01/23/2013 - Aligning Assets Towards the Goal: A Blog from VA’s Tom O’Toole on the Homeless Patient Aligned Care Teams (HPACT)

The adage, “It takes a village” has been applied to lot of different efforts over the years to the point of over-use.  However, when it comes to ending homelessness among Veterans by 2015, there is probably no better descriptor for what is needed and what is being done. Last year, as part of this effort, the Department of Veterans Affairs (VA) launched an ambitious pilot project to develop Homeless Patient Aligned Care Teams (H-PACT) to provide comprehensive, wrap-around primary care coupled with homeless programming to help Veterans make the transition out of homelessness and to help keep them housed. This joint effort between the Office of Homeless Programs and Office of Primary Care Services funded 32 sites around the country located in a variety of settings, including Community Resource and Referral Centers  (easy access community- based centers), VA outpatient clinics (community-based outpatient clinics) and within VA Medical Centers. These are sites where we see homeless Veterans struggling to subsist, where they often find themselves cycling through the system dealing with the consequences of their homelessness in emergency departments and hospital wards, and where we have the resources in place to make a difference. 

While such efforts are not new, basing a vulnerable population-focused care model within VA is particularly opportune for several reasons. First, it is based in the largest integrated care network in the United States that has one of the most advanced electronic medical records at its fingertips with care delivered to the highest quality. The resources, skills and capacities are in place to truly have an impact.  Second, the initiative creates a structure that formally links health care to housing and provides a vehicle for the case management and longitudinal care that is necessary for the Housing First model to succeed. Finally, it takes advantage of an unprecedented leadership commitment within the Federal government to harness all available resources to end homelessness among Veterans. 

This should not discount the work still to be done within this project. We have undertaken a major training initiative to enhance the skills and competencies or our staff in this area.  We have also been building the reporting and tracking capacities within our system to monitor how we are doing and where we can do better. We are also are working within the field to identify what works best, where we can innovate, and how we can replicate those best practices to the benefit of our homeless Veterans.  

To date, over 4,000 homeless Veterans have been enrolled in H-PACTs; twenty-nine of the 32 sites are up and running and seeing patients and the care being provided is making a real difference.  During the first 9 months of program operations, our H-PACT-enrolled Veterans had over 8,160 primary care visits, 4,100 specialty care appointments, and 90 percent of them were actively receiving homeless program supports.   We also observed a 66 percent reduction in emergency department use and 35 percent reduction in hospitalizations compared with care received prior to enrolling in the H-PACT.

More work is needed but this effort represents a glimpse of what can be done when we align our assets towards the national goal of ending homelessness among Veterans. The H-PACT initiative is one small part of the bigger effort underway within VA but truly reflects the “no wrong door” philosophy within the system that holds us all accountable to this mission’s objective. 

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