Caring for the Homeless: How Community Health Centers Approach Cross-Sector Collaborations in the context of Alternative Payment Models
Open AccessHousing instability is a significant public health concern in the United States. Homelessness affects an estimated one-quarter of American households and has been consistently and significantly been associated with poor health outcomes, high rates of morbidity and mortality, and utilization of costly care in high-acuity, hospital-based settings. Community health centers (CHCs) are local, non-profit community-governed health care providers that offer numerous services, which address health related social needs (HRSN) and social determinants of health (SDoH). Medicaid is a major source of funding for CHCs. As alternative Medicaid payment models proliferate, CHCs may have an expanded opportunity to establish new and strengthen existing cross-sector collaborations to address housing instability among their patient population. In this study, I explored how CHCs work across sectors to address housing instability and homelessness among their patients and how value-based payments have encouraged, facilitated, or inhibited those collaborations. This study found that CHCs partner across sectors for multiple purposes. Motivations for partnering are diverse but are typically rooted in providing responsive care and smooth referral pathways to outside services that enhance possibility and improved or stable health. CHCs still largely rely on foundation and HRSA grant funds to support SDOH screening and data collection. While value-based payment structures can be beneficial to health centers working to provide comprehensive services, they did not drive how, when, and for what purpose they partner with outside organizations for clinics in this case study. Conversely, existing community connections, clinician engagement in practice transformation, and patient needs were drivers of decisions on when clinics engaged in alternative and value-based payment arrangements.
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