Reducing Costs and Improving Health of Elderly Homeless Women Through a Medical Home Without Walls

Ballooning health care costs are taking their toll on US financial health.  Certain situations (care for the elderly and end-of-life care, over-reliance on ERs, bounce-backs after inpatient stays) and the many challenges of access to care for vulnerable populations contribute to these costs. Persons who are homeless can utilize resources 4 times as much as housed individuals because of multiple co-morbid socio-economic factors and medical conditions.  Women of Means is a non-profit organization in Boston comprised of volunteer physicians and a paid nursing staff  that has delivered free walk-in acute, episodic  and de facto primary care to Boston’s homeless women since 1999.  In 2010, we developed targeted services to homeless women over age 55 showing that intensive care and case management can improve health metrics and reduce inappropriate resource utilization.  In 2013, we launched the nation’s first Medical Home Without Walls, an ACO-contracted comprehensive “medical home” within the homeless community that delivers primary care, outreach, care coordination and “gap” services to 50 homeless and marginally housed women over 65 who rely on shelters to meet basic survival needs. Results from the first year show significant reductions in ER and inpatient stays, improvements in housing, safety, health literacy and “milestone events.”  This project is providing data on the cost of care for elderly homeless women and how those costs can be reduced. The model’s components can be applied to other vulnerable populations.