
p
14% of income on energy
gy vs. 3.5% for
other households
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How Most Residents Experience Housing Intervention Programs
Treasury
DOL
HHS
DOE
HUD
Philanthropy
Private
IAQ
Fed Loan Bank Board
CDFI
WIA
Green Jobs
ETA
Medicaid
Medicare
Lead
EERE
EECBG
WAP
LIHEAP
CSBG
Lead
State
Problems are About People
Old allergen‐ridden carpets
Basement wall water damage, high humidity
Deteriorated inefficient windows
Door jam friction surface
Water heater
Chipping paint
Safety hazard Bathroom water leak & moisture under tiles
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Braid
Align
g
National Efforts
•
•
•
HUD, DOE, CDC, CMS
Healthy Homes Work
Group
St t
Strategy
ffor A
Action
ti
Funding Streams
•
•
•
•
•
Weatherization
CDBG, HOME, lead
hazard reduction, etc.
St t and
State
d llocall
programs
Philanthropy
Utility and other private
sector
t
Coordinate
Partners
•
Single application
•
•
•
Common eligibility
Single, comprehensive audit
Integrated home improvement
and education services
Common data platform
•
4
The Results
How Residents Experience
the GHHI Model
$
GHHI
Interventions
5
GHHI in Action
New hardwood floors installed
Basement moisture control
Energy Star window installed
Water heater blanket insulation installed
Friction surface eliminated
Paint stabilization
Stairs replaced and treads installed
Water leak repaired and tiles replaced
6
7
GHHI Sites
Syracuse
Lewiston
Lansing
Buffalo
Flint
Dubuque
Detroit
Chicago
Cleveland
Oakland
Salt Lake County
Denver
Providence
New Haven
Newark
Philadelphia
Baltimore•
Atlanta
Jackson
San Antonio
Green: GHHI Designated Sites
Blue: Onboarding
www.GHHI.org
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Key Elements to GHHI Site Development
1. Learning Network
2 Compact
2.
3. Outcome Broker
4. Single Portal Intake
5. Comprehensive Environmental Assessment/Energy Audit
6. Integrated Interventions
7 Workforce Development
7.
8. Shared Data Platform
9. Evaluation and Cost Benefit Analysis
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GHHI Learning Network
• Diverse set of stakeholders
• Work Plan development
• Set benchmarks for success
• Identify and remove barriers to collaboration
• Establish subcommittees (e.g. unit production,
data policy,
data,
policy outreach)
• Conduct data analysis to measure outcomes and benefits
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Compacts - Galvanizing City,
City County,
County State,
State
and Philanthropic Leaders
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Role of the Outcome Broker
•
Facilitate the identification of partners, resources and opportunities
•
C di t referral
Coordinate
f
l process
•
Partnership facilitation, capacity building and technical assistance, and development
•
Drives the work plan
•
Serves as day-to-day liaison with the national effort
•
Housed in agency or organization that best fits the local site, many options
•
Promote local collaboration and coordination
•
Help identify and remove barriers, and support and uplift best practices
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Single Portal System
• No matter who a client calls first, access to the entire partnership
• Clients with multifaceted needs require a multifaceted approach
• Example: Baltimore’s LIGHT program coordinates over 60 programs from
which clients may be eligible to receive service
• A single application for Weatherization, Lead Abatement and Rehabilitation
at Baltimore Housing
• Digital signatures and handheld scanners to fill-out applications and scan
g
y documents in the field
eligibility
13
The Assessment Team
Environmental Health Educator
•
Conducts resident education
•
Coordinates pre and post client health surveys
•
Develops recommended action plans for the residents
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Distribution & explanation of Healthy Homes Maintenance Kit
•
Coordinating referrals to partnering organizations for any other client services
Environmental Assessment Technician
Technician-Energy
Energy Auditor
•
Conducts pre-intervention environmental assessments
•
Uses a Comprehensive Health and Housing Assessment Tool
•
p complete
p
scopes
p of work for the p
properties
p
Develops
•
Conducts post intervention assessments and audits
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Interventions done in a coordinated fashion – examples:
Green
Health & Safety
Energy Audit
Health & Safety Assessment
Weatherization
Lead Hazard Reduction
Insulation
Asthma Trigger Reduction
Reducing Air Infiltration & Leakage
Integrated Pest Management
Energy Efficiency Measures
Trip & Fall Risk Reduction
Remediating Gas Leaks & CO
Fire & Injury Prevention Measures
E
Energy
Effi
Efficiency
i
Education
Ed
ti
H lth & Safety
Health
S f t Ed
Education
ti
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Workforce Development
• Cross training of contractors and inspectors from
multiple
l i l fields
fi ld to increase
i
efficiencies
ffi i
i
• Increased contractor and inspector capacity
• Building off of existing training infrastructure: adding new
modules and certifications
• Economic development for residents of low income
communities
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Data and Information Sharing
•
GHHI ETO data platform (multiple partners can use the system)
•
Process to track information on homes and clients
•
Ability to review data locally and nationally
•
Utilize university and other partners for
data collection and analysis
g data to tell the storyy
• Using
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Evaluation and Cost-Benefit
Cost Benefit Analysis
• Cost Benefit Analysis for government innovation, wealth retention and
long term health and energy outcomes
• Evaluation tools to measure improvements in health outcomes
gy consumption
p
reductions and energy
gy
• Evaluation tools to measure energy
cost savings
• Evaluation tools to measure cost savings from integrated assessment and
intervention approach
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Outcomes - Impact and Benefits of GHHI
• Close to 5000 GHHI units completed nationwide
• Co
Corporate,
po ate philanthropic,
philanth opic and private
p i ate resources
eso ces have
ha e committed over
o e $62
million to support local GHHI efforts:
Health - reduction in asthma hospitalizations – increasing school
attendance,
tt d
l
lowering
i missed
i d workk days
d
for
f parents,
t and
d reducing
d i
medical costs (specifics on next slide)
Energy consumption reductions ($400/year per home)
Government program cost savings (up to 20%)
Over 1,100 persons trained for the Green & Healthy Homes Workforce
with a $4,000 - $8,000 increase in wages
Reduction in WAP and other program deferrals
Reduction
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Outcomes - Asthma Impact
●
60% reduction in total number of asthma related client hospitalizations
post-intervention
●
50% increase in participants never having to visit the doctor’s office due to
p
asthma episodes
●
55% increase in participants reporting their child’s asthma as well controlled
●
62% increase in participants reporting asthma-related perfect attendance for
their child (0 school absences due to asthma episodes)
●
88% increase in participants reporting never having to miss a day of
work due to their child’s asthma episodes
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P li and
Policy
d Innovation
I
ti
• DOE’s Weatherization Plus Health (NASCSP)
• US Conference of Mayors Resolution
• Healthy Homes Work Group – Advancing Healthy Housing: A Strategy
for Action
• HUD NOFA (Priority Points)
• Center for Medicare and Medicaid Innovation
• Software Development
• Update GHHI intervention standards and lead conversation on healthy
building materials, eliminating red
red-list
list materials
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I
Innovative
i Funding
F di
– Emerging
E
i
Practices
P
i
• Utility Foundation Funds
• DOE WIPP (and proposed Coons-Collins weatherization bill)
• Settlement Funds (Attorney General)
• Philanthropy
Phil th
(multiple
( lti l roles)
l )
• Public Service Commission
• For rural communities – USDA Energy Efficiency and Conservation
Loan Program
• Connections to health care resources
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Social Impact Bonds (Pay for Success)
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Asthma Social Impact Bond: Fresno
Fresno, CA
Reducing Asthma Emergencies Projections – 1,100 children from Medi-Cal
health plans and self-funded employers
•
Goal: Reduce ED visits (30%) and hospital stays (50%)
Invest in Prevention - $3 million in upfront investment
• Bond investors provide upfront capital
• Agreed interest rate and payback period
Return on Investment – Principal + Interest, Intermediary/evaluation, retained
savings
• Payers share validated savings
Opportunity - $8.5 million savings opportunity
*See Collective Health for more information
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New O
N
Opportunities
i i from
f
the
h H
Health
l h Sector
S
Preventive Services Reimbursed by Medicaid
•
Starting Jan 1, 2014, state Medicaid programs can choose to reimburse for preventive
services provided by professionals outside of a state’s clinical licensure system – such
as certified asthma educators – so long as the services have been initially
recommended by a physician or licensed practitioner.
•
GHHI is working on a manual for Healthy Homes services with corresponding costs, to
h l states
help
t t look
l k att paymentt models
d l
•
Next Steps: States need to have a list of provided services, a payment structure, and
qualifications for the professionals
q
p
providing
p
g the services. State Medicaid offices would
submit a State Plan Amendment (SPA) to CMS to begin the negotiation.
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Hospital
i l Community
C
i Benefit
fi Investments
•
ACA revised requirements for nonprofit hospitals, in order to assure that hospitals’
“community
community benefit
benefit” investments are transparent
transparent, concrete,
concrete measurable
measurable, and
responsive to community needs.
•
A Community Health Needs Assessment (CHNA) is conducted every 3 years by the
hospital, which then adopts an implementation plan. Community benefit
investments can encompass “physical improvements and housing” and
“environmental improvements.”
•
Next Steps – Contact all non-profit hospitals, and determine where they are in their
CHNA process. Ensure asthma
h
and
d environmentall health
h l h is included,
l d d and
d workk with
h
the hospital on including the built environment as part of their implementation plan.
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Medicaid
di id Section
i
1115 Waiver:
i
The p
purpose
p
of the 1115 waiver is to g
give states additional flexibilityy to design
g and
improve their programs to demonstrate and evaluate new approaches that:
• Provide services not typically covered by Medicaid
• Use innovative service delivery systems that improve care and increase efficiency
• Are
A costt neutral
t l or show
h
costt savings
i
Massachusetts has expanded a 1115 waiver to do home education, case management,
and environmental supplies for asthma
•
Nextt St
N
Steps – Talk
T lk to
t M
Medicaid
di id office
ffi about
b t interest
i t
t in
i emulating
l ti MA 1115 waiver.
i
Process is more rigorous than the state plan amendments
27
Managed
d Care Contracts
•
Many Medicaid agencies contract with managed care organizations (MCOs) to
provide coverage
g to Medicaid‐eligible
g
populations. There is more flexibilityy in what
MCOs provide under that contract than what can be provided in traditional fee-forservice Medicaid reimbursement
•
2002, Monroe Plan for Medical Care – a MCO plan in New York – launched a
program for children with
ith asthma
asthma, that incl
included
ded ed
educational
cational materials
materials, home
environmental assessments, and supplies for reducing exposure to environmental
triggers. For every $1 spent, $1.48 was saved in direct medical costs through a 60
percent reduction in hospitalizations and 78 percent fewer ED visits.
•
Next Steps – Contact MCOs about establishing similar programs to the Monroe
Plan’s asthma work.
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Technical Assistance
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Develop local partnerships
Identify and support Outcome Broker
p
Secure Compact
Provide gap analysis and resource identification
Work planning
Provide Comprehensive Assessment Tool
Provide best practices and training around assessments
assessments, triage
triage, and
integrated interventions
Provide shared data platform and evaluation support
Engage philanthropy and private sector
Aid in funding proposals (federal, local, philanthropic, private)
Conduct regular webinars and boot camps
Provide support for workforce development programs
Provide information on new policies and strategies
Help document and communicate outcomes
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Michael McKnight
g
Senior Program Officer
[email protected]
202-769-5763
www.ghhi.org
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