Community Data Informs Payer Philanthropy for Housing Stability

Poor or unstable housing contributes to a myriad of negative health outcomes. Developmental risks in young children, asthma exacerbations, and increased rates of depression are just a few of the impacts housing insecurity can have on an individual.

Unstable housing, in its worst form, can lead to homelessness, which is inherently tied to worse health outcomes. But overcrowding, moving frequently, poor housing conditions, and difficulty paying rent can also lead to poor health.

As social determinants of health are becoming more prominently addressed by the healthcare industry, housing is quickly becoming a top priority for many insurers and providers.

A full understanding of the impacts of social determinants of health is limited, though, because of inconsistent data from a variety of sources. So, those trying to find solutions must make decisions based on lagged data that does not give them a full understanding of the extent of the problem.

To tackle this problem and identify the highest areas of need in the state, Blue Cross Blue Shield Rhode Island (BCBSRI) created the Rhode Island Life Index.

“We wanted to understand what Rhode Island residents thought about their ability to be well and what they think about the community overall,” said Carolyn Belisle, managing director of community investment at BCBSRI.

The Life Index surveyed over 2,200 Rhode Islanders across the state, asking them about their perceptions of the social determinants of health and well-being in their communities.

The results revealed housing as the biggest concern for community members across the state, receiving a percent of possible score of only 48. In other words, respondents believed the areas they lived in were less than halfway to achieving the ideal, healthy community.  

The results varied slightly, but not greatly, between Rhode Island’s core and non-core cities. Core cities are those where 25 percent or more of children are living below the federal poverty level and tend to be more urbanized.

“What surprised me was that even in the non-core areas, the communities that aren’t as significantly struggling with poverty, housing was still a really big issue,” Belisle emphasized.

Results indicated that both urban and non-urban areas of the state are struggling to maintain adequate, healthy housing.

“Housing very loudly was showing up as the issue,” Belisle furthered. “There seemed to be a universal acknowledgment that housing is such a critical issue. It is affecting Rhode Islanders and their perceptions about how easy or not it is to be healthy in the state.”

After identifying the problem, BCBSRI showed its commitment to finding a solution through five year-end grants totaling $200,000. These grants will be used to tackle housing instability from a variety of angles, ranging from housing policy to providing housing to homeless individuals.  

Grantees include Housing Network of Rhode Island, Crossroads Rhode Island, HousingWorks RI, The Village Common, and Family Service of Rhode Island. But Belisle highlighted three organizations that articulated the layered approach BCBSRI is taking to address the housing problem.

HousingWorks Rhode Island conducts research and analysis to inform public policy around affordable and healthy housing.

“We were excited to be able to help them stand up some of that work that they really want to get done around home modification programs, doing a community assessment of home modification, and helping caregivers understand what resources are available to them for helping their older adults in their life age in community in the way they want to,” Belisle explained.

Similarly, another grantee, Housing Network of Rhode Island, is focusing on education around housing policy.

“They are an entity that sits atop the community development corporations and the affordable housing developers,” Belisle explained. “In partnership with United Way and several other organizations, they have established a campaign, Homes RI. The campaign is intended to get Rhode Islanders to understand that housing is an everybody issue.”

Through education and advocacy, the campaign aims to shine a spotlight on affordable housing. Generating a rallying cry will help promote a statewide policy change, Belisle furthered.

At the other end of the spectrum, Crossroads Rhode Island is tackling the immediate need for individuals experiencing homelessness to find stable housing. The organization subscribes to the housing first model which emphasizes providing individuals who are homeless with housing first. When housing is no longer a challenge, these individuals can focus on pursuing personal goals and improve their quality of life.

“Crossroads is increasingly challenged with a segment of their population who aren’t currently eligible for Medicare, but they want to be able to connect them to and help them navigate their really complex healthcare needs,” Belisle said. “Our funding is going to allow Crossroads to secure a health navigator staffing position, who can do intensive case management and social support with that segment of their population.”

These year-end gifts were only the beginning of BCBSRI’s social determinants of health work as results from the RI Life Index will continue to inform their future investment and philanthropic strategy.

Each year BCBSRI awards Blue Angle Community Health Grants to community organizations focused on improving the health and well-being of Rhode Islanders. The 2020 grants will focus on organizations supporting access to safe and affordable housing, as a result of the RI Life Index.

“This is a cornerstone philanthropic endeavor that we’ve had here at Blue Cross for many years, almost two decades now,” Belisle explained. “We knew we wanted to align whatever the report results told us with that vehicle of the Blue Angel Community Health Grant Program.”

Ideally, future iterations of the survey will continue to inform philanthropic initiatives and raising awareness of the challenges across the state, Belisle noted. The process for the second version of the survey is already underway.

“We are actively engaged in conversations around the next installment of the RI Life Index,” Belisle revealed. “This year we over-sampled the older adult population. We are thinking about oversampling by race and ethnicity for this next round.”

The inaugural Life Index will serve as a baseline, so future work can measure progress over time.

“We recognize that a lot of these social determinants of health are deeply rooted. We certainly are not going to have a tremendous movement in an annual fashion,” she concluded. “But we do know that by repeating something year over year, it keeps it in the conversation. It is yet another tool to move the needle on some of these issues because there will be a continuous light that we shine on the various domains and elements.”