![Page 1: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/1.jpg)
Homeless Veterans Patient Aligned Care Team (H-PACT)
December 2012
Office of Homeless ProgramsOffice of Primary Care Operations
![Page 2: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/2.jpg)
VETERANS HEALTH ADMINISTRATION2
Background
• Homeless Veterans have more chronic medical, mental health and substance abuse needs that are more difficult to treat in traditional care models and to coordinate within fragmented delivery systems.
• Transportation and scheduling challenges, competing priorities, and services not aligned with their needs keep many homeless Veterans from accessing primary care and receiving services necessary to exit homelessness.
• Homeless Veterans end up relying on emergency departments for care and are hospitalized at much higher rates than their housed counterparts.
• Homeless Veterans are three to six times more likely to become ill than housed people and cost three times more to care for than non-homeless Veterans.
![Page 3: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/3.jpg)
VETERANS HEALTH ADMINISTRATION3
Background
• Integrated Primary Care-Homeless Services care models tailored to the needs and specific challenges of homeless Veterans have been able to:
– Reduce emergency department use by up to 40%– Reduce hospitalizations by 30-50%– Improve chronic disease management outcomes– Expedite housing placement and retention
![Page 4: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/4.jpg)
VETERANS HEALTH ADMINISTRATION4
The Need for a Paradigm Shift
How do we take advantage of health care seeking behavior and the “treatable moment” embedded in a health care episode?
How can the resources and “safe haven” of the health care setting be used to break the cycle of homelessness and poor health?
![Page 5: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/5.jpg)
VETERANS HEALTH ADMINISTRATION5
Homeless Patient Aligned Care Team
• Program goal is creating a collaborative Homeless Programs-Primary Care model that eliminates barriers to quality health care and improves health and housing outcomes of Veterans that are homeless or at imminent risk of homelessness.
• Not intended to replace care being provided or alter ongoing care relationships for those homeless Veterans engaged in treatment models (e.g. Severe Mental Illness (SMI), HIV care).
![Page 6: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/6.jpg)
VETERANS HEALTH ADMINISTRATION6
H-PACT Model
• Three different homeless-oriented primary care PACT models will be supported by this initiative for local station implementation. Model adoption will be based on site-specific need, capacity, geography and targeted focus:
– Co-located, integrated Homeless PACT.
– PACT team enhanced with homeless case management.
– Community Resource and Referral Center (CRRC)-based Homeless outreach/PACT.
![Page 7: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/7.jpg)
Health and Homelessness
Housing Security for Homeless Persons
Health Care sites as “First Stops” for newly homeless
The health encounter as a “treatable moment”
for behavior change and treatment engagement
Health maintenance and support as a means of keeping people in housing
![Page 8: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/8.jpg)
VETERANS HEALTH ADMINISTRATION8
H-PACT Program
• H-PACT’s must be able to:
– Provide Accessible, Just-in-Time Continuity Care to homeless Veteranswhen and where they need it.
– Respond to the “Treatable Moment” with staff trained and prepared to engage patients in behavior change, and with resources in place to act on patient motivation.
– Create a care setting that promotes trust and relationship building necessary for longitudinal primary care and care coordination.
– Address competing social and sustenance needs of the Veteran trying to access health services.
– Employ a Rapid Engagement/Housing-First approach.
![Page 9: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/9.jpg)
VETERANS HEALTH ADMINISTRATION9
H-PACT Goals
• Deliverables:– Systems redesign – Population-Centered Homeless PACTs:
– Rapid Access – Reduce barriers and obstacles to receiving care; bring homeless into care earlier in their homelessness.
– Sustained Engagement – Provide ongoing, longitudinal care that responds to changing needs, interests and readiness of the Veteran.
– Improved Clinical Outcomes for multi-morbid homeless Veterans– Improved Quality of Life – Provide comprehensive chronic disease and
preventive care to a traditionally disenfranchised group – Greater Efficiencies in our care delivery system
– Care Offsets – Reduce emergency department and hospital use; increase primary care, outpatient mental health, and substance abuse treatment.
– Ending Veteran homelessness– Housing placement/stabilization – Integrate clinical care with housing
objectives; partner with housing staff and community agencies.
![Page 10: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/10.jpg)
H-PACT Model for Treatment Engagement of Homeless Veteran
Disengaged/Disenfranchised from Care Treatment Engagement StabilizationUnstable sheltering Housing First Chronic disease managementSignificant barriers to treatmentengagement Facilitated access/population tailored care Prevent recidivismHealth Care low amongMaslow Hierarchy of needs Care management of conditions Early identification new needsHigh rates of ED and inpatient care Leading to homelessnessPremature morbidity/mortality Perpetuating homelessness
Delayed and deferred because of homelessness
Address competing needs
Identification and Referral
Emergency Departments
Inpatient Wards
Community outreach/ Agency referrals
Homeless PACT
Enhanced, open access
Intensive case management
Care tailored to population needs/de-stigmatizing care One-stop care – On-site addressing of competing sustenance needs
Homeless situation stabilized; transferred to general population PACT team w/ specialty care access
Homeless situation not stabilized: Patient stays in Homeless PACT due to ongoing homelessness, imminent risk of return to homelessness
Homeless situation stabilized; transferred to Special Population PACT based on patient need: SMI PACT Women’s Health PACT HIV PACT
Intervention Disposition
![Page 11: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/11.jpg)
VETERANS HEALTH ADMINISTRATION11
H-PACT Program
• Implementation Update
– 37 sites funded to develop H-PACTs
– 19 VISNs, 24 states, 20 in high impact/high volume
cities, 7 in rural communities
– Active engagement from Primary Care, Homeless and
Mental Health programs
![Page 12: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/12.jpg)
VETERANS HEALTH ADMINISTRATION12
Data Snapshot
• 30 H-PACT sites are actively seeing homeless Veterans.
• Over 4000 patients enrolled to date. Anticipated approximately 10,000 will be enrolled by end of FY 2013.
• H-PACT enrollment increasing by approximately 400 Veterans per month.
• Most Veterans will stay in the H-PACT 12 to 18 months, depending on individual circumstances, preferences.
April 22, 2023
![Page 13: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/13.jpg)
13
VISN Station VISN Station VISN Station VISN Station 1 Providence VAMC 4 Philadelphia VAMC
10 Chalmers P. Wylie
VAMC (Columbus)20 VA Puget Sound HCS
(Seattle)
1 VA Connecticut Healthcare System
(West Haven)
4 VA Pittsburgh HCS 11 Battle Creek VAMC
20 Portland VAMC
1 VA Maine HCS (Togus)
5 VA Maryland HCS (Baltimore)
11 John D. Dingell VAMC (Detroit)
21 VA Northern California HCS
1 VA Boston HCS (Causeway Street
CBOC)
5 Washington DC VAMC
12 Jesse Brown VAMC (Chicago)
21 VA Pacific Islands HCS (Honolulu)
1 Leeds VA Primary Care Center (New Bedford)
6 Hampton VAMC 16 Micheal E. DeBakey VAMC
(Houston)
21 San Francisco VAMC
2 Canandiagua VAMC 7 Ralph H. Johnson VAMC (Charleston)
16 Southeast Louisiana
Veterans HCS (New Orleans)
22 VA San Diego HCS
3 Northport VAMC 7 Birmingham VAMC
17 South Texas Veterans HCS
(San Antonio)
22 VA Greater Los Angeles HCS
3 James J. Peters VAMC (Bronx)
8 James A. Haley VAMC (Tampa)
18 Phoenix VA HCS 22 VA Southern Nevada HCS
3 VA Hudson Valley HCS (Montrose)
9 Lexington VAMC 19 VA Eastern Colorado HCS
(Denver)
23 Minneapolis VA HCS
23 Iowa City VA HCS
![Page 14: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/14.jpg)
VETERANS HEALTH ADMINISTRATION14
Anticipated outcomes
– Reduced emergency department visits, hospital admissions
– Increased ambulatory care use (primary care, specialty, mental health, addictions)
– Expedited housing/reduced recidivism– Improved chronic disease monitoring/management– Enhanced care, cost-efficiencies
April 22, 2023
![Page 15: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/15.jpg)
VETERANS HEALTH ADMINISTRATION15
H-PACT and Community Partners
• Referral source
• Development of partnerships
• Collaborative effort to serve homeless Veterans
15
![Page 16: Homeless Veterans Patient Aligned Care Team (H-PACT)](https://reader035.vdocuments.site/reader035/viewer/2022062810/56815c38550346895dca2a3b/html5/thumbnails/16.jpg)
VETERANS HEALTH ADMINISTRATION16
Questions?
For more information please contact:
Rico Aiello, H-PACT Project [email protected]
16