Rob Grossinger is a vice president at Enterprise Community Partners, Inc., where he works on community stabilization and the intersection of health care and housing. He spoke with Build Healthy Places Network’s Barbara Ray in Chicago.
Barbara Ray: Why is an affordable housing developer interested in public health?
Rob Grossinger: Let’s start with the overarching holy grail: Affordable housing needs more resources. So we look at this other system [health care] with trillions of dollars and we think, “Aha! We can get that money to build housing.”
In the meantime—and coincidentally—the health system started saying, “There’s such a thing as social determinants of health. Only treating illness is not effective if those things that make people sick are unchanged,”
Doctors were saying, “I can treat someone, but if they go back to their flea-infested, asthma-producing, stress-inducing home, then I’ll see them again in 30 days.” We get terrible outcomes from the health care system because we treat, we don’t prevent.
Then the Affordable Care Act came along and said, “If that person comes back in 30 days, we’ll penalize you. We’ll hit your pocket book.”
Why look to housing as a platform for health care?
Housing is stable. You start with where a person lives, where they put their head down, and where they eat, and you ask, “Is it safe? Is it making them sicker or can it make them healthier?” Housing can serve as a platform for services and health care to be more effective. Yes, John Smith could be living in housing and get services outside his building and do perfectly well. But we need to ask what kinds of services or resources could he be getting more conveniently that will lead to even better outcomes.
Do we know that answer? What will lead to better outcomes?
The whole thing starts with taking an inventory. What services have the best efficacy and can you deliver them in a housing setting, and of which can you say, “Here’s cab fare. Go over to the clinic.”? We have to start asking, “What health services are best provided within the four walls of the building and which should you deliver somewhere else? And who should pay for what?”
You’ve mentioned the financial incentive for the health care system to look at social determinants, but what’s the incentive for the housing sector?
There’s a lot of mission-driven affordable housing providers who want to provide health services to their tenants because they know it works, and it makes them better tenants. They may pay rent on time, [and] maybe they’re even healthy enough to get a job. But they have to go out and raise money to do it. The rents don’t cover it. If you can get the health care system to foot the bill, or a hospital system sends in their own visiting nurse, that lets the housing organization focus on raising money for housing-related things.
So right now, the housing industry is saying, “Look, what can the health care system pay for in our housing?” To me, that’s a short-sighted question. To me, we should be asking, “What can you pay for our residents?” And together we can say, “What’s best provided in the housing and best provided outside the housing?”
Are you hopeful that the two systems can come together to improve outcomes?
Yes. Health care has to evolve. Health care is the one thing we should agree as a country that has to be fixed to be more economical, more efficient, and more outcome based, and not just “I’m sick, I’m going to walk in here and you’re going to take care of me and get paid for taking care of me.”
Where will this all start to emerge? Is it a federal role to nudge this along?
We’re going to have our breakthroughs locally. You’ll have housing developers that begin to talk to local hospitals and clinics and say, “We need to work together.”
If the housing developer can say to the health care system, “Pay us a little from your funds and we can do medication follow-up or discharge follow-up,” [then] the hospitals will say, “OK, because we can’t keep releasing people and have them come back because we’re getting killed from our penalties.”
So ultimately, we’re back to the holy grail: money motivates?
I met this woman in the health care system and said to her, “You know that cartoon where the wolf is talking to the sheep very nicely but over his head is a picture of the sheep cooked on a plate? Is that how you feel when you go in to meet with housing people? Do you feel like a huge wallet?”
She nodded. “All they want is my money and to figure out how the health care system can pay for what they’re doing. They never talk about what I need.”
The two systems need a demilitarized zone where they can start to talk and not have each be thinking about what is best for only themselves. We need to be able to ask, “What’s best for John Smith?” That’s what we should be thinking about.
The Network has the possibility to become that neutral Switzerland, bringing together community development and the health care system and getting them to think of what’s best for our industries as a whole.
Homepage photo/ North Charleston