Heat maps
reveal where asthma issues, poor housing quality, and Medicaid enrollment
overlap to inform social determinants of health hot spots.
By Sara Heath
October 24, 2019
- Hot spot maps from the United Hospital Fund (UFH)
could help identify key areas in New York City where Medicaid intervention and
social determinants of health programming could help improve the health of
individuals.
The maps specifically
look at areas of poor housing quality, high incidence of pediatric asthma, and
Medicaid enrollment. When laid on top of one another, these maps could identify
areas where Medicaid can introduce housing interventions to improve the
health of NYC residents.
The maps show that
certain neighborhoods, including Hunts Point and Longwood in the Bronx, and
East Harlem South in Manhattan, have high rates of childhood asthma. These regions
also have high Medicaid enrollment and poor housing quality. Specifically,
these areas have high rates of housing defects and cockroach exposure.
The Lower East Side
of Manhattan and Rockaways in Queens also have high incidences of poor housing
quality and asthma-related pediatric health episodes, the maps showed.
At the same time,
these neighborhoods see high rates of asthma-related pediatric health episodes
– not only do many of the children living in these neighborhoods have an asthma
diagnosis, but they experience adverse health impacts that can result in costly
hospital visits.
These health issues
are likely tied to poor housing quality, according to Misha Sharp, the UHF
senior research analyst who co-authored the report.
“It has been
well-demonstrated that the lack of stable housing can have a powerful impact on
health, but the quality of housing also has considerable health effects,” Sharp
said in a statement. “Medicaid interventions
directed at improving housing could be well worth it, by reducing costly
emergency room visits and hospitalizations for children with asthma.”
State and City
officials are putting some programs to work to address the social determinants
of health, the report added. Through New York Medicaid’s reform
initiative, the Delivery System Reform Incentive Payment (DSRIP) program, the
Bronx Partners for Healthy Communities (BPHC) Performing Provider System
collaborated with the Northwest Bronx Community and Clergy Coalition to host
patient education sessions led by peer community health leaders.
Peer support leaders
visited buildings with a high population of children with asthma and high
asthma-related health services use, the report authors reviewed. Patient
education efforts centered on facility improvements that can address health
issues as well as in-home services patients suffering from severe asthma
symptoms may access.
The report also
outlined the Healthy Homes value-based payment (VBP) pilot, a program from the
state’s Department of Health and its Energy and Research Development Authority.
Through the pilot, state workers and Medicaid managed care plans and providers
will work together to identify asthmatic children living with housing with poor
quality to housing intervention programs.
The programs will
review asthma care management, strategies for reducing asthma attack triggers,
and home environmental triggers and tools for improving them.
This pilot program
aims to serve as a paradigm for integrating the social determinants of health
into payment models.
Of course, making
these statewide reforms for addressing asthma care costs, housing quality, and
other social determinants of health will not be
easy, the report authors pointed out. Legal and policy limits, lacking
financing plans, and logistical and operational issues might plague efforts to
integrate housing quality and stability into healthcare benefits.
But these latest
efforts are working to iron out some of those problem areas, according to
Nathan Myers, the director of UHF’s Medicaid Institute and another report
co-author. New programs from New York Medicaid could serve as an example for
how to integrate social determinants of health benefits into payer plans.
“Nevertheless, New
York Medicaid’s ongoing reforms may provide new opportunities to address the
housing issues that contribute to childhood asthma,” Myers said in a statement.
“Such efforts could help Medicaid advance its goal of reducing avoidable
hospitalizations while improving housing, and health, for children in New York
City and across the state.”
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