Project Summary
The City and County of Denver, Colorado has been awarded a total of $6.3 million by the U.S. Department of the Treasury under the Social Impact Partnerships to Pay for Results Act (SIPPRA).
This award supports Denver’s Housing to Health (H2H) Pay for Success project, a permanent supportive housing program designed to reduce chronic homelessness and improve health outcomes among individuals with repeated interactions with the criminal justice and healthcare systems.
The award includes:
- $5.5 million project grant.
- $826,800 for independent evaluation.
H2H aims to improve outcomes for vulnerable populations by providing stable housing and increasing access to health services. The goal is to reduce Medicaid and Medicare expenditures by decreasing reliance on emergency services and involvement in the criminal justice system.
Intermediate Outcomes:
- Increased housing stability.
- Decreased jail days.
- Increased access to outpatient health services.
Long-Term Outcomes:
- Decreased ED visits and other avoidable admissions.
- Decreased federal Medicaid and Medicare expenditures.
The Colorado Coalition for the Homeless (CCH) and WellPower will deliver permanent supportive housing, modified assertive community treatment (ACT), and case management to 125 participants.
- Permanent supportive housing is an evidence-based intervention that provides housing plus intensive case management and connects clients with community services, including primary health care.
- ACT is an evidence-based approach that consists of a multidisciplinary team that strives to meet behavioral health and other needs of clients in order to maximize opportunities for recovery. Team members directly provide individualized, flexible and comprehensive treatment, support and rehabilitation services, including illness management and recovery skills, individual supportive therapy, substance abuse treatment, skills training and assistance with daily living activities, assistance with natural support networks, supportive housing and support in accessing benefits, transportation and medical care, prescriptions, administration and monitoring, and peer support.
- Case management includes evidence-based motivational interviewing and trauma-informed care to assist participants in engaging and connecting with integrated health services, as deemed clinically appropriate and fitting the clients’ needs.
H2H will target individuals who are chronically homeless, have a record of at least eight arrests over the past three years in Denver County, have two or more emergency department visits in the year before the program and are at high risk for avoidable and high-cost health services paid through Medicaid.
CCH will enroll 100 clients and WellPower will enroll 25 clients for the project.
- Reduction in homelessness among high-need individuals.
- Improved health care outcomes.
- Lower use of emergency medical services.
- Decreased interaction with the criminal justice system.
- Improved housing stability and retention.
| Role | Entity | Responsibilities |
| Local government | City and County of Denver | Project sponsor. End payor housing stability and jail day outcomes. Repay investors with SIPPRA funds if performance benchmarks are met for the Medicaid outcomes. |
| Intermediary | The Corporation for Supportive Housing | Serves as fiscal agent – overseeing the flow of funds in the transaction. Manages service provider performance and facilitate investor agreements and payments from Denver to investors. Serves as project manager— oversees the day-to-day operations of the program, staffs project oversight committees, communicating with all parties, and providing advisory services. |
| Service providers | Colorado Coalition for the Homeless | Provides supportive housing Deliver ACT services. |
| WellPower | Provide supportive housing | |
| Denver Health and Hospital Authority | Deliver ACT Services. Data sharing partner. Referral coordinator for participants in the hospital. | |
| Independent evaluator |
Urban Institute |
Establish research design. Estimate project impacts to evaluate whether performance benchmarks are met. Provide evaluation progress reports. |
| Investors | Northern Trust | Provide capital to fundservices. |
| The Denver Foundation | ||
| Gary Community Foundation | ||
| Colorado Access Foundation | ||
| Grantors | Kaiser Permanente | Provide grant funding to fund services. |
| Colorado Trust |
The outcome payment will be equal to the sum of the annual difference between the treatment group’s Medicaid and Medicare expenditures and the control group’s Medicaid and Medicare expenditures over the period of performance.
The project will use a randomized control trial to evaluate the effectiveness of H2H. To determine the amount of any net reductions in federal expenditures for associated Medicaid and Medicare claims, the evaluator will compare the amounts billed for these claims for the treatment and control groups using individual-level data from Colorado Department of Health Care Policy and Financing.
One outcome payment will be made at the end of the evaluation period.
| Service Delivery | $ 10,519,833 |
| Intermediary | $ 1,230,167 |
| Evaluation | $ 1,000,000 |
| Total Project Costs | $ 12,750,000 |
- Project Period of Performance Start Date: July 2022
- Project Period of Performance End Date: June 2029
- Evaluation Start Date: July 2022
- Evaluation End Date: December 2029
Individuals must be at least 18 years old, have had at least eight arrests over the past three years, have been experiencing homelessness at the time of referral, have two of more emergency department visits in the year before the program. Potentially eligible clients will be referred to H2H through Denver Health and Denver Police Department.
H2H’S randomized controlled trial design will compare the outcomes of people experiencing homelessness and frequent jail stays and Emergency Department visits who receive supportive housing to those who receive usual care.
Because supportive housing is a scarce resource and not available to all the people who need it, the limited 125 housing slots will be allocated by lottery.
The evaluation will track outcomes for both groups and attribute any differences to H2H.
The evaluation metrics will include information on housing stability, reductions in jail days, and net reductions in federal expenditures for Medicaid and Medicare claims. Treasury will pay for the net reductions in federal expenditures for Medicaid and Medicare claims.
| Entity | Estimated Savings | Description |
|---|---|---|
| Federal government | $5.5 million | Denver estimates cost savings to Medicaid and Medicare to average $5,800 per person per year after the intervention. |
| Local government | $9.2 million | Denver estimates cost savings to thecity to be $11,000 per individual per year, after the intervention, driven by reductions in jail, police, court, emergency shelter, detoxification facilities, and other first responders. |
Further information is available through the official press release and federal registry notice. These documents provide detailed background on the SIPPRA award and program expectations.