NHS FPX 6008 Assessment 3 Business Case for Change

Name

Capella university

NHS-FPX 6008 Economics and Decision Making in Health Care

Prof. Name

Date

Business Case for Change

Greetings! My name is _______. In today’s presentation, I will address a pressing healthcare economic issue: homelessness in California. The focus will be on its effect on the Stanford Hospital community, which has experienced significant strain. I will focus on the related complexities while presenting practical strategies to address and manage homelessness.

Problem and the Impact of Healthcare Economic Issues

Homelessness has become a critical medical and financial challenge. It influences the distribution of resources and the general health of the people. It is considered a state with no permanent, reliable and adequate shelter. Homelessness has increased dramatically in the United States (U.S) over the past ten years. According to the Department of Housing and Urban Development reports, more than 580,000 people experienced homelessness on any given night in 2020. Substance use is very common in this population.

Around 17% of individuals were reported as chronic users in 2020 (Padwa et al., 2021). Homelessness contributes to serious health inequities and higher mortality as barriers to health care prevent access to services. About one-quarter of homeless people cannot gain access to medical care. Homelessness strains healthcare economics by expanding expenses due to unmet health needs, lack of adequate housing, poverty and mental illness.

Impact on Medical Professionals, Health Organizations, and Community 

Homelessness impacts Stanford Hospital significantly as systemic healthcare shortcomings affect me, my fellow professionals and the state of California. As healthcare providers, patients who are homeless have severe health-related complications exacerbated by unstable shelter. The inability to use stable housing as a location for managing chronic diseases can prevent timely follow-up of patients. Furthermore, the increased demand for emergency services from the homeless population makes it difficult to meet the needs of the community at large. It is complex and multifaceted regarding medical and socioeconomic factors (Padwa et al., 2021). This scenario leads to increased stress and emotional exhaustion of the nursing staff, including me.

Homelessness imposes a heavy load on organizational resources and generates considerable economic problems. Many homeless individuals go to the emergency room instead of getting primary care services. It causes overcrowding in hospitals and increases operating costs. Homeless patients have an average of 0.72–5.9 ED visits per year compared to 1.63–18.75 ED visits for non-homeless patients (Vohra et al., 2022). This reliance on emergency care increases healthcare costs and risks the sustainability of healthcare facilities. In addition, homeless patients are admitted at a rate higher than that of the general population. One in three admissions are emergency stays, more than for housed patients.

These admissions involve intensive care and longer hospital stays, which cost around $2,559–$2,907 per admission (Sauro et al., 2023). At the community level, the high prevalence of homelessness strains healthcare infrastructure. It limits resources available to other groups and increases the need for additional services like nutritional support and preventive programs. This severe demand for local resources escalates the poverty situation. It worsens public health consequences and adds to the growing homeless emergency and its flows statewide. These challenges demand more innovative and personalized strategies. Implementing effective measures enhances health outcomes and reduces economic strain on health care.

Feasibility and Cost-Benefit Considerations

Evaluating cost-efficiency and feasibility is indispensable to addressing the financial burden of homelessness within the healthcare sector. Executing sustainable solutions for managing homelessness can yield feasible and cost-effective results for Standford Hospital while addressing broader structural gaps in California’s healthcare system.

Feasibility Considerations 

Managing homelessness in the Stanford Hospital system is crucial in better managing primary healthcare services among the homeless. Targeted strategic investment in mobile health clinics that provide mental health and community outreach programs with provisions of primary healthcare to the homeless. Affordable housing measures will relieve many of these pressures. It eases these issues through reduced costs and improved patient outcomes in the long term. Although the initial investment needed to establish these solutions is high, the long-term benefits far compensate for the short-term costs (Békási et al., 2022). Adding primary care services to managing homeless patients improves the detection and management of long-lasting health conditions.

It enhances patient satisfaction, reduces hospital visits and helps reduce healthcare inequalities. Access to primary care is a more effective way to reduce the population of hospital congestion. It is much less likely homeless people will look for primary care in a hospital than those staying in stable housing. According to Békási et al. (2022), homeless patients are more likely to experience frequent clinic visits. Moreover, creating strong collaborations with shelters, social service organizations, and community groups generates access to necessary resources. It addresses the social determinants of health that cause homelessness. These approaches are practical and feasible within the healthcare system to improve health outcomes.

Cost-Benefit Considerations

This cost-benefit evaluation underlines the effective management of homelessness. It helps reduce healthcare facilities’ operational and financial challenges like Stanford Hospital, California. As the need for emergency services increases with the homeless population, the burden on healthcare facilities could be reduced by investing in solutions such as outreach on primary and preventative care, employment, mental health services and affordable housing. These investments lead to substantial financial savings. It improved patient outcomes and better community health. For instance, preventative care is more affordable than emergency treatments. Research shows that affordable housing initiatives yield a significant Social Return on Investment (SROI) with studies estimating a return of $2 to $8 for every $1 invested (Drabo et al., 2021).

The Patient-Centered Medical Home (PCMH) model offers a comprehensive, coordinated care approach.  It focuses on prevention, continuity of care and integrated services. The PCMH model integrates primary care, mental health support and social services to reduce hospital visits and healthcare costs (Tryon et al., 2022). Addressing homelessness promotes better interpersonal relationships and unlocks further organization funding. Stanford Hospital and the wider California healthcare system might see an annual increase in financing of up to $700,000 in their financial sustainability and patient care outcomes. 

Mitigating Risks to Financial Security

Several approaches can be taken to solve the financial issues associated with homelessness. First, implementing cost-effective solutions such as telehealth and mobile clinics reduces operational costs, unlocking healthcare access to homeless populations. According to Békási et al. (2022), telemedicine is a cost-effective way of enhancing service delivery and reducing healthcare disparities among homeless individuals. Combining housing support with healthcare has decreased emergency department visits by up to 60% and reduced healthcare spending by up to 40%.

It improves health outcomes, reduces resource waste, alleviates staff burnout and ensures equitable healthcare at Stanford Hospital (Vohra et al., 2022). Telehealth consultations increase 90% attendance at scheduled appointments and nearly 75% completing six or more visits (Békási et al., 2022). It safeguards good continuity of care for homeless patients. Furthermore, financial support options must be broadened. Partnerships must be fostered to eliminate financial strain. This can include seeking grants, building relationships with local nonprofits and pursuing donations. It reduces dependence on a single funding source and firming the economy.

Collaborative efforts optimize the allocation of resources and enhance support for integrated healthcare programs. Lastly, training healthcare staff to better address the unique needs of homeless individuals and foster interprofessional collaboration can enhance care delivery. It reduces costs and ensures consistent care. Properly trained staff can improve the quality and efficiency of care (Barker et al., 2022). It minimizes fragmentation and optimizes the continuity of services. These interventions support Stanford Hospital and California’s healthcare systems to strengthen their financial position and health outcomes for the homeless population.

Proposed Changes to Address Homelessness

The proposed solution to address the economic challenges of homelessness within Stanford Hospital’s healthcare system is a multi-dimensional approach. It improves outcomes for the homeless population while fostering financial sustainability. A central part of this strategy will be the creation of a mobile clinic with a community-based program that combines patient education, social services and preventive care. These programs promise to decrease emergency department visits and total healthcare costs. According to Goto et al. (2023), community-based housing programs effectively provide healthcare services for homeless populations. The daily cost per individual in these programs was $157.45, while the savings in acute care services ranged from $18,000 to $48,000 daily. The Mobile Injury Clinic is a cost-efficient approach to providing care. Its operating costs are only $146.65 per patient (Goto et al., 2023).

Improving care coordination through multidisciplinary collaboration and partnership with local shelters is an important approach to managing homelessness. It requires an all-rounded approach to chronic condition management and integration of services. Building interprofessional cooperation is vital for managing the complex and diverse needs of homeless people.

Individuals transitioning from hospitals and those requiring long-term care should have an integrated team of healthcare and social services workers capable of navigating their health and social problems (Barker et al., 2022). The above strategy boosts efficiency in running operations. It lowers the degree of care fragmentation and reduces healthcare expenses and possible readmissions. The Housing First model emphasizes stable housing as the first step of support services. The strategy minimizes the healthcare system’s cost and the hospitalization rate and improves health outcomes for homeless people (Barker et al., 2022).

Potential Benefits to the Organization, Colleagues, and Community  

The proposed strategy to address homelessness in Stanford Hospital and the wider California healthcare system has numerous benefits for the healthcare organization, staff and the community. Job satisfaction among healthcare workers can be increased. It reduces burnout, and they see the positive effects of their work on the homeless population. The multidisciplinary approach reduces the level of staff stress as challenges associated with the management of chronic health conditions among the homeless population are minimized. It promotes personal growth while improving relationships with peers and community partners (Békási et al., 2022). Implementing prevention services and Housing First initiatives helps reduce a healthcare facility’s cost by minimizing a prolonged stay in the hospital.

It ensures financial viability. Improved care coordination will make the hospital’s operations much more streamlined, efficient and effective in allocating resources. This will enhance organizational efficacy. It addresses the medical and social needs of the homeless population (Tryon et al., 2022). On a community level, these initiatives will improve health outcomes by expanding access to preventive and primary care for unhoused people. It promotes greater economic stability through counseling and other mental health support services. This approach reduces the stigma surrounding homelessness and makes a more inclusive society where everyone can access equal service. Community resources will also be freed up and directed toward improving the well-being of California’s residents.

Solutions Addressing Cultural and Ethical Considerations

The proposed strategies to manage the homeless population will be culturally competent, ethical and inclusive. The community-based preventative and primary care program will focus on training staff in culturally sensitive approaches so that healthcare services are respectful and responsive to the diverse backgrounds of homeless individuals. These strategies strive to improve health outcomes by delivering core care to chronic illness and mental health disorders (Goto et al., 2023). These approaches prioritize the safety of individuals individual safety as defined by principles of beneficence and non-maleficence. The proposed revisions make equitable quality healthcare accessible to everyone homeless in Stanford Hospital. It makes healthcare an impartial environment.

Integrating multidisciplinary teams promotes holistic, fair care. It respects the dignity of homeless patients and upholds the rule of justice. Moreover, collaboration with community-based organizations helps maintain patient autonomy and address the complex needs of homeless patients (Anderson et al., 2023). Primary care services attempt to remove financial barriers through low-cost healthcare and mobile clinics targeting marginalized groups. Housing-first interventions ensure fair resource allocation through collaboration with local community organizations to provide affordable housing solutions. Such efforts improve healthcare access and outcomes for all homeless people. It fosters an inclusive and stable healthcare environment through cultural competence and fair resource distribution.

Conclusion

Homelessness in California, particularly in the Stanford Hospital community, presents significant healthcare issues. The proposed solution involves executing mobile health clinics, affordable housing measures and partnerships with shelters to address the healthcare needs of the homeless. This multi-dimensional approach emphasizes prevention, mental health services, and improved care coordination through a PCMH model. These strategies support reducing healthcare costs and improving patient outcomes.

References

Anderson, A. J., Noyes, K., & Hewner, S. (2023). Expanding the evidence for cross-sector collaboration in implementation science: Creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge. Frontiers in Health Services, 3, 1124054. https://doi.org/10.3389/frhs.2023.1124054

NHS FPX 6008 Assessment 3 Business Case for Change

Barker, L. C., Evoy, J., Butt, A., Wijayasinghe, S., Nakouz, D., Hutcheson, T., McCarney, K., Kaloty, R., & Vigod, S. N. (2022). Delivering collaborative mental health care within supportive housing: Implementation evaluation of a community-hospital partnership. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-021-03668-3

Békási, S., Girasek, E., & Győrffy, Z. (2022). Telemedicine in community shelters: Possibilities to improve chronic care among people experiencing homelessness in Hungary. International Journal for Equity in Health, 21(1), 1–17. https://doi.org/10.1186/s12939-022-01803-4

Drabo, E. F., Eckel, G., Ross, S. L., Brozic, M., Carlton, C. G., Warren, T. Y., Kleb, G., Laird, A., Porter, K. M., & Pollack, C. E. (2021). A Social-Return-On-Investment analysis Of Bon Secours hospital’s “housing for health” affordable housing program. Health Affairs, 40(3), 513–520. https://doi.org/10.1377/hlthaff.2020.00998

Goto, T., Wang, C., Kwiat, C., Nguyen, C., & Saligan, L. N. (2023). Community-based wound care programs for unhoused individuals. Journal of Epidemiology and Global Health, 13(4), 604–614. https://doi.org/10.1007/s44197-023-00157-6

Padwa, H., Bass, B., & Urada, D. (2021). Homelessness and publicly funded substance use disorder treatment in California, 2016–2019: Analysis of treatment needs, level of care placement, and outcomes. Journal of Substance Abuse Treatment, 137, 108711. https://doi.org/10.1016/j.jsat.2021.108711

Sauro, K. M., O’Rielly, C. M., Kersen, J., Soo, A., Bagshaw, S. M., & Stelfox, H. T. (2023). Critical illness among patients experiencing homelessness: A retrospective cohort study. Critical Care, 27(1), 477. https://doi.org/10.1186/s13054-023-04753-7

Tryon, J., Marcus, R., Earnshaw, V., Chisolm, N., Darko, T., McKeithan, L., & Rajabiun, S. (2022). “Choose the people who know”: How patient-centered medical homes reduce disclosure anxiety for people living with HIV and experiencing homelessness. Journal of Health Care for the Poor and Underserved, 33(3), 1432–1448. https://doi.org/10.1353/hpu.2022.0122

NHS FPX 6008 Assessment 3 Business Case for Change

Vohra, N., Paudyal, V., & Price, M. J. (2022). Homelessness and the use of emergency department as a source of healthcare: A systematic review. International Journal of Emergency Medicine, 15(1), 32. https://doi.org/10.1186/s12245-022-00435-3