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Helping Make Connections to Improve Lives and Save Healthcare Costs in Hawaii

Struggling with homelessness and a litany of health conditions, Karen* found herself in the emergency room 60 times in seven months — feeling it was the only option to get the help she needed. Then, 11 months ago, she was connected to support services following a hospital visit, which gave her access to assistance to help her get her life back on track. Karen now has a roof over her head and a care team that has helped her cut her emergency room visits to just seven times, improving both her quality of life and her health. 


Karen is living proof that most of what affects our health is not solely determined by health care. Health is impacted by social factors including where we live, our ability to access healthy food, our mental and behavioral state and our relationships.

Historically, health care has focused on managing medical costs in the doctor’s office, the emergency room and the hospital room. Sadly, that’s often too late. In 2018, health care costs in the United States skyrocketed to $3.65 trillion. These growing costs impact everyone - from the providers of services to higher deductibles for patients to increased premiums for families across the financial spectrum. In the case of Karen, her lack of access to housing and basic necessities contributed to many of her medical issues – which resulted in more than $175,000 in expenses. But once she was connected with the support services and resources she needed, many of Karen’s medical issues were addressed — resulting in fewer visits to the emergency room and a cost savings of nearly $153,000.

UnitedHealthcare is working to redefine what access to care looks like by addressing the underlying causes that create the need for medical care in the first place – issues like homelessness, unemployment and lack of transportation. It is proactively approaching people like Karen in the emergency room and doctors’ offices.  Along with taking their blood pressure, UnitedHealthcare assesses patients’ social needs and connects them to services outside the health care system.

UnitedHealthcare received a five-year, $4.5 million Accountable Health Communities (AHC) grant from the Centers for Medicare and Medicaid Services to help further this work.  Patients with Medicare or Medicaid who see a doctor at The Queen’s Medical Centers, Waianae Coast Comprehensive Health Center, or Kalihi-Palama Health Center are given a survey seeking information regarding housing, food and transportation needs. The survey also assesses whether patients can pay utility bills, which provide heat, clean water and electricity, or if they are in unsafe relationships. When someone reports any of these needs, UnitedHealthcare connects them to community agencies that can possibly help.

This is changing what health care looks like in an important way. A doctor’s office or emergency room is a safe space for these questions – and these connections to services are becoming part of an individual’s treatment plan. So a patient may get a prescription for medicine, as well as a referral to a program that can help with a water shut-off notice.

The program is already having an impact:

  • A man experiencing homelessness with significant health issues was recently connected with support services.  He moved into his own apartment and is now scheduled for the surgery he needed.
  • A woman who received an eviction notice because she couldn’t pay her electricity bill was connected with a program that helped get her back on track and stay in her home.
  • A teenager living on the streets was connected with a shelter and is starting his life again.

These stories demonstrate the real impact of understanding an individual’s social needs and making connections to improve health outcomes.

Of the 12,000 Oahu residents surveyed so far, preliminary results show one in five reports at least one of these non-health needs in addition to the illness or injury that brought them to the doctor in the first place.

By connecting individuals to the support they need, UnitedHealthcare may help save costs in the health care system; and most importantly improve and save lives.

* Not her real name