A Community Partnership to House and Care for Complex Patients

Suhas Gondi
Samuel I. Berchuck
Rebecca T. Brown
Mark Hinderlie
Lauren Easton
Leah Smith
Jacob E. Berchuck
Henry S. Burden
Caroline M. Berchuck
Peer-Reviewed Article
August 2021


A cross-sector partnership to enroll older adults experiencing homelessness in permanent supportive housing led to meaningful reductions in health care costs.


Permanent supportive housing — which provides case management, counseling, and employment services along with housing assistance — shows promising results for improving health outcomes and quality of life for people experiencing homelessness. This case study details a partnership between Commonwealth Care Alliance (CCA) and Hearth, Inc. to provide permanent supportive housing for older adults experiencing homelessness and evaluates the impact of this partnership on health care utilization and costs. CCA is a Massachusetts non-profit community-based payer and provider serving people who are dually eligible for Medicaid and Medicare, and Hearth, Inc. is a community-based organization that develops affordable housing and provides senior services for older adults experiencing homelessness.


Permanent supportive housing at Hearth for 57 CCA members was associated with decreases in total medical expenses, medical expense ratio, and acute care claims, which were all growing costs prior to the intervention. The case study describes what made the partnership successful, including workflows, interdisciplinary team structure, and strategies to address typical challenges. It also outlines considerations for health care organizations that are interested in launching their own housing initiatives.


Risk-bearing health care organizations such as CCA can finance initiatives and partnerships that allow them to successfully address homelessness for their members. Because of this, their specific partnership with Hearth led to reduced costs and utilization for older adults experiencing homelessness.

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