Health Care Utilization Patterns of Homeless Individuals in Boston: Preparing for Medicaid Expansion Under the Affordable Care Act

Abstract

Objectives. We studied 6494 Boston Health Care for the Homeless Program (BHCHP) patients to understand the disease burden and health care utilization patterns for a group of insured homeless individuals. Methods. We studied merged BHCHP data and MassHealth eligibility, claims, and encounter data from 2010. MassHealth claims and encounter data provided a comprehensive history of health care utilization and expenditures, as well as associated diagnoses, in both general medical and behavioral health services sectors and across a broad range of health care settings. Results. The burden of disease was high, with the majority of patients experiencing mental illness, substance use disorders, and a number of medical diseases. Hospitalization and emergency room use were frequent and total expenditures were 3.8 times the rate of an average Medicaid recipient. Conclusions. The Affordable Care Act provides a framework for reforming the health care system to improve the coordination of care and outcomes for vulnerable populations. However, improved health care coverage alone may not be enough. Health care must be integrated with other resources to address the complex challenges presented by inadequate housing, hunger, and unsafe environments.

The Role of Charity Care and Primary Care Physician Assignment on ED Use in Homeless Patients

“…Meanwhile, multiple charity programs providing PCP clinic access and charity insurance coverage to homeless patients have been examined as mediating factors in minimizing inappropriate ED use [12][13][14][15][16][17]. Providing charity insurance coverage to the homeless is one supporting program that simply furnishes health care insurance coverage to this population with very low or no cost paid by the patients.…”

“…Some studies reported that providing charity insurance can decrease inappropriate ED use. Lack of health insurance that usually refers to selfpaid homeless patients was strongly associated with inappropriate ED use in several studies, whereas other studies showed little or no association [3,[12][13][14]. Similarly, providing PCP clinics to homeless patients has also been studied.…”

Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis

“…Multiple studies have examined the population that will be newly eligible for Medicaid to assess their potential health care utilization. [34][35][36] One study characterized the utilization patterns of a homeless population in Boston and found that the majority of these patients had mental illness, substance use disorders, and multiple comorbid conditions, such as diabetes. 34 These homeless Note: The sum of the point estimates for all categories of cost is not equal to the point estimate for all costs because of the logtransformation used in the analysis.…”

Voices of Homeless Alcoholics Who Frequent Bellevue Hospital: A Qualitative Study

“…1,2 Chronically alcohol-dependent, homeless individuals are fixtures in many emergency departments (EDs) and disproportionately affect health care infrastructure and the increasing costs of public health. [3][4][5][6][7][8][9][10][11][12] Despite their repeated ED and detoxification unit admissions, this group experiences poor health and appears incapable of escaping social circumstances that perpetuate and exacerbate their problems.…”