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Realigning King County Health Care for the Homeless Network Planning
Summary of Thought Leader Input and Recommendations
July 2016
Introduction
In 2015 Public Health - Seattle and King County (PHSKC) brought together a diverse group of community and
government thought leaders to help the Health Care for the Homeless Network (HCHN) adjust its strategic
course in consideration of a rapidly evolving policy and planning environment. These leaders brought to the
table broad and deep expertise regarding:
 Medicaid reform and safety net health care policy and planning, more generally;
 Housing and homeless services policy and planning;
 Governmental and philanthropic funding of health and housing services for vulnerable populations;
 Publically-funded behavioral health care and its integration with medical and housing services;
 Medical and clinic operations issues related to homelessness; and
 The perspective of the consumers, providers, and advocates who serve on HCHN’s community advisory
board, the Health Care for the Homeless Planning Council.
PHSKC asked these leaders to join in a series of meetings to help it step back and contemplate a future vision for
HCHN. Specifically, we asked the group to help HCHN better align with and more effectively leverage:
1. Community initiatives related to State of Washington health care reform
2. Local Continuum of Care strategic planning for homeless services and housing.
This document summarizes the work done in these meetings. It outlines the group’s analysis of the advantages
and disadvantages of how HCHN is currently positioned to contribute to incipient local and State innovations
aimed at improving health outcomes and lowering public costs for vulnerable low-income populations. Further,
it provides guideposts for the evolution of HCHN’s primary strategic focus, which has historically centered on
assessing the needs of the most vulnerable among the homeless population and then securing and
implementing grants that target these needs. These guideposts will serve to help HCHN shift its focus to
becoming a full-fledged, effective partner in broad community initiatives that hold great promise for improving
the health and stability of community members experiencing the crisis of homelessness.
Process
Through January 2016 the group met four times, beginning with an overview of the history, scope, and scale of
HCHN programs and partnerships and ending with the creation of specific recommendations. The following
briefly summarizes each meeting:
1. 7/31/15
After receiving an HCHN overview presentation, the group determined its main areas of focus for future
meetings. It agreed to start with taking a thorough look at how state and local health care reform
initiatives are driving change in how safety net health care services will be purchased and how the
effectiveness of these services will be measured. It also agreed to take a close look at the intersection of
health and housing through two lenses: (1) All Home’s strategic plan and response to federal homeless
housing policy changes and (2) health care reform work focused on addressing the problem of

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homelessness and unstable housing as barriers to health and recovery. The group also made
suggestions for other leaders who might be brought in to round out the discussion.
Attendees: Greg Francis, Health Care for the Homeless Planning Council; Mark Putnam, All Home;
Jason Johnson, City of Seattle Human Services Department; Betsy Jones, Office of the King County
Executive; Gordon McHenry, Solid Ground; David Wertheimer, Gates Foundation; TJ Cosgrove, PHSKC;
Jerry DeGrieck, PHSKC; John Gilvar, PHSKC; Denise Hawthorne, PHSKC
2. 9/11/15
With guidance from PHSKC Director of Health Policy and Planning Janna Wilson, the group dove into the
current plans for State health care reform and King County health and human service transformation. It
then moved into a discussion of these plans’ population-based approaches to reducing poor health
outcomes and high health care delivery system costs for people with risk factors such as chronic
behavioral health conditions. It explored how existing HCHN strategies align with these approaches and
brainstormed on the potential use of new flexible funding tied to the State’s Medicaid global waiver
application as well as innovative managed care models that single out high-risk populations, such as
Hennepin County’s (Minnesota). Finally the group began offering ideas about its vision for the future
state HCHN should move toward in order to take full advantage of the overlap of broad population-
based initiatives with HCHN’s mission and program models. For example, the group discussed reframing
HCHN’s value to the community and, more specifically, how HCHN data and evaluation efforts could
evolve to better align with data and evaluation strategies tied to health care reform and housing
strategies.
Attendees: Maureen Brown, Health Care for the Homeless Planning Council; Brad Finegood, King County
Behavioral Health and Recovery Division; Jeff Sakuma, City of Seattle Human Services Department;
Janna Wilson, PHSKC; David Wertheimer, Betsy Jones, Gordon McHenry, TJ Cosgrove, John Gilvar,
Denise Hawthorne
3. 11/2/15
All Home Executive Director Mark Putnam outlined All Home’s new strategic plan for making
homelessness in King County (1) rare, (2) brief, and (3) one-time. The group then discussed the
alignment of All Home initiatives that flow from this plan with HCHN’s collaboration with multiple
community partners to integrate best practices for health and housing. This discussion led to
brainstorming around ways for HCHN and All Home leadership to more intentionally collaborate on
multiple fronts.
In addition the group reviewed and revised a draft planning matrix that PHSKC developed to reflect
discussion at the first two meetings regarding moving HCHN from its Current State toward a Future
State Vision. This matrix broke the discussion into the following broad strategic areas of focus: Value
Propositions, Outcomes, Data, Health Care Reform Opportunities, Housing Partnerships, and Funding.
The group then discussed how this matrix could be used to organize development of concrete
recommendations at the final meeting.
Attendees: Sola Plumacher, City of Seattle Human Services Department; Mark Putnam; Gordon
McHenry; Brad Finegood; David Wertheimer; Greg Francis; Jerry DeGrieck; Janna Wilson; TJ Cosgrove;
John Gilvar; Denise Hawthorne
Products: Meeting #3 finalized a planning matrix (attached).
4. 1/26/16
The group began the final meeting by walking through the planning matrix. It then engaged in a
facilitated SWOC exercise to identify HCHN’s Strengths, Weaknesses, Opportunities, and Challenges in
terms of adapting to health care reform and other aspects of the policy and planning landscape that are

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evolving rapidly. Finally, it brainstormed strategies for positioning HCHN to take action, both in the
near-term and long-term.
Attendees: Mark Putnam, Greg Francis, Maureen Brown, David Wertheimer, Jeff Sakuma, Betsy Jones,
Sarah Hopkins (PHSKC facilitator), Janna Wilson, TJ Cosgrove, Jerry DeGrieck, John Gilvar, Denise
Hawthorne
Products: Please see Recommendations section below.
Recommendations
The work of the thought leaders group culminated in the brainstorming of potential strategies for taking HCHN
from the Current State to the Future State Vision. These strategies call for HCHN to position itself to better
leverage an emerging policy consensus around the need for client-centered interventions that concurrently
address the housing, physical health, and behavioral health needs of people experiencing homelessness in
helping them achieve greater personal stability. They demand that HCHN better highlight and bring to
community planning tables its long history of success in fostering both holistic care coordination that crosses
agency boundaries and the seamless integration of behavioral health, physical health, and housing services.
They also demand that HCHN undertake this work in a way that very intentionally weaves together
improvements in the areas of (1) using data to measure and document outcomes, (2) building new
partnerships and strengthening connections, especially with key Continuum of Care planning participants, and
(3) using the health-housing lens in framing its successful programs and developing new initiatives.
Three broad themes ran through the group’s discussions of all of the proposed strategies. They are:
1. Continuum of Care Collaboration. Increase collaboration with All Home and other key community
partners in the housing and homeless services arena. Work with All Home leadership to identify and
exploit opportunities for increasing State and local support for Health-Housing initiatives to bring
chronically homeless people into housing and concurrently provide treatment, care coordination, and
case management for physical and behavioral health needs. In particular, seek alignment with All
Home’s implementation of Coordinated Entry into housing, which includes stratifying those seeking
housing by screening for vulnerability, including medical and behavioral health vulnerability.
2. Inform Healthcare Reform. Strengthen HCHN’s profile and influence within local and State planning
initiatives currently developing population-based Medicaid investments, such as the Accountable
Community of Health. Demonstrate and frame the value of integrated HCHN care delivery models
within the context of State of Washington health care reform goals. In particular, better articulate,
highlight, and optimize HCHN collaborative models of care that align with the State’s health care
delivery system reform goals proposed in its Global Waiver application as well as the permanent
supportive housing benefit demonstration proposed in the waiver. These HCHN models of care revolve
around services that have historically been excluded from fee-for-service Medicaid reimbursement.
Examples include outreach, intensive case management that follows the patient across providers, and
transdisciplinary care coordination that includes shelter and/or housing providers. The Housing Health
Outreach Team, the Mobile Medical Program, the REACH Program, the Edward Thomas House Medical
Respite Program, and other HCHN collaborations all provide services in ways that align extremely well
with the State’s health care delivery system reform key areas of focus:
 Bi-directional integrated delivery of physical and behavioral health services
 Alignment of care coordination and case management to serve the whole person

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 Transitional care focused on specific populations
 Outreach, engagement, and recovery supports1
3. Assurance. Enhance HCHN’s ability to encourage adoption of best practices throughout the local health
care safety net provider community. In addition to enhancing and highlighting HCHN programs and
models that are dedicated to the homeless population, HCHN should explore ways to make the care
delivery models of all community health providers more responsive to the needs of homeless patients.
We have organized the group’s strategy proposals into the attached matrix. This matrix will help guide HCHN in
taking action that aligns with these common themes and also reflects the interwoven areas of improvement
listed above: (1) Data and Outcomes, (2) Partnering and Connections, and (3) Health Care and Housing. The
matrix also notes work begun between the last group meeting in January 2016 and this summary document’s
completion.
1
State of Washington Health Care Authority Fact Sheet: Healthier Washington Medicaid Transformation Waiver,
http://www.hca.wa.gov/hw/Documents/waiverfactsheet2.pdf