connecticut green & healthy homes · services, which will result in over 12,900 fewer homes...

www.ghhi.org | 1©2016 Green & Healthy Homes Initiative. All rights reserved.


www.ghhi.org©201 Green & Healthy Homes Initiative. All rights reserved.


Connecticut Green & Healthy Homes

Working Together to Advance Connecticut’sHealth, Energy and Housing Goals

Pre-Feasibility Report ReleaseJuly 10, 2018





The Burden of Unhealthy and Energy Inefficient Homes





Equity - Impacts of Housing and Energy Insecurity

Health Impacts• Exposure to

environmental hazards• Lead based paint• Asthma triggers

• Mental health conditions• Stress• Anxiety• Depression

• Childhood stress• Chronic health

conditions

Economic Impacts• Reduced

productivity• Lower job security • Fewer benefits

• Paid time off

• Health insurance

Education Impacts• Poor grade level

performance• Lower graduation

rates• Lost earning

potential





Strong Evidence Base for Healthy Homes Services in the Literature

Patients who have asthma at any level of severity should: • Reduce, if possible, exposure to allergens to which the patient is

sensitized and exposed.

• Know that effective allergen avoidance requires a multifaceted, comprehensive approach; individual steps alone are generally ineffective.

…the Task Force recommends the use of home-based, multi-trigger, multicomponent interventions with an environmental focus for children and adolescents with asthma, on the basis of strong evidence of effectiveness in reducing symptom-days, improving quality of life scores or symptom scores, and reducing the number of school days missed.

2007

2011

2009

Surgeon General’s Call to Action to Promote Healthy Homes• Describes the steps to protect themselves from disease,

disability and injury that may result from home health hazards

• Know that effective allergen avoidance requires a multifaceted, comprehensive approach; individual steps alone are generally ineffective.





Evidence-based Interventions Produce Measurable ResultsOverview of a Healthy Homes Intervention

Initial Home Visit

Evaluation of outcomes

Intake and enrollment

Healthy Homes education and home repairs

1 2

3 4

Healthy Homes Educator: Provides education, supplies

Assessor: Comprehensive environmental assessment and energy audit, Coordinated scope of work

Fix asthma triggers, and injury & lead hazards.

Evidence-based best practices: • Home visits• Follow-up and referral

to meet needs• Coordination with

medical providers

Identify eligible households, call to enroll into the program.





The Business Case for Lead and Healthy Homes

Sources: HUD, Gould, RWJ Commission on Building a Healthier America, HHS economic review of published studies

Lead poisoning costs society $50.9 billionannually and yet is entirely preventable

Asthma results in $50 billion in annual medical costs, and 40% of costs are tied

to environmental triggers in the home

6.8 million children18.7 million adults

1.58 million hospital days

$500-$1,000cost of ER visit

$7,500-20,000cost of hospitalization

$1invested in asthma

interventions

$5.30 - $14return on

investment

Impacts during Childhood• 535,000 children under 6 with

elevated blood lead level• 700% increase in school drop out rate• 600% increase risk of juvenile

delinquency• Lower IQ, ADHD, special education

Impacts in Adulthood• Diminished earnings from lower IQ• Higher likelihood of incarceration• Higher social service usage

Increased lifetime earnings of $1,024,000 per child if lead

poisoning prevented

ROI between $17-221 per dollar invested in preventive lead

remediation





Non-Energy Benefits

• GHHI research captures the true value of energy-efficiency interventions, by measuring the health, economic and other benefits that accrue at the individual, household, and community level.





.

Challenge for Families Seeking Help





.

The GHHI Model: “No Wrong Door”

Philanthropy Government Private-sector

$System• Single intake system• Comprehensive

assessment• Coordinate services• Integrated

interventions• Cross-trained workers• Shared data

Outcomes• Lead-hazard reduction• Asthma-trigger control• Household injury

prevention• Energy efficiency • Weatherization • Housing rehabilitation

Alignservices & funding

Braid relevant resources

Coordinateservice delivery





Connecticut’s Strong Partnerships and Capacity in Housing, Health and Energy Sectors

Connecticut Green & Healthy Homes Project





Harnessing Connecticut’s Potential for Statewide Service Delivery





Meeting Connecticut’s Specific Needs

• Socioeconomic: Over one third of Connecticut households are either living in poverty or struggling to meet basic needs even as they work one or more low-wage jobs.

• Housing: Over ¼ of homes surveyed by the Department of Public Health in 2017’s Healthy Homes Surveillance Report had at least one health hazard. 25% of homes served by rate payer-funded energy programs were deferred for energy efficiency upgrades due to health and safety conditions.

• Energy: The average energy burden for a Connecticut household is 11.8% of annual income, 30% higher than the national average energy burden. The energy burden is 60% higher on average for low-income households.






Meeting Connecticut’s Specific NeedsConnecticut Green & Healthy Homes

• Health: • The state had over 21,700 annual asthma-related hospitalizations,

and over $102 million in Medicaid claims related to asthma.

• Statewide, falls are the leading injury-related cause of mortality for older adults, and the fourth leading cause across all ages. Falls were involved in over 42,000 hospitalizations statewide over 5 years.

• Over 2,100 children under the age of six are diagnosed with elevated blood lead levels in Connecticut. Just under 75% of these children were diagnosed with blood lead levels of 5-9 µg/dL.





Current Programs and CapacityConnecticut Green & Healthy Homes

• Energize CT: Clean Energy and Healthy Homes Pilot, Home Energy Solutions-(HES) and Home Energy Solutions - Income Eligible (HES-IE) Programs is a strong framework for housing health and safety interventions in low income households, sustainably supported through a mix of public, philanthropic and private capital investment

• Green Bank: Solar for All with PosiGen Solar Solutions, EnergizeCT Smart-E Loan, Multifamily Programs, EnergizeCT Health & Safety Revolving Loan Program

• DOH: Partnership with CT Children’s Medical Center Healthy Homes Program, non-lasping fund for lead abatement, state bond funding for lead and healthy homes, Connecticut Public Housing Capital Improvement Program, Energy Conservation Loan

• DPH: Putting on AIRS, Falls Prevention Program, Community Health Worker Certification

• Community-based: Operation Fuel, GHHI New Haven, CT Social Health Initiative, etc.





Statewide Model Can Address GapsConnecticut Green & Healthy Homes

• Funding: Connecticut has a number of innovative financing mechanisms for housing rehabilitation, through partnerships between the Department of Housing, the Connecticut Housing Finance Authority, EnergizeCT and Connecticut Green Bank among others. Many of the financing and incentives are not available to 1-4 unit rental properties.

• 2017 budget process - diversion of funds away from housing, health and energy services, which will result in over 12,900 fewer homes (5,600 LMI households), getting EE services, and pressure on Green Bank residential financing programs

• Limited geographic reach of some innovative programs as a result of funding limitations





Innovations in Health-related Funding OpportunitiesConnecticut Green & Healthy Homes

Medicaid, Chip Waivers & State Plan Amendments

Hospital Community Benefits

Pay for Success financing with value-based purchasing

Connecticut’s Patient-Centered Medical Home + Shared Savings Program

Medicare Advantage Plans

Developing an innovative healthy homes funding toolbox…

Connecticut’s State Improvement Plan (SIM) funds





Impact Measures, Data Capacity and CoordinationConnecticut Green & Healthy Homes

• Pathways for coordinated intake and referrals across energy and health sectors (ie CHW’s and EE Services)

• Connecticut’s housing, health and energy programs collect, analyze and report a large amount of data. Programs use a variety of data collection protocols, data platforms and measures of intervention impact

• The State’s data system for energy utilization and costs is not currently linked to housing or health data

• Health data are routinely shared between DPH and DSS, but there is not a shared data platform or shared impact measures among the agencies





EligibilityConnecticut Green & Healthy Homes

• The current framework for housing, health and energy services includes a number of eligibility criteria standards, some of which conflict or limit the resources that LMI families can access

Agency State-Administered Housing Program

Income Eligibility Criteria

Eversource/UI

HES-IE 60% of State Median Income

DOH CDBG/HOME 80% of Area Median Income

DEEP Weatherization Assistance Program

60% of State Median Income

DPH Putting on AIRS None DPH Falls Prevention Program NoneDPH/Eligible Jurisdictions

Lead Hazard Control 80% of Area Median Income





Policy Alignment with Sustainably-Supported Statewide Services Model






Commitment to SustainabilityConnecticut Green & Healthy Homes

• Pairing Health and Safety Interventions with the Energy Efficiency Provider Network• Energy and Healthy Homes Pilot projects: the Clean Energy and Healthy

Homes Pilot

• Connecting Housing, Health and Energy to Reducing Greenhouse Gas Emissions• Governor’s Council on Climate Change recently invited the Connecticut Green &

Healthy Homes Project partners to present information about the purpose, progress and future goals of this work.

• Reducing Energy Burdens and Supporting Healthy Housing through Innovative Programs

• EnergizeCT HES/HES-IE which was projected to serve 360,000 homes by 2030.• CT Green Bank’s work has reduced energy burdens in over 22,000 homes and

businesses, and its focus on solutions for low-to-moderate income communities led to catalytic support for the current research into the feasibility of a statewide, sustainably-supported model for housing, health and energy services





Commitment to Increase Access to Affordable HousingConnecticut Green & Healthy Homes

• Supporting and Improving Connecticut’s Housing Stock• Through the Department of Housing, investment in affordable housing has seen

a 10 fold increase in Connecticut since 2013. • Effort to reduce homelessness: strengthening the state’s coordinated

access network system, producing more supportive housing units, funding capital improvements in shelters, and designing and adopting various interventions to address the different root causes of homelessness

• DOH/CHFA partnership enables housing rehab financing to be tied to meeting health, safety, energy efficiency design standards statewide, including integration of utility incentives for EE

• Starting in 2014, DOH and CHFA began a statewide effort to invest in rehabilitation and redevelopment of the state’s public housing portfolio, using green standards and benchmarking energy impact





Commitment to Health Equity and Addressing Social Determinants of HealthConnecticut Green & Healthy Homes

• Improving Connecticut’s Health Outcomes through Planning and Action• The State Health Improvement Plan’s Environmental Health Action Team Action

Agenda goals:

• Reduction and elimination of elevated blood lead levels among children,• Improvements to air quality awareness to mitigate asthma symptoms,• Adoption of a uniform property maintenance code statewide, to improve

conditions particularly in low-income, privately-owned rental housing.

• DPH’s investments include • community health centers and school based health centers, identifying

health professional shortage areas, and supporting local public health infrastructure.

• DPH builds coalitions to improve health through advocacy, policy, and system changes and implements two multi-community evidence-based home visiting programs which address asthma (Putting on AIRS) and household injury (Falls Prevention Program





Commitment to Health Equity and Addressing Social Determinants of HealthConnecticut Green & Healthy Homes

• Opportunities to align this model Connecticut’s Medicaid program priorities?

• Direct provider payments: In 2012, Connecticut Medicaid removed managed care organizations as intermediaries, and now contracts directly with providers on a fee for service basis through statewide administrative service organizations

• Shared-Savings Opportunities: In recent years, Connecticut has developed a shared-savings model for primary care networks (“patient-centered medical homes”), that provides flexibility for these caregivers to pay for new methods of addressing social determinants of health through savings generated from the reduction in healthcare utilization

• Innovation Opportunities: Connecticut is currently experimenting with different community-based care models for social determinants of health through its $45M Statewide Innovation Model (SIM) federal grant, including asthma and healthy homes efforts





Key Pre-Feasibility Findings and Next Steps






Key FindingsConnecticut Green & Healthy Homes

• Connecticut is a national leader in residential energy-efficiency services and clean energy financing.

• ~20,000 households annually receive efficiency services.• $185 million of residential financing catalyzed in last 5 years.

• The unique organization of the state’s public insurance delivery system may enable support for healthy housing services with proven health outcomes.

• Robust public-private leverage models in place in housing and energy sectors (DOH, CHFA, and CT Green Bank).

• State agencies share a vision for improving housing quality to advance goals across the housing, health and energy sectors.






Analyze health care utilization rates and associated costs

Project potential cost savings

Examine the incentives for reducing healthcare costs

Continue to grow the support of partners

Next Steps and Further Research





Key Priorities of Work Connecticut Green & Healthy Homes

• To provide a comprehensive analysis of the economic, technical and operational feasibility of a statewide model for housing, health and energy services in Connecticut.

• To identify sustainable funding support via innovative strategies for public, private and philanthropic investment in housing, health and energy services, including outcomes-based Medicaid investment, philanthropic support and leveraged public investment.

• To design models that leverage and expand Connecticut’s existing framework for Utility Rate Payer-Funded Energy Efficiency Services to implement a comprehensive statewide housing, health and energy services model.





Timeline and Key MilestonesConnecticut Green & Healthy Homes

Phase I - $74,000 funded by CT Green Bank Stakeholder Convenings (Fall 2017, Winter

2018) Pre-Feasibility Research (Jun 2017-May

2018)

Phase II - $220,000 funded by TBD Feasibility Research and Full Report

(Summer-Winter 2018) Pilot Project Design (Spring 2019)

Phase III – $5 million funded by TBD (estimate) Pilot Project Development and up to 3-year

Implementation and Evaluation (2019-2022)28





Recent Project ActivitiesConnecticut Green & Healthy Homes

29

•Connecticut Green Bank has contracted with Green & Healthy Homes Initiative for Phase II project activities.

•State agency investment of over $65,000 in Phase II activities, and interest from state, regional and national funders.

•Legislative briefing organized by Rep. Steinberg on June 6th, 2018

•Planned meetings with key statewide healthcare advocates in August, 2018





How to Get InvolvedConnecticut Green & Healthy Homes

30

•Join our email list‒ email [email protected] to get added

•Attend one of the upcoming convenings in the next year‒community input on pilot designs‒home performance and community health workers cross training‒hospital executives‒broader philanthropy• dates TBD

•Participate in discussions around pilot design and locations

mailto:[email protected]





Key Partners






Contact Information

Ruth Ann [email protected]

Kerry O’[email protected]

Kristin [email protected]

Catherine [email protected]

https://ctgreenbank.com/ct-ghhi/





https://ctgreenbank.com/ct-ghhi/

connecticut green & healthy homes · services, which will result in over 12,900 fewer homes...

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