General Recommendations: Approaching Health Players for Partnership

Community Health Needs Assessments

The Center’s top recommendation is for housing organizations to engage in local hospitals’ community health needs assessments (CHNA). This recommendation is timely – all US tax-exempt hospitals began engaging in the third round of CHNAs in 2018, which must be completed and approved in 2019. Under the CHNA rules, tax-exempt hospitals must assess the health needs of the community they serve, prioritize those needs and develop a plan to address them in the years ahead using community benefit dollars. Hospitals must seek input from those representing broad community interests, which explicitly includes members of medically underserved, low-income, and minority populations, or those serving or representing them. Based on the CHNA, hospitals are required to write health improvement plans for how they will address community needs through community benefit programming. 

How to get engaged in the Community Health Needs Assessment process:

  • Identify the nonprofit hospitals in your organization’s service areas
  • Review the hospital website or reach out to the hospital/ investigate the status of CHNA
  • Assess your organization's ability to actively pursue collaboration with the hospital
  • Share existing assessment on economic development or housing-related issues
  • Provide data on residents of properties, including demographics and health
  • Assist with CHNA by helping to solicit information from residents through town hall meetings, surveys, or focus groups
  • Submit written input on CHNA
  • Measure the effectiveness of efforts by tracking whether health/housing issues are elevated in CHNA

 Participating in CHNAs is a clear and timely action to take, but for ongoing representation of housing in community health conversations, the Center provides the following recommendations:

Actively Participate at “Key Tables” - The Center recommends that housing organizations become active participants in several tables at which the intersection of health and housing is relevant. Being at these tables will help housing organizations get to know health care stakeholders, understand who the influential decision makers are, share useful information about their organization, and ensure that stable, affordable housing becomes a priority. Examples of key tables include the Mayor’s or Governor’s Roundtable on Homelessness or a Local Multi-Stakeholder Workgroup on Mental Health.

Get Familiar with Relevant Health Programs - The Center recommends that housing organizations become familiar with a set of health care programs for low-income populations (and the players that serve them) in the areas in which the housing organizations operate. These programs may offer an opportunity for partnership. Examples of health programs include the State Medicaid, Mental Health or Aging Departments and the City or County Health Departments.

Monitor Health Care Bodies and Processes - The Center recommends that housing organizations closely monitor spaces where key health care conversations are occurring in order to identify opportunities to collaborate with health care entities. Examples include the Massachusetts Health Policy Commission.

Charting a Path Forward to Successful Collaboration

The Center’s work with HPN and its members confirmed the widely-held perception that, with some exceptions, the housing and health sectors are still largely operating in isolation. Both sectors use terminology that is often indecipherable to others. Too often, even housing organizations interested in collaborating with health entities do not have a deep understanding of the health policy environment, know who the key health care decision makers are, know how to effectively initiate discussions, or know what type of information would help to make a compelling case for partnership. Breaking down the barriers between the health care and the housing sectors is possible when the right steps are taken.

Translate – Players in the sectors do not necessarily speak the same language. Before entering into discussions with health care entities, housing organizations need to familiarize themselves with key terms, regulations and programs in order to facilitate productive conversations and show the potential partner that you are working together to try and solve the same problems. The Building Healthy Places Network has created a useful “Jargon Buster”. The Center has created two glossaries: one of basic health care terms and one that is more specific to health system transformation

Understand Mutual Interest – As the health care system shifts emphasizing value over volume, health care entities are increasingly open to partnerships that improve quality, reduce risks and reduce or stabilize costs. In order to establish mutually beneficial partnerships with health care entities, housing organizations should take the time to understand the current dynamics of the health care system, and understand and effectively articulate the assets they possess that can help health care entities achieve this goal. Staff or programs that assist people with complex health and social needs to better manage their health will be considered a valuable asset.

Collect the Right Data – It is critical for housing organizations to be able to describe in concrete terms what they bring to a collaboration. This begins with data. Housing organizations can collect standardized data on specific health care-related needs for their residents through an annual survey, a tool that many housing organizations already use, augmented with additional questions, at the least to ascertain if residents have a primary care physician and their source of insurance. Additional data may cover chronic diseases (diabetes, heart disease) and the number of annual emergency room visits since these tend to be substantial drivers of cost and a target for health entity interventions.

There are sample surveys available that contain questions in the areas of housing stabilization, health, education, workforce development and asset building. Health data in conjunction with existing property management data, is valuable in efforts to develop deeper partnerships with health care institutions since it allows a housing organization to tell the story of who they serve and how their partnerships and services benefit resident families.

Connect Your Data to the Health Entity’s Catchment Area – A starting place for connecting resident health data to the those serviced by a local health entity is to map resident locations to hospitals and health centers. Housing organizations can also compare their residents’ needs with those living in the communities served by local health entities. Opportunity360 is a tool that enables users to create customized reports that examine five foundational criteria shown to have the greatest impact on how we live: housing stability, education, health and wellness, economic security and mobility.

Within this tool’s health and well-being category, users can obtain information about a community’s health status and access/ affordability of health care. County Health Rankings created by the Robert Wood Johnson Foundation allows users to get a county-by-county snapshot of health outcomes, quality of life, health behaviors, clinical care, and social & economic factors. Both resources help housing entities demonstrate to health entities the similarity between their own residents’ needs and those of the larger community served.

Dedicated Staff - To prepare to leverage collaboration opportunities, housing organizations need to devote staff who can invest the time to build relationships with health entities; ideally at both the leadership level and at an implementation level. Having staff in place with informative data in hand, will greatly increase a housing organization’s ability to take advantage of opportunities as they arise. Housing organizations may augment existing staff capacity by seeking grants from philanthropic organizations or hiring graduate-level fellows or interns.

Create Your Narrative – With data in hand, a housing organization should create a narrative that tells the story of its organization, its residents and their needs and the assets it brings to any potential partnership. Often, resident service coordinators are critical to health and housing collaborations. As the eyes and ears in the buildings, they are trusted, have a sense of residents’ needs, and can assist in the coordination of care. This is a valuable asset for health insurers and providers, who understand the importance of coordinating care for the most complex patients or members in order to avoid expensive emergency room visits, hospital admissions and readmissions.

Get to Know the Right People – A strong lesson from the Center’s work with HPN and its members is that local housing and health entities do not necessarily know one another. Getting to know health care stakeholders requires being at the health care tables where social determinants, including housing, are likely to be discussed or should be part of the discussion. Complex health care entities tend to have many points of entry, so identifying key staff with commitment and influence to promote partnerships can be challenging. It requires working with knowledgeable people in the health care field who can make introductions to the trustworthy and competent people in the health sector. A health organization’s Board of Directors may also play a role in facilitating introductions. It is important to recognize that partnerships need to be built at multiple levels of each organization.

Seek External Support – Housing organizations may consider approaching local foundations to seek support. For example, they might seek philanthropic funding to build internal capacity or, should the opportunity present itself, to support a pilot project with a health care entity.

Recognize This Takes Time – Most of all, housing organizations, especially those that are new to collaborating with health entities, should recognize that building the relationships that lead to formal partnerships takes time. Relationships may build over time through smaller projects and then advance to bigger ones. This was the case with the partnership between United Healthcare and Arizona-based Chicanos Por La Causa (CPLC). This relationship started with a “getting-to-know-you” period, followed by a modest partnership to develop software to help a CPLC health center track its clients and service referrals. It then grew into a pilot program to improve the health of low-income people with diabetes. The success of that pilot program led to greater joint investment into staff who were placed at the CPLC health center, and ultimately led to a $20 million investment by United to CPLC to renovate 500 apartments for low-income and market rate housing. The United Healthcare and CPLC collaboration is a remarkable success story, but one that took over five years to build.

Four Case Studies Show What’s Possible

Housing Partnership Network, our members, and the Center partnered to find ways to make partnerships between the health and housing sectors mutually beneficial and encourage increased engagement not only to improve the health and well-being of our communities, but also to increase business efficiencies, reduce population health risk and prevent overutilization of costly health resources. The Center’s work with four HPN members, and our publication of these findings is intended to reduce the amount of discovery required for future housing organizations to dive into seeking partnerships with their local health providers. The case studies provide models for health and housing organizations to follow and advance. And the learnings from the Center are a road map for housing organizations interested in taking the first step toward successful partnerships that yield not only better health outcomes for their residents, but ongoing investments from local and national healthcare organizations – like the $1 million low-interest loan Cinnaire received as a result of their partnership with a local branch of the Trinity health system.

Case Study: CommonBond Communities

Case Study: Mission First Housing Group

Case Study: Cinnaire

Case Study: The Planning Office of Urban Affairs

Please contact us for further information. We look forward to communicating with you about how we can help your organization achieve its goals.