Andy McMahon is vice president of health and human services policy for UnitedHealthcare. Previously, he served as vice president for policy and external affairs for the Corporation for Supportive Housing, where he led federal policy and engagement with national partners and stakeholders to expand investment and reform public policy in supportive housing.
The Ascent: UnitedHealthcare has invested more than $350 million to finance low-income and supportive housing since 2011 in 14 states. What's the impetus for that?
McMahon: One of the most important reasons is the population that is housed in the tax credit project a health care company is investing in. From an economics perspective, it makes sense for a health care company to target supportive housing for individuals and families that have acute and complex primary and behavioral health care needs. They are the most vulnerable, yes, and they’re also very high utilizers of crisis systems and expensive care. That’s a key element, because supportive housing improves the health of individuals and families, and also reduces cost.
Another really smart reason for UnitedHealthcare or another health care entity to invest is the financial benefit for the company. The low-income housing tax credit allows the company to invest in projects that are aligned with its mission. These are not grant investments. They are investments that advance the creation of affordable housing, while also providing a financial benefit to the company. But more importantly, if you’re providing supportive housing, you’re almost certainly investing in the health and well-being of the community. In Medicaid expansion states, it’s especially smart for Medicaid managed care organizations to make that investment because they probably have a proportion of the residents who are Medicaid plan members.
The Ascent: What changes have you seen in recent years in the way organizations are approaching the intersection of stable housing and population health?
McMahon: Both sides are figuring it out. The notion of social determinants of health has been around for quite some time, but in the last few years, organizations are not just acknowledging it, they’re doing something about it. There’s a lot more action and investment.
The affordable housing community has recognized the connection between housing and health and has done more to create those partnerships. With supportive housing, you absolutely must have the connection between housing and behavioral and clinical health care, so there’s been more understanding of the issues. On the housing investment side, there’s greater realization that the housing should be developed to promote health. There’s more consideration about how that housing can be a healthy environment for those living there—is there on-site or nearby care coordination? Is there a play space for kids?
I also see a much greater realization that, in many cases, health and housing systems are serving a significantly overlapping population, and the family is better off when those connections between the two are made.
The Ascent: What are some common elements of successful housing and health partnerships?
McMahon: There absolutely is a framework and core elements to successfully doing this work and connecting complex and vulnerable individuals to housing. But it’s also critical to tailor the effort to the local context.
The way to do that is to use data and population metrics so we understand the needs of the population on the front end, and then track the impact on the back end. That helps ensure we’re getting the right intervention to the right person at the right time. And those partnerships need to include close collaboration and alignment of resources.
Housing is such a scarce resource. You want to figure out who are the most vulnerable people so you can serve their needs first. If you have a family of four living under a bridge, it’s a different priority than a single person who’s couch hopping with friends. Data helps us target resources, and to measure the impact these investments have on improving health and reducing costs. It helps us make the case, so we can be accountable for the results and, ultimately, expand investments in supportive and affordable housing.
Read more about housing and health in an upcoming RMHP issue brief.