UHHP Strategic Plan

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UNITED HOMELESS HEALTHCARE PROVIDERS

STRATEGIC PLAN
2007 – 2009

INTRODUCTION
United Homeless Healthcare Partners (UHHP) is a collaborative of organizations dedicated to addressing the critical issues surrounding the provision of healthcare services to the homeless residents of Los Angeles County.  The County Departments of Health Services and Public Health established UHHP in November 2005 to address policy issues and planning for service improvements.

The goals of UHHP are to:

• Advocate for policies that support both the homeless healthcare providers’ ability to provide services and the homeless individuals’ ability to receive these services;
• Support and expand countywide efforts to provide comprehensive and integrated healthcare for homeless individuals and families; and
• Serve as a strong and unified voice within Los Angeles County to expand the dollars solicited and spent for homeless healthcare in this region.

BACKGROUND
A broad understanding of the health profile of the homeless population in Los Angeles County is important to realize the impact that current healthcare policies have on the homeless residents of Los Angeles County and those that serve them.   While many of these policies may be designed to improve efficiency and effectiveness in serving the general population, they have negative consequences for the homeless and providers of homeless healthcare services

According to the Los Angeles Homeless Services Authority 2005 Greater Los Angeles Homeless Count, there are approximately 82,000 homeless individuals every night in Los Angeles County.1  During any given year, more than 250,000 individuals are homeless in this region.  The following chart shows the distribution of this population within the county’s Service Planning Areas (SPAs)2 and underscores the fact that geography is another element that must be considered in addressing homeless healthcare.

2 Los Angeles County is divided into eight Service Planning Areas (SPAs) for the purpose of delivering healthcare and healthcare planning.  The Los Angeles County Children's Planning Council designed the SPAs, and the Los Angeles County Board of Supervisors approved the regional map in November 1993, creating the eight SPAs. 

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Table 1
Distribution of Homeless within County of Los Angeles Service Planning Areas

Source: Los Angeles Homeless Services Authority, 2005 Greater Los Angeles Homeless Count.  (January 12, 2006).

A sampling of participants in the homeless count reported on various aspects of their lives and health.  They indicated:

1. 35% use drugs
2. 40% use alcohol
3. 25% use both drugs and alcohol
4. 34% report mental illness
5. 16 % have a dual diagnosis
6. 35% are physically disabled 
7. 34% report domestic violence3

In response to a question about how many disabilities they lived with, the participants reported:

1. 20% reported one disability 
2. 25% reported two disabilities 
3. 20% reported three disabilities
4. 35% reported four or more disabilities4

When asked the source of medical attention they received in the past year, they indicated:

1. 32% stated that primary healthcare is hospital ER -
1. 54% had been to the ER at least once in the previous 12 months
2. 22% receive healthcare at free or community clinic
3. 18% receive care at a public health clinic 
4. 25% report being unable to receive needed medical attention5  

Given this profile, it is apparent that a significant portion of the homeless population presents very complex medical and psychosocial issues.  In the U.S. today, it is a challenge to provide any kind of healthcare services.  These challenges are intensely magnified when serving the homeless with their multiple medical issues, lack of “medical homes,” and absence of a fixed address to contact them for follow-up services.
These factors are compounded by public policies that negatively impact both the homeless healthcare providers’ ability to provide services and the homeless individuals’ ability to receive these services.  Further, the large geographic area and diversity of Los Angeles County have made it difficult for homeless healthcare providers to address the issues that have limited their ability to provide comprehensive and integrated healthcare for homeless individuals and families.

4 Ibid.

5 Ibid.

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UHHP Vision

The vision of United Homeless Healthcare Partners is to solve the homeless healthcare crisis in Los Angeles County by:

1. Supporting the providers of healthcare services throughout the region in building stronger networks, leveraging resources, and ensuring that healthcare services are accessible to the homeless residents of Los Angeles County.
2. Advocating for policies that support both the homeless healthcare providers’ ability to provide services and the homeless individuals’ ability to receive these services. 

UHHP Mission

The mission of United Homeless Healthcare Partners is to serve as a strong and unified voice for Los Angeles to:

1. Expand the dollars solicited and spent for homeless healthcare in Los Angeles County.
2. Advocate for policies at all levels of government that support improved health outcomes in the Los Angeles homeless population.
3. Support and expand countywide efforts to provide comprehensive and integrated healthcare for homeless residents.

STRATEGIC OBJECTIVES

To make a major impact on the homeless healthcare crisis in Los Angeles County, UHHP will focus on three specific areas:

1. Advocating for policies that support both the homeless healthcare providers’ ability to provide services and the homeless individuals’ ability to receive these services, and
2. Supporting the providers of healthcare services throughout the region to build stronger networks, leverage resources, and ensure that healthcare services are accessible to homeless residents of Los Angeles County.
3. Developing UHHP as a sustainable and financially stable organization to promote and continue these efforts.

The related strategic objectives for 2007 – 2009 are:

1. By the end of 2009, establish and implement a robust homeless healthcare policy development, advocacy, and research program for United Homeless Healthcare Partners.
2. By the end of 2009, dramatically improve delivery of health services to homeless individuals so that 25%6 of the homeless residents of Los Angeles County have a medical home providing quality service.7
3. By the end of 2007, ensure that United Homeless Healthcare Partners is an on-going, financially stable organization.

6 Measurement methods to be determined.  A “medical home” is defined as a primary care facility that the patient identifies as the place where he/she receives care.

7 As defined by the Skid Row Homeless Healthcare Initiative.

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ACTION PLAN – POLICY DEVELOPMENT, ADVOCACY, & RESEARCH

STRATEGIC OBJECTIVE: By the end of 2009, establish and implement a robust homeless healthcare policy development, advocacy, and research program for United Homeless Healthcare Partners.

Making policy changes is critical to the provision of healthcare for the homeless.  According to the National Heath Care for the Homeless Council 2006 Policy Statements, current Medicaid policies exclude most homeless people and most people experiencing homelessness do not qualify for Medicaid under current policy, regardless of their degree of impoverishment or medical need.  Like all states, California has designed its Medicaid reimbursement policies to address the unique needs of its citizens within the guidelines established by the Federal government.  Those policies have not always considered the impact on the homeless population.

UHHP has identified policy, advocacy and research as among the most important levers to address the needs of the homeless residents of Los Angeles County, and recognizes that the membership of Los Angeles Health Action (LAHA) can be an important voice and sounding board for policy proposals. LAHA was established to expand access to health coverage and care to all Los Angeles County residents through policy and advocacy, coalition building, and linking existing resources. LAHA is an active member of UHHP and has been instrumental in shaping the work of the Policy and Research Work Group.  This action plan details the steps required to identify key public policy issues and to develop an annual platform of policy and legislation that will impact homeless healthcare funding and availability.

UHHP will be successful in our advocacy efforts if:

• We develop policy statements that are adopted by UHHP membership.
• We develop a united legislative platform that advocates for policies that support both the homeless healthcare providers’ ability to provide services and the homeless individuals’ ability to receive these services

• At least 70% of UHHP members are advocating within, and when possible outside of their organizations for these policy changes.
• All UHHP members have received technical support to engage in advocacy as appropriate to their positions.
• 25% of our members and staff participate in a planned schedule of advocacy activities before other policy advocacy groups and decision-makers such as city councils, County Supervisors, and State and Federal administrative and legislative bodies.

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ACTION PLAN – SERVICE DELIVERY

STRATEGIC OBJECTIVE: By the end of 2009, dramatically improve delivery of health services to homeless individuals so that 25%8 of the homeless residents of Los Angeles County have a medical home providing quality service.9

UHHP, in recognition of the extraordinary diversity within Los Angeles County, intends to develop and assess service delivery models that can be considered and introduced in different areas within the County.  The guiding principle in this work is that the providers in the geographic area will develop a new or adapt an existing model to implement and that the roles of UHHP will be those of convener, facilitator, and information source.

8 Measurement methods to be determined.  A “medical home” is defined as a primary care facility that the patient identifies as the place where he/she receives care.

9 As defined by the Skid Row Homeless Healthcare Initiative.

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ACTION PLAN – ORGANIZATION DEVELOPMENT

STRATEGIC OBJECTIVE: By the end of 2007, ensure that United Homeless Healthcare Partners is an on-going, financially stable organization.

Beginning in November 2005, UHHP has been bringing together the major stakeholders in Los Angeles who are concerned with healthcare for the homeless.   

For UHHP to achieve the overarching goals of:

• Advocating for policies that support improved health outcomes for the homeless residents of Los Angeles County;
• Serving as a strong and unified voice within Los Angeles County to expand the dollars solicited and spent for homeless healthcare in this region; and
• Supporting and expanding countywide efforts to provide comprehensive and integrated healthcare for homeless individuals and families.

UHHP needs to continue as an organized, collaborative structure that can be sustained through a strong membership base, a professional staff, and a sound financial structure.

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