Pairing affordable housing and healthcare services significantly improves access to primary care and cuts emergency department visits while also lowering Medicaid costs, according to research from the Center for Outcomes Research and Education and Enterprise Community Partners Inc.

The Health in Housing: Exploring the Intersection between Housing and Health Care study analyzed Medicaid claims data from January 2011 to June 2015 for 1,625 residents in 145 affordable housing properties in Portland, OR. Forty-one of the properties, with 431 residents, offered housing for seniors and people with disabilities (SPD). The study also examined family housing and permanent supportive housing.

Total Medicaid expenditures declined by 16% related to the SPD housing residents studied. The implication, according to the authors, is that access to affordable housing likely will drive down costs to the healthcare system.

The study found that after moving into affordable housing, overall Medicaid costs (for residents of all property types) were $48 lower per resident per month. That amount represented an annualized reduction of $936,000 for the study group. Researchers also found that outpatient primary care use increased 20%, and ED use fell by 18%.

“The Health in Housing study holds national implications for healthcare systems, payers and policymakers looking for upstream solutions to address major healthcare needs and fulfill reform goals,” said Megan Sandel, M.D., an associate professor at the Boston University School of Medicine and a member of Enterprise’s board of trustees. “Housing with integrated health services is an important solution toward bending the healthcare cost curve.”

The presence of health services and staff was found to be a significant driver of reductions in healthcare expenditures and ED usage.

Results also provide insights into the health of SPD housing residents, services offered and opportunities for providers.

“The report provides invaluable insights on how we can work with new partners and advance programs that fulfill the promise of accountable care,” said Janet L. Meyer, CEO, Health Share of Oregon. “Stable, affordable housing provides the foundation to provide readily accessible, patient-focused health care.”

Fifty-five percent of SPD housing residents reported their health status as excellent, good or very good, and the remaining residents reporting their health as fair or poor. Twenty-five percent of SPD housing residents said that their health had improved since moving into their current residence; 45% said it remained the same, and 30% said it had gotten worse.

When researchers asked all residents who were aware of a service how often they actually used it, they found evidence of untapped potential at properties with services. For instance, less than half of all residents studied who knew about available medical services reported using them “somewhat” or “very” frequently (versus “rarely” or “never”). Interestingly, although no properties in the study officially reported offering dental services, some of the surveyed residents reported accessing dental services that they believed were part of the integrated services offered through their properties.

SPD housing residents reported accessing these services “somewhat” or “very” frequently:

  • Assistance with food resources: 56%
  • Medical services: 33%
  • Nutrition, fitness, health resources: 32%
  • Transportation services: 31%
  • Mental health/substance use services: 16%
  • Dental services: 6%

Ninety percent to 100% of SPD housing residents said that each service they used was very or somewhat helpful. Fifty-six percent of SPD housing residents, including those who did not use services, said they were very or somewhat satisfied with offered services and resources.

Twenty-six percent of SPD housing residents, however, said they would like health services that are not offered at their housing site. SPD housing residents said they’d like to see these services offered: access to produce/healthy meals; activities for seniors; eviction prevention; fitness/on-site exercise rooms; nutrition/cooking; on-site dental and medical care and mental health services; physical therapy; private mental health services; better or more reliable transportation; and yoga.