'I was freezing until I got here'
The city of Sacramento is offering hefty financial bonuses to hospitals, health plans and government and nonprofit agencies for attending meetings and helping to launch its $64 million Whole Person Care program on homelessness.
Mayor Darrell Steinberg and other Sacramento leaders consider the pilot program central to achieving their goal of housing 2,000 homeless people by 2020. It is designed to bring together health service providers to treat homeless patients and avoid costly emergency medical care, as well as to find them a stable place to live.
"Partner organizations" can collect payments of $100,000 to $250,000 for participating in meetings and hitting various "performance targets" at the end of each year of the program, which runs through 2020, said the city's homeless services coordinator, Emily Halcon. Initial targets include attending a certain number of meetings and developing internal policies, patient screening tools and referral criteria, Halcon said.
Should all partners hit their goals for the duration of the program, incentive payments would total $7.9 million. Whole Person Care is funded by local money and federal matching dollars and administered by the state.
Participants include the Sacramento police and fire departments, hospital systems, federally funded health clinics, health plans, housing agencies and social service providers, including Sacramento Steps Forward and the Salvation Army. These agencies and others are working with the city to develop a system that would keep homeless people out of emergency rooms and steer them toward behavioral health services, insurance coverage and housing.
The financial incentives are an unusual but potentially effective way to ensure that all of the agencies involved give 100 percent to a program that has lofty goals and a short timeline, Halcon said.
"They are in recognition that, to truly change systems and service delivery, you need a lot of intensive work" from service providers, each of which will be a crucial part of the program's success, she said.
"It's not just, 'Show up at a meeting and get funds,'" she said. The monthly steering committee meetings are intensive sessions "where we expect active participation, presentations and input from all of our partners" who then follow up with additional work.
"We see the incentive payments primarily as compensation for efforts already provided," Halcon continued.
Such payments are highly unusual, several experts said.
Bob Erlenbusch, executive director of the Sacramento Regional Coalition to End Homelessness, questioned why entities "are getting paid for something they should already be doing."
"It's outrageous," he said. "I've never heard of anything like it in 30 years of working on homeless issues.
"Attending meetings and working on the project should be part of their job," Erlenbusch said. "That money could go a long way toward immediately helping people. How many people could we immediately house for that amount of money?"
Whole Person Care pilot projects throughout the state are allowed to pay partners that help "ensure the overall success" of their program, said Carol Sloan, public information officer for the California Department of Health Care Services, which administers the project.
"Sacramento took a creative approach and incentivized their providers to participate in order to encourage and recognize their engagement above and beyond their traditional workload," Sloan said. The approach, she said, has led to "the development of new relationships and new policies and partnerships that we hope will be sustained at the local levels after the sunset of the pilot project."
Ryan Loofbourrow, chief executive officer of the nonprofit Sacramento Steps Forward, said he was "pleasantly surprised" to learn that his agency would get incentives for participating in Whole Person Care, locally named Pathways to Health + Home.
"This is the first time I've heard of it happening," he said. "But in this type of effort it makes sense to me. You're pulling together so many different groups that in addition to fulfilling their daily mission have to invest a lot of time" in a new project.
Loofbourrow said his agency has spent "hundreds of hours" in staff time on the Pathways effort.
"We're dedicated to it, regardless" of the payments, he said. "But the financial incentives certainly has made making this big commitment a bit easier."
Sacramento Steps Forward, which distributes millions in federal funding to local groups that aid homeless people, stands to earn $250,000 this year if it fulfills all of its commitments, according to planning documents for the local Whole Person Care program.
Each of four participating hospital systems are eligible for $100,000 each year. Government agencies and other entities can get payments of $155,000 to $250,000 if they achieve certain goals during a given year of the program.
To earn a maximum of $100,000 this year, for example, an individual hospital would need to meet various individual "incentives," including attending steering committee meetings. The hospital would need to attend half of the meetings to earn $5,000, and would get an additional $5,000 for going to 75 percent of meetings. The rest of the money is tied to other goals.
Incentive dollars can be used by agencies any way they see fit, Halcon said. Some partners might use it for reimbursement for expenses related to changing data systems and other practices for tracking, treating and discharging homeless patients, she said.
"In order to deliver these robust services, these agencies have to change their internal policies. There is a cost to that," Halcon said.
Halcon pointed out that the city will be able to draw its $32 million federal match only after meeting various goals for the program set by the state.
"We only meet our outcomes if our partners are as committed as the city is," she said.