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Housing as a Form of Health Care: Part 1

Just in Reach and Pay for Success

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I think it’s almost impossible to improve health outcomes when people are living in the street. … We can’t improve health outcomes until we stabilize people in housing.” Judge Peter Espinoza – LA County Office of Diversion and Reentry

A Recidivism Crisis

Imagine being released from jail--and not having any home to go to.

In Los Angeles County, there are nearly 60,000 people experiencing homelessness on any given night. The Prison Policy Initiative reported that nationally “among formerly incarcerated people, the rate of homelessness…was 10 times that of the general public.” Untreated serious mental illnesses (SMI) and substance abuse issues are rampant. With these types of barriers to reintegration, recidivism has become a massive problem. And overwhelmed county jails are tasked to be de facto care facilities for the many inmates struggling with SMI and substance use disorders who cycle in and out of jail.

Infographic: Statistics on inmates with a serious mental illness


How do you improve health outcomes when the people you’re trying to reach don’t have a roof over their heads?

Just in Reach

Just in Reach is a program designed to break this cycle of chronic recidivism. It’s an innovative collaboration between the Los Angeles County Office of Diversion and Reentry and the Los Angeles County Department of Health Services, with significant financial support by UnitedHealthcare (UHC), the Conrad N. Hilton Foundation, the U.S. Department of Housing and Urban Development, and the California Board of State and Community Corrections.

Over four years, the Just in Reach program will provide permanent supportive housing solutions to 300 homeless individuals who are currently in the custody of the Los Angeles County jail. The participants for the program are chosen before release from jail, which allows for continuity of care.

Permanent, stable housing right after release from jail can have a transformative effect—not only with recidivism, but with health care outcomes. As Andrea Illoulian of the Hilton Foundation notes: “The innovation of permanent supportive housing has been really revolutionary. There are a lot of social issues. Not all of them have clear solutions. But this one does.”

What Is Pay for Success?

A funding approach called Pay for Success, sometimes structured and referred to as a Social Impact Bond, has allowed the scope of this project to be greatly increased.

For the Just in Reach project, UnitedHealthcare and the Conrad N. Hilton Foundation both provided an initial investment. The key is that success measures are based not on the number of people who have received services, but rather clear outcomes achieved. In the case of Just in Reach, these outcomes are: (1) housing retention and (2) number of rearrests. If the goals are met, the initial investment is repaid with a small amount of interest.

The big advantage of the Pay for Success approach is the ability to scale up a program with initial capital from private or philanthropic partners, which allows for a greater reach with proven interventions (such as housing for people who are homeless) to more people.

A Call for Action

Just in Reach is a long-term, multi-year commitment for all partners, including UHC—as well as the individuals leaving jail who desire something better for themselves. The willingness to “pay for success” with Just in Reach can be a rallying cry for other organizations to tackle social determinants of health with programs that are empathic, nimble, and outcome-based.

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Click here for another installment of “Housing as Health Care,” this time in Las Vegas with drastic reductions in ER visits and health care costs.

Read more about UHC’s involvement in the Just in Reach program here.

Other resources on Pay for Success and Just in Reach:

Nonprofit Finance Fund

Urban Institute