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Partnerships With ‘Harm Reduction Centers’ May Cut Hospital Readmissions

Centers provide resources to high-risk, marginalized patients

Harm reduction centers (HRCs) — where drug users and sex workers can get clean needles, syringes, free condoms, and human immunodeficiency virus (HIV) prevention information — have existed for decades. They have generally operated on the outskirts of the health care system with the help of state and federal programs as well as private donations.

But HRCs are now trying to reposition themselves as a commodity for hospitals and insurers because of their unique experience in coordinating care for high-risk and often marginalized patients, according to a report from the New York Academy of Medicine.

Partnerships between hospitals and HRCs may be able to “coordinate complementary services and improve access for people with the greatest need for comprehensive care,” the report noted. These arrangements can take various forms, including:

  • Teaching hospitals establishing part-time clinic hours at HRCs
  • Larger health care organizations coordinating and co-locating clinical and harm reduction services
  • Hospitals placing clinical and pharmacy services at a HRCs

A case study accompanying the main report looked at how BOOM!Health in New York City combined harm reduction services with on-site primary care, mental health services, drug-addiction treatment, and pharmacy services, as well as food and nutrition counseling and legal aid services.

The integrated health clinic would have struggled to survive, BOOM!Health’s outgoing president Robert Cordero said in an interview with Kaiser Health News, but health care reform has made it easier for HRC/hospital partnerships to obtain Medicaid funding at levels high enough to sustain coordinated programs.

“We reached out to the hospitals, and that’s how much of the relationship-building is happening,” Cordero said. “And then we pitched them on subcontracting through Medicaid funding, which is how we ended up partnering with a federally qualified health center that gets a higher rate from Medicaid. And that means they have a little more to spend and more time with patients.”

Under this arrangement, hospitals pay a “per member, per month” rate. Medicaid assigns patients with two or more conditions to the hospitals, which must be able to demonstrate outcomes, Cordero said.

HRC/hospital partnerships form as hospitals are increasingly under scrutiny for discharging homeless patients into situations that will likely lead to readmissions. Many cities have created “respite care centers” where social-services groups can connect discharged patients with food, housing, and other services.

In other cases, hospitals send medical vans into communities to provide free primary-care services for homeless patients or to take patients to see a doctor before they need emergency care or hospital admission.

Sources: Kaiser Health News; August 10, 2015; FierceHealthcare; August 10, 2015; and New York Academy of Medicine; June 2015.

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