The Short Story
In 2011, responding to healthcare reform through the Affordable Care Act, and recognizing that homeless and housing-insecure patients are among the most vulnerable, high-needs, and high-cost patients, a combination of hospitals, housing providers, and social service organizations in the Bronx convened to coordinate the services of the healthcare and housing sectors.
These stakeholders agreed that shared housing and health care provider understanding is necessary to support high cost/high need clients who require intensive, coordinated services to achieve improved health outcomes. With the implementation of health care reform and the establishment of Health Homes to focus on high cost Medicaid populations, it became apparent that the homeless and precariously housed populations are a significant driver of inappropriate health care utilization and high Medicaid costs due to the lack of integrated, coordinated services including stable housing.
The Bronx Health & Housing Consortium organized to address this need, providing a structured format for information-sharing and collaboration that has grown to include more than 60 organizations and eventually fostering the creation of a second consortium in Brooklyn.
The Long Story
Early interest in housing/healthcare collaborations in the Bronx was driven by three organizations: Montefiore Medical Center; BronxWorks (a CBO offering homelessness prevention, street outreach, shelter, supportive housing and other social services); and NYC Correctional Health Services (now Health+Hospitals/Correctional Health Services).
Montefiore’s interest in cross-sector collaboration was motivated, in part, by the growing imperative to improve health outcomes and reduce costs. Montefiore had begun examining the needs of difficult-to-discharge patients to better understand how housing insecurity drove hospital utilization and Medicaid costs.
BronxWorks also recognized that its clients had both health and housing needs. They identified two pressing issues: (1) shelter clients entering the hospital often lost their shelter beds because case managers did not know where they were; and (2) hospitals’ inappropriate discharge of medically-complex patients to shelters and supportive housing due to insufficient knowledge about the level of care available in these settings. BronxWorks began meeting with Montefiore hospital staff to inform them about shelter regulations and supportive housing services.
Correctional Health Services, which provides healthcare in NYC jails, was also aware of its patients’ coinciding health and housing needs. Many people in the correctional system have serious health needs. Upon return to the community, they often lack access to healthcare and housing, leaving them at risk for poor health outcomes and re-incarceration.6 Correctional Health Services was interested in developing partnerships to assist patients with community-based healthcare and housing opportunities.
Together, these three institutions became the founding organizations of what would become the Bronx Consortium. High-level staff within these organizations became early “champions” of the Bronx Consortium, actively participating in its development, securing support and in-kind contributions from their respective institutions, and writing it into grant proposals.
Connecting with Health Homes and Supportive Housing Providers
Champions within the three founding organizations engaged two other stakeholders instrumental in the Bronx Consortium’s creation: newly-formed Health Homes and supportive housing providers.
The champions anticipated that housing would be a primary concern among Health Home clients, and that Health Home staff would need training and resources. The four Health Homes analyzed their enrollment data and found that 21% of their clients reported being homeless, while others reported being at risk of eviction. The Health Homes noted difficulties their care coordinators faced in finding housing for clients, knowing where shelters were located, and connecting with shelter staff.
The Bronx Consortium champions also understood that supportive housing providers were eager to establish better relationships with hospitals and Health Homes, as keeping their medically-complex tenants stably housed requires coordination with multiple providers.
The overlapping health and housing needs of their clients created a natural alliance between the Health Homes, supportive housing providers, and the newly forming Bronx Consortium. As the Bronx Consortium began to meet regularly, relationships among these stakeholders developed and solidified.
Forming a Steering Committee and Becoming a 501c3
Wanting an equal balance between health and housing organizations, the champions from Montefiore, BronxWorks, and Correctional Health Services invited representatives of the four Bronx-based Health Homes and three Bronx supportive housing providers to form a Steering Committee to lead and guide the Bronx Consortium. The Steering Committee decided that efforts should focus on supporting health and housing organizations rather than serving clients/patients directly.
BronxWorks and Montefiore provided crucial in-kind support, including staff time for organization and management of the Bronx Consortium. Beginning in 2012, BronxWorks also began serving as the Consortium’s fiscal conduit.
In 2017, intending to expand its model outside the Bronx, the Bronx Consortium applied for and received 501c3 tax-exempt status and incorporated as The Health & Housing Consortium, Inc. That accomplished, it was able to pursue new funding opportunities and raised funds to hire its first full-time staff member, an executive director, in 2018.
Expanding to Brooklyn
In 2017, NYU Langone Health (NYULH) merged with Lutheran Hospital (now NYU Langone Health–Brooklyn) in Sunset Park, a predominantly low-income, immigrant neighborhood in Southwest Brooklyn. With the merger, NYULH expanded its community benefit portfolio, previously focused on Manhattan, to include Brooklyn.15 NYULH-Brooklyn’s Vice President of Care Management and leaders of NYULH’s community benefit portfolio from the NYULH Department of Population Health were familiar with the Bronx Consortium and saw the potential value of a similar model in Southwest Brooklyn. Leaders from the Bronx Consortium became advisors in establishing the Brooklyn Health & Housing Consortium.