It’s NOT a home.

Health Homes stems from the Medicaid Redesign. The program works to reduce unnecessary hospital stays and emergency room visits by linking High Medicaid Users to needed services. High Medicaid Users are people who have chronic behavioral, substance abuse, and/or medical needs (or a combination thereof).

Essentially, Health Homes is The Ounce of Prevention is Worth a Pound of Cure Program, but that’s a mouthful.

Addressing Barriers to Needed Care

It’s hard to prioritize medical needs when you might also be dealing with issues such as homelessness, chronic behavioral issues, or substance abuse. Sometimes, these things align to create a perfect storm and that’s when ER visits and hospital stays might spike. If these can be avoided, there are not only cost benefits, but better outcomes all around.

Really, it comes down to how social determinants of health are often the biggest barriers to accessing needed care. Health Homes works to remove those barriers.

Working Together to Overcome Barriers

At Unity House, our Health Homes Team works directly with people who need care coordination services. Trained staff perform outreach to High Medicaid Users,  assess needs and craft a Care Plan with goals. If people are linked to resources around their physical and mental health, around their housing and other needs, those services will help prevent a cascade of costly interventions. It’s not always easy, however, maneuvering all the systems, especially if your challenges are multi-fold.

Assessment is Key

Assessment of needs by staff is an important part of the process, yet can be challenging in a culture where there is often stigma around mental illness, blame for substance abuse, and shame around homelessness. Further, it’s not always easy to ask for or receive help. Unity House staff are trained to provide trauma-informed care, to build trust, and to honor the inherent dignity of everyone.

At a recent training event for staff, Unity House had the benefit of two experts who were able to offer specific strategies for assessment, especially when someone might not be in the best head space. Tariq and Nick are experts by virtue of the fact that they are consumers of services. Residents of a one of our housing programs, they offered valuable insight for staff. Their role playing with case workers was not only a new way to talk about an issue that gets constant review, but also a window onto a complex issue and an opportunity to ask pointed questions.

Among Unity House’s core values is working together to open the doors of access and opportunity to everyone, but particularly those in greatest need. Our Health Homes program speaks particularly to those in greatest need and we are grateful for Volunteer Experts like Tariq and Nick who not only share their experience, but also their hope: that with the right supports, people can work toward a life of empowered choices. We appreciate that Tariq and Nick choose to share their wisdom in service of others.

If you would like more information on Unity House’s Health Homes program, or our Supportive Housing & Case Management Services and how you can be of support, please call Diane Cameron Pascone at (518) 274-2607 x4133.