Patient-Aligned Care Teams Tailored to the Homeless Can Reduce Acute Care Services and Healthcare Costs

April 3, 2020

Takeaway: This study highlights opportunities to be proactive in considering how high-need/high-cost vulnerable populations, such as homeless persons, can be cared for in a cost-effective manner. 

Healthcare for socially disadvantaged, high-risk, or high-need patients, such as homeless persons, is often defined by high rates of acute care service use and poor clinical outcomes. This multicenter trial compared healthcare service use and cost outcomes among homeless Veterans enrolled in a traditional (not tailored to a homeless population) PACT (n=83) with outcomes among Veterans enrolled in a homeless population–tailored H-PACT (n=183). [VA’s Patient-aligned Care Team (PACT).] Veterans in this study included those who were living outdoors, and those staying in an emergency shelter or transitional housing. Investigators examined health services use, cost, and patient satisfaction from June 2012 to January 2014. Findings show:

• Annual costs per patient were significantly higher in the PACT group than the H-PACT group ($37,415 vs $28,036), and most cost savings came from fewer VA and non-VA hospitalizations.
• A significantly greater percentage of Veterans in the PACT arm compared to H-PACT were hospitalized for any cause (35% vs 23%), had a mental health–related ED visit (48% vs 34%), or attended group therapy (54% vs 40%).

The Homeless PACT program is now operational in 54 VA medical centers, Community-Based Outpatient Clinics, and Community Resource and Referral Centers across the country. In Fiscal Year 2019, more than 17,600 homeless and at-risk Veterans were enrolled in the 80 H-PACT teams across the country, and approximately 22,000 are served annually.

O’Toole T, Johnson E, Borgia M, et al. Population-tailored Care for Homeless Veterans and Acute Care Use, Cost, and Satisfaction: A Prospective Quasi-experimental Trial. Preventing Chronic Disease. February 15, 2018;15:E23.