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THE PREVENTIVE EFFECT of HOUSING FIRST on HEALTH CARE UTILIZATION and COSTS AMONG CHRONICALLY HOMELESS INDIVIDUALS: New Evidence Using Propensity Score Analysis

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THE PREVENTIVE EFFECT of HOUSING FIRST on HEALTH CARE UTILIZATION and COSTS AMONG CHRONICALLY HOMELESS INDIVIDUALS: New Evidence Using Propensity Score Analysis THE PREVENTIVE EFFECT OF HOUSING FIRST ON HEALTH CARE UTILIZATION AND COSTS AMONG CHRONICALLY HOMELESS INDIVIDUALS: New Evidence Using Propensity Score Analysis DECEMBER 2020 ABOUT THE AUTHORS Kevin Brennan was a Manager at Analysis Group, Inc. from 2007 through August 2018. Mr. Brennan led the development of technology solutions to enable rapid and efficient analyses of very large databases to investigate legal issues. He provided expert technical advice and analytical services to consultants and clients of Analysis Group's Health Economics practice, and has prepared reports and testified as an expert witness in litigation matters on enterprise information systems and the software industry. Since August 2018, Mr. Brennan has served as Visiting Professor of Practice in the Daverio School of Accountancy at the University of Akron’s College of Business Administration. Kathryn Buggs was a Senior Analyst at Analysis Group, Inc. until July 2020. Since Fall 2020, she has been enrolled at the University of Michigan Law School. Pete Zuckerman was a Senior Analyst at Analysis Group, Inc. until July 2020. Since Fall 2020, he has been enrolled in the Doctoral Program in the Department of Statistics at the University of Washington. Singumbe Muyeba, PhD, is Assistant Professor at the University of Denver’s Josef Korbel School of International Studies. His research and teaching are in the areas of international development, homelessness and housing poverty in the United States, urbanization, property rights to low-income property among the poor, and the crisis of slums in Sub-Saharan Africa. He has a book and peer-reviewed publications in national and international journals in these research areas. Prior to his appointment at the Korbel School, Professor Muyeba was Research and Evaluation Specialist at the Massachusetts Housing and Shelter Alliance. Alexis D. Henry, ScD, is Associate Professor of Psychiatry Research and Evaluation Unit within the Public and Private Health Solutions arm at Commonwealth Medicine at the University of Massachusetts Medical School. John (Jack) Gettens, PhD, is Assistant Professor of Family Medicine and Community Health Research and Evaluation Unit within the Public and Private Health Solutions arm at Commonwealth Medicine at the University of Massachusetts Medical School. Parag Kunte, MPH, is Senior Biostatistician for the Research and Evaluation Unit within the Public and Private Health Solutions arm at Commonwealth Medicine at the University of Massachusetts Medical School. ACKNOWLEDGMENTS The authors conducted the research underlying this report as part of the Analysis Group, Inc., Pro Bono Program, which enables employees to independently participate in projects that contribute to their communities and research interests. While this research was conducted by the authors in 2019, the design and development of this project has been ongoing since 2014. The authors would like to especially thank Manas Babas, Samantha Flattery, Michaela Johnson, and Erich Trieschman for their material contributions. Results and opinions expressed herein are the work of the authors and do not represent any opinions or positions of Analysis Group, Inc. The authors would also like to acknowledge the support of Joe Finn, President and Executive Director of the Massachusetts Housing & Shelter Alliance, and Thomas Brigham, Program Director of the Home and Healthy for Good and the Social Innovation Pay for Success initiative. The study proposal and methodology were reviewed and approved by the University of Massachusetts Medical School (UMMS) Institutional Review Board, and the study was conducted under a Data Use Agreement among MassHealth, UMMS, and the Analysis Group. We are grateful for our partner organizations’ support and contributions to the study. Finally, the authors wish to thank the Blue Cross Blue Shield of Massachusetts Foundation for its generous support throughout the entire project from the original proposal to the preparation of this final report. Design: Madolyn Allison Line Editing: Barbara Wallraff TABLE OF CONTENTS INTRODUCTION .......................................................................................................................................................1 REVIEW OF THE LITERATURE ................................................................................................................................1 STUDIES .....................................................................................................................................................................1 METHODS ..................................................................................................................................................................2 RESULTS .....................................................................................................................................................................3 NEW CONTRIBUTIONS FROM THIS STUDY ........................................................................................................4 METHODS ..................................................................................................................................................................5 DATA SOURCE ...........................................................................................................................................................5 STUDY DESIGN .........................................................................................................................................................5 IDENTIFICATION OF STUDY COHORTS ................................................................................................................5 INCLUSION CRITERIA ..............................................................................................................................................7 STUDY MEASURES ...................................................................................................................................................7 STATISTICAL ANALYSIS ...........................................................................................................................................7 RESULTS ....................................................................................................................................................................9 BASELINE DEMOGRAPHIC AND CLINICAL CHARACTERISTICS .......................................................................9 HEALTH RESOURCE UTILIZATION AND COSTS ..................................................................................................9 DISCUSSION .......................................................................................................................................................... 10 LIMITATIONS .......................................................................................................................................................... 11 AREAS FOR FUTURE STUDY ................................................................................................................................ 12 CONCLUSION......................................................................................................................................................... 12 REFERENCES ......................................................................................................................................................... 13 APPENDIX A. UNMATCHED AND MATCHED BASELINE CHARACTERISTICS ................................................ 15 APPENDIX B. UNMATCHED AND MATCHED FOLLOW-UP CHARACTERISTICS ........................................... 17 INTRODUCTION The principal objective of this study is to examine the effect of the Housing First model on Massachusetts’ Medicaid program (MassHealth) expenditures. Housing First offers chronically homeless individuals immediate, stable housing to serve as the foundation for the delivery of the range of other support services. In this model, support services are provided after entry into housing and being receptive to them is not a condition for maintaining housing tenure. The individual is provided housing, treatment programs for substance use, psychiatric care, and a lease agreement that is indistinguishable from one obtained on the private market. The Massachusetts Housing & Shelter Alliance (MHSA) administers two statewide Housing First initiatives: the Home and Healthy for Good (HHG) program, which has served over 1,100 formerly chronically homeless individuals since 2005, and the Social Innovation Financing Pay for Success (PFS) program, which has served over 800 formerly chronically homeless individuals since 2015. This report is a collaborative effort among MHSA, economic consultants supported by Analysis Group, Inc. Pro Bono Program, and the University of Massachusetts Medical School (UMMS). The study methodology integrates MHSA and MassHealth administrative claims data to compare MassHealth expenditures before and after the provision of Hous- ing First services among MassHealth members with a history of chronic homelessness (the “intervention group”) to expenditures for a matched group of members who are chronically homeless but have not received Housing First services (the “comparison” group). Pursuant to the terms of an Interdepartmental Services Agreement between MassHealth and UMMS that establishes UMMS as a MassHealth Business Associate, MassHealth has allowed UMMS researchers to access the administrative data for the study. REVIEW OF THE LITERATURE
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