The Denver Housing to Health project provides supportive housing for people who are experiencing chronic homelessness, have frequent interactions with the criminal legal system, and have unmet health care needs. In this brief, we describe the program’s theory of change, the health care needs of people who were eligible for the program, and the unique role that Denver Health, a large safety net hospital and health care system, played as an implementation partner. We also detail how hospital and housing partners worked together to identify and serve people experiencing homelessness with many unmet health care needs in the program.

See our project page for more on Denver’s Housing to Health Pay for Success project.

Why This Matters

On a single night in 2024, 158,585 people across the country were experiencing chronic homelessness, a 38 percent increase since before the COVID-19 pandemic began in early 2020. Because housing and health are inextricably linked, this trend represents a serious challenge for both the housing and health care sectors. The Housing to Health program offers a compelling model for how hospitals can partner with housing providers to end homelessness and improve health by increasing use of outpatient services and prescription medicines and decreasing avoidable emergency department visits, inpatient stays, and ambulance rides. In theory, these shifts could reduce Medicaid expenditures and allow for greater investment in health-related social needs like supportive housing, helping to scale an evidence-based and cost-effective model to end homelessness and improve health care outcomes.

What We Found

• Among people eligible for the Housing to Health program, 80 percent had a mental health condition, 94 percent had a substance use disorder, and 86 percent had a chronic physical health condition. They were utilizing hospital care at high rates before the program, averaging 33 emergency department visits and 22 inpatient days over three years.
• Denver Health’s safety net health system serves a large Medicaid population with unmet health-related social needs, including a large and growing population of people experiencing homelessness, which made the health care system an ideal data analytics and implementation partner for the Housing to Health program.
• To build engagement throughout the health system before the project launched, the Denver Health implementation team met with a wide range of departmental leaders and clinical staff that served patients experiencing homelessness.
• To help supportive housing providers locate and reach out to people referred to the program, Denver Health regularly accessed an electronic health record report to identify people currently in the hospital, emergency department, or detoxification center.
• After identifying patients in the health care system, the Denver Health team used direct and passive outreach to connect them with supportive housing providers. In the first two years of implementation, 48 patients were initially located and directly connected with supportive housing providers, 33 received outreach letters with program information, and 37 received multiple reconnections to the program after a new emergency department visit or readmission to the hospital.
• The roles of the Denver Health implementation team underscore the importance of “embedded intermediaries” in building effective housing-health partnerships. Working from within the health care system, this dedicated team implemented workflows to reach eligible patients across a number of diverse health care settings.
• Forthcoming evaluation reports will release findings from the randomized controlled trial, including estimates of the impact of supportive housing on health care utilization and the net cost, or cost reductions, to Medicaid.

How We Did It

We coauthored this brief with the Housing to Health project team at Denver Health. The analysis draws from data from the Colorado Department of Health Care Policy and Financing and Denver Health and Hospital Authority records. Quotations from Housing to Health partners are from early implementation interviews conducted by the Urban Institute in June 2023.