This story is part of a series looking at places around the U.S. that are successfully reducing homelessness. Check out all of our stories. The University of Illinois Hospital is one of a few hospitals in the Chicago area that have started providing permanent housing for homeless patients that repeatedly show up in emergency rooms. The program, called Better Health Through Housing, in partnership with the Center for Housing and Health, treats chronic homelessness as a health issue. Finding people permanent supportive housing also reduces health care costs, says Stephen Brown, director of preventive emergency medicine at the University of Illinois Hospital. "So if someone is living unsheltered under a bridge, and they have no other options because they might have been kicked out of crisis shelters, they're going to come to our emergency department and seek care," he says. "So we've now got some pretty compelling data that the solution may be cheaper than the problem." While many people who are homeless come to the hospital just to seek shelter, many others come to the ER for legitimate health issues, Brown says. Putting them in permanent housing also helps improve their overall health, he says: They aren't out on the street where they're more prone to injury, violence and frostbite. "Being homeless is hard on the body ... and if you have a chronic medical condition, it's only going to exacerbate it," he says. "We also found some individuals that were just coming for what we call 'secondary gain,' and their health care costs plummeted because they had no reason to seek out shelter in emergency departments any longer." Interview Highlights On how the program works "We partnered with the Center for Housing and Health, it's a subsidiary of the AIDS Foundation. They were looking to replicate some of the outcomes from a randomized-control trial here that was done in the early 2000s that demonstrated the efficacy of what we call 'housing first' — putting somebody into housing immediately without any preconditions. And so we're a state institution with a health equity mission, and it really gravitated with us [as] really something that we wanted to participate in, and so we agreed to be their first hospital partner. We identified chronically homeless individuals — those that are homeless continuously for over a year or who have had four episodes in the previous three years — and then transition them into permanent supportive housing. And then we tracked their mortality, their morbidity and their cost and utilization."

"We often joke it's probably cheaper to put them up in a hotel on North Michigan [Avenue] at $625 a night. An ER visit's about $1,200." Stephen Brown

On the role of hospitals in finding housing for homeless people "So when we started doing this, we were kind of in the blind and found our way around this. I think we didn't really have a strong justification to doing this other than it was part of our health equity mission, and it was the right thing to do. But kind of backing into it after having gone through this experience I think we've got a lot of compelling data that essentially says that housing is health. That once you put someone into stable housing with a little bit of support, or more support depending on the severity of their mental illness or substance abuse, they tend to do well. And that means that they stop coming to emergency departments. So they often come for nonmedical reasons. We call it secondary gain. So if someone is living unsheltered under a bridge, and they have no other options because they might have been kicked out of crisis shelters, they're going to come to our emergency department and seek care. So we've now got some pretty compelling data that the solution may be cheaper than the problem." On the cost of finding housing for people who are homeless "We pay $1,000 per member per month, a maximum of $12,000 a year. That's put together with a number of other subsidies that the Center for Housing and Health has with [the Department of Housing and Urban Development] and other grantors. If you were to look at the total cost of housing and support for an individual that would be in a housing-first model, it's about fully loaded about $25,000 a year. Now if you contrast that with just the health care costs and only my health care costs — I'm not able to look at Medicaid claims data — we had patients that had health care costs somewhere between two-and-a-half to 160 times our average patient cost. One gentleman who was deceased before I ever met him had a reimbursable cost from the state of $938,000. We often joke it's probably cheaper to put them up in a hotel on North Michigan [Avenue] at $625 a night. An ER visit's about $1,200." On how the program is funded "We did this originally through a gifting account through some philanthropic dollars in our first fiscal year. The hospital's now committed through fiscal year 2023 through our operating budget. I must say though what we're doing is not sustainable because we're not being paid for it. But there's a much larger effort going on in Chicago through what we call the flexible housing pool that's going to make this sustainable. And we're attracting a number of insurance companies that are looking at some of the data ... and we're making a really compelling economic argument to insurance companies that it's worth the investment in housing. So there are several managed-care organizations that manage Medicaid patients here that are very interested in some of the data that we have."

"Whenever I talk to anybody in all these different public sectors, everybody says the same things, 'Your people are my people.' " Stephen Brown