Tag: Homelessness

Trailblazing Affordable Care Initiative by UnitedHealth

Bloomberg Businessweek – America’s Largest Health Insurer Is Giving Apartments to Homeless People – John Tozzi 11/4/19

In 1986, Congress enacted a law to bar hospitals from turning away patients who are unable to pay. Any hospital with an emergency room that participates in federal health programs must evaluate and stabilize every patient who comes through the door, including those who are uninsured, indigent, addicted to drugs, or mentally ill.

No institution has a similar obligation to ensure that those people have a safe place to sleep. As a society, we’ve effectively decided that people shouldn’t die on the street, but it’s acceptable for them to live there. There are more than half a million homeless in the U.S., about a third of them unsheltered—that is, living on streets, under bridges, or in abandoned properties. When they need medical care or simply a bed and a meal, many go to the emergency room. That’s where America has drawn the line: We’ll pay for a hospital bed but not for a home, even when the home would be cheaper.

Jeffrey Brenner is trying to move that line. He’s a doctor who for more than 25 years has worked largely with the poor, many of them homeless. Recently, his place in the health-care system has shifted. After decades in shoestring clinics and nonprofits, he’s become an executive at UnitedHealth Group Inc., America’s largest health insurer. Brenner is expected to contribute to its bottom line. He plans to do it by giving people places to live.

The research and development lab for this experiment is a pair of apartment complexes in a down-at-the-heels corner of Phoenix called Maryvale. Here, Brenner is using UnitedHealth’s money to pay for housing and support services for roughly 60 formerly homeless recipients of Medicaid, the safety-net insurance program for low-income people. Most states outsource their Medicaid programs to private companies such as UnitedHealth, paying the insurer a per-head monthly fee—typically $500 to $1,000—to manage members’ care. The company’s 6 million Medicaid members produced $43 billion in 2018, almost 20% of total revenue.

It’s a profitable business overall. But the most expensive patients, who often present a complex blend of medical, mental health, and social challenges, cost UnitedHealth vastly more than it takes in to care for them… And despite their extreme costs, these patients often get poor care. “This is just sad. This is just stupid,” Brenner says. “Why do we let this go on?”

Sitting in a vacant studio apartment on the second floor of one of the complexes, Brenner shows me data on a patient named Steve, a 54-year-old with multiple sclerosis, cerebral palsy, heart disease, and diabetes. He was homeless before UnitedHealth got him into an apartment. In the 12 months prior to moving in, Steve went to the ER 81 times, spent 17 days hospitalized, and had medical costs, on average, of $12,945 per month. In the nine months since he got a roof over his head and health coaching from Brenner’s team, Steve’s average monthly medical expenses have dropped more than 80%, to $2,073.

After testing the idea in Phoenix, Milwaukee, and Las Vegas, UnitedHealth is expanding Brenner’s housing program, called MyConnections, to 30 markets by early 2020. It’s a business imperative.

The goal is for them to “graduate” within a year to paying their own rent. (Most get a disability check; those who don’t get help from MyConnections to apply.)

Brenner aims to reduce expenses not by denying care, but by spending more on social interventions, starting with housing. How to do it is still largely uncharted. “I don’t think we’ve figured any of this out,” he says. “We’re at a hopeful moment of recognizing how deep the problem is.” A trip to any big-city ER reveals the magnitude of the challenge.

One of Brenner’s greatest challenges is deciding who should benefit from the program. Giving patients housing sounds beguilingly simple, but the economics are a high-wire act. Medicaid isn’t paying UnitedHealth anything directly for housing assistance. The company spends from $1,200 to $1,800 a month to house and support each member, so it must save at least that much to break even on Brenner’s program.

On average about 60 members are enrolled in the Phoenix sites at any given time. Once a week, Brenner and his team get on the phone to evaluate potential candidates—anywhere from 2 to 14 people whose names have surfaced in UnitedHealth’s data. They want patients who are homeless and whose medical spending exceeds $50,000 annually, with most of that coming from ER visits and inpatient stays. People living on the streets with less extreme medical costs may need a home just as much, but it doesn’t pay for UnitedHealth to give them one.

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February 2, 2018

Perspective

statista – The U.S. Cities With The Most Homeless People – Niall McCarthy 1/26

Worthy Insights / Opinion Pieces / Advice

FT – Short sellers eye better days after Steinhoff and Carillion wins – Miles Johnson and Robert Smith 1/31

  • “A rising tide, as the saying goes, lifts all boats. This effect, which has been played out across financial markets for several years, has inflicted pain and frustration on specialist short sellers of stocks and bonds who try and profit by betting against companies they believe harbor accounting irregularities.”
  • “But after years of frustration, some of the funds who have been doggedly shorting certain companies have been rewarded. Hedge funds that made bearish bets against the South African retailer Steinhoff International and the UK construction group Carillion saw these trades dramatically pay off as both companies collapsed under the weight of their debts.”
  • “’In the past few months there have been a number of accounting-related shorts, such as Steinhoff International and Carillion, that have been big money makers,’ says Alper Ince, an investor in hedge funds at Paamco. ‘I think there is an expectation among short sellers that we may see more of these after years of companies making big acquisitions and taking on more leverage’.”
  • “’There had been chatter about Steinhoff’s accounting for years, but being short investment grade companies has been an absolute death trade,’ says a London based credit trader. ‘It’s a bit like the old mantra ‘don’t fight the Fed’ — you can’t short investment grade bonds when you know the ECB is buying them on the other side’.”
  • “The ECB was one of the largest holders of Steinhoff’s outstanding €800m bond, owning around €100m of the debt before it sold its position entirely at a deep loss earlier this month.”

NYT – Worries Grow That the Price of Bitcoin Is Being Propped Up – Nathaniel Popper 1/31

  • “A growing number of virtual currency investors are worried that the prices of Bitcoin and other digital tokens have been artificially propped up by a widely used exchange called Bitfinex, which has a checkered history of hacks and opaque business practices.”

Markets / Economy

WSJ – Daily Shot: German 5yr Bond Yield 1/31

Energy

WSJ – Daily Shot: US Crude Oil Production 1/26

FT – Shale powers US oil output to heights of 1970 – Ed Crooks 1/31

Cryptocurrency

Bloomberg Quint – India to Curb Cryptocurrency Use While Embracing Blockchain – Anto Antony 2/1

  • “India’s government said it doesn’t consider cryptocurrencies as legal tender and will take all measures to eliminate payments using them.”

How much.net – Visualizing The Meteoric Rise of Cryptocurrency in the Past 5 Years – Raul 1/30

Reuters – South Korea says no plans to ban cryptocurrency exchanges, uncovers $600 million (in) illegal trades – Dahee Kim, Cynthia Kim 1/30

Social Media

NYT – Twitter Followers Vanish Amid Inquiries Into Fake Accounts – Nicholas Confessore, Gabriel Dance, and Rich Harris 1/31

China

FT – Distressed debt investors line up to offer HNA financing – Henny Sender and Don Weinland 1/31

  • “Chinese conglomerate seeks up to $2bn secured against Hong Kong land holdings.”

Other Interesting Links

NYT – San Francisco Will Clear Thousands of Marijuana Convictions – Timothy Williams and Thomas Fuller 1/31

  • “Thousands of people with misdemeanor convictions for marijuana possession dating back 40 years will have their criminal records cleared, the San Francisco district attorney’s office said Wednesday. San Diego is also forgiving old convictions.”