UnitedHealth Group is at the forefront of health organizations working to increase affordable housing for vulnerable individuals and families.
The company (NYSE: UNH) recently announced that its investments in affordable housing have surpassed $1 billion. Since 2011, the company has helped create more than 25,000 homes for individuals and families across the country.
Catherine Anderson, UnitedHealth Group’s senior vice president of health equity strategy, connects the dots between health and housing and shares her company’s approach to investing in affordable housing.
What are UnitedHealth Group’s plans related to affordable housing this year?
UnitedHealth Group will continue to invest in housing with a purpose and align with partners who prioritize the integration of housing and health so that communities across the country benefit from having the necessary infrastructure and services that enable all people to live their healthiest lives. We will continue to make these investments through low-income housing tax credits (LIHTCs), social impact investment strategies, and the Community Reinvestment Act (CRA). In fact, since our year-end 2023 report closed, we have already expanded our housing investments to two additional states: Washington and Maryland. Collectively, these investments are worth $25 million and a total of 149 additional rental homes. We have several more impactful housing and health investment opportunities on the horizon and look forward to announcing them as they become finalized.
Are you ever asked why does a health company invest in housing? If so, what is your response?
That is a question I frequently hear.
As a health care company, our mission is to help people live healthier lives and make the health care system work better for everyone. Investments in housing are part of UnitedHealth Group’s commitment to advance health equity and promote community environments because we know that housing investments can positively impact health care utilization and health outcomes. Data shows that individuals with a history of homelessness have 40% fewer wellness visits for preventive care and experience, 150% more emergency department visits, and 160% more acute inpatient admissions. Data also suggests that utilization patterns and health care costs are twice as high for individuals that have experienced homelessness.
The impact that health related social needs, like housing, continues to have on the health care utilization patterns and health outcomes of the individuals and communities we serve has further reinforced UnitedHealth Group’s commitment to expanding our housing investment portfolio and to ensure that our housing investments are coupled with community-based health care programming.
Since 2011, UnitedHealth Group has invested $1 billion to help create more than 25,000 rental homes across now 33 states (and counting) and the District of Columbia.
As a LIHTC investor, what do you look for in the developments that you invest in? Are there any requirements placed on these developments?
UnitedHealth Group’s affordable housing investments are made through LIHTCs, social impact investment strategies, and the CRA. UnitedHealth Group’s investment portfolio is mission-driven and focuses on integrating health and housing. Our portfolio strategically spans a continuum of housing solutions from mixed-income properties and affordable housing developments to supportive housing for people experiencing homelessness, aiming not only to alleviate the housing crisis but also to ensure proper wraparound care to promote residents’ health and well-being. UnitedHealth Group’s housing investments range from new developments to rehabilitation and preservation. Geographies include urban, suburban, and rural settings, and demographics are inclusive of families, seniors, and military veterans.
Almost 75% of the dollars invested to-date represent LIHTC investments where UnitedHealth Group was the only LIHTC investor in the project. Our role as a proprietary investor allows us to focus on specific locations with greater needs.
We’ve worked closely with partners like the National Affordable Housing Trust (NAHT) and its Stewards of Affordable Housing for the Future (SAHF) Affordable Communities Fund, for example, to identify the communities we serve through our Optum and UnitedHealthcare businesses that are experiencing significant housing capacity challenges. We leverage sources like the America’s Health Rankings and other internal data sources to ensure we are positively impacting communities with the greatest need while also ensuring that selected investments have characteristics that aligned with the demographics of individuals we serve in those communities in hopes that these investments can help them live healthier lives.
Tell us about a recent housing project that UnitedHealth Group has been involved in:
One of our most recent completed projects was a $24 million renovation of Aya Tower in East Point, Georgia. Back in April, I was excited to attend the ribbon-cutting ceremony and a mural dedication marking the grand opening of the new affordable housing redevelopment right outside of Atlanta.
The property, which had been vacant since 2004, now provides 88 affordable one- and two-bedroom apartments for families earning between $30,000 and $40,000 annually. Additionally, through UnitedHealth Group’s community partnerships with East Point Housing Authority, Grady Health, and Goodwill of North Georgia, residents and community members will have access to several health and social services in adjacent buildings including in a new community center that will be developed by East Point Housing Authority. The Atlanta area is one of America’s largest and fastest-growing markets. Increased housing costs, in what was previously considered an affordable metro area, have put pressure on low- and middle-income families.
Our investment in Aya Tower is a great example of our company’s mission in action, which is helping people live healthier lives and helping make the health system work better for everyone.
How has your affordable housing strategy evolved over the years?
For well over a decade, UnitedHealth Group has prioritized investing in housing developments that offer affordable and mixed-income rental homes to help revitalize the communities of greatest need because it is tied to our mission of helping people live healthier lives and helping the health care system work better for everyone.
In 2019, we intentionally evolved our investment strategy to increase its alignment with our health equity strategy by ensuring housing investments are integrated with health and social services and the impact of safe, stable housing and supportive services is be measured on the health of the residents. To accomplish this, UnitedHealth Group made a pioneering investment in the Health & Housing Fund, a partnership of SAHF and NAHT. NAHT has raised and placed capital with some of the highest mission-focused partners in the marketplace, including organizations that prioritize resident services. Through this partnership, UnitedHealth Group has committed more than $200 million in capital toward affordable rental homes and has committed grant funding for onsite and near-site resident services that target a standard set of social drivers of measurable health outcomes.
At the same time, we also initiated our social impact investing strategy leveraging private debt or private equity as another avenue to invest in health, housing, and community development opportunities.
As a result, over 20% of the developments within UnitedHealth Group’s housing portfolio have now been created in connection with on-site or near-site health and social programming that is made available to all residents and community members. This critical element of UnitedHealth Group’s investment strategy is intended to increase access and reduce barriers to health and well-being services for residents with the understanding that many individuals who have previously been challenged with accessing housing have also been challenged with accessing health care services necessary for prevention, wellness, and chronic condition management.
What’s a health condition or trend that you and UnitedHealth Group have been monitoring and trying to address with affordable housing?
One of UnitedHealth Group’s largest housing development partnerships that integrates supportive health and social programming is through our Health & Housing Fund, which ensures every housing investment has critical community-based programming.
Services and programs at properties financed through the Health & Housing Fund address the goals and needs of residents and the broader community. The Health & Housing Fund builds on SAHF’s Resident Outcomes Initiative, which is continuing to demonstrate the impact of service-enriched affordable homes for residents while promoting a resident-centered framework for service coordination. These partnerships are helping to not just address access to health care, but also address the social factors and environmental influences that lead to poor health outcomes and health disparities.
So far, the Health & Housing Fund has supported a variety of programs and services that address the social and environmental factors that impact health and wellness. While outcomes are somewhat standardized across properties, the model provides flexibility to property owners and residents to design programs that are tailored to the goals, priorities, and needs of specific populations and communities.
Examples include: • Technology lending programs using tablets to address social isolation for residents;
• Food pantries with nutrition education and healthy eating programming to address nutrition insecurity;
• Resident service coordinators to help residents navigate health care access and improve overall well-being; and
• Resident-led fitness and wellness programs that include an activity tracker lending program.
Our partner, SAHF, has helped us measure the impact of these programs. We have seen:
• Residents are more likely to have an established relationship with a health care provider compared with U.S.- wide populations at similar income levels;
• Routine checkups: Residents are more likely to have a routine checkup in the past year compared with U.S.-wide populations at similar income levels; and
• Mental health: Residents are more likely to report positive mental health than low-income individuals across the United States.
Share with us an interesting fact or statistic about health and housing:
Studies show that 80% of what influences a person’s health has nothing to do with clinical care.
According to the Center on Budget and Policy Priorities, households that struggle to pay the rent are at a heightened risk for negative health outcomes. High housing costs can force them to make difficult choices between paying rent and paying for medicine, food, heating, transportation, and other essentials.
Adults are more likely to cut back on prescription medications, and children perform worse on cognitive development tests than children of families in affordable housing. By taking the stresses of unstable housing off their plate, people have more time and energy to work with their providers on improving their health, which overtime yields lower cost across the health care system.
We also see reductions in utilization of crisis systems of care like emergency department visits and unnecessary in-patient hospitalizations when people are stably housed and getting the support they need. This is why UnitedHealth Group’s coordinated investment strategy in housing, health, and social services demonstrates a deep commitment to advancing health equity.
How will the health and affordable housing connection be different 10 years from now?
Given the interconnectedness of housing and health, the private sector has an incentive to be a strong supporter of housing programs at the federal, state, and local levels, as well as being a supporter of developing cross-sector partnerships that are critical to the sustainability of the programs. In 10 years from now, we hope to see more large private-sector organizations leaning in with intentional housing and health investments to improve health outcomes, reduce the cost and strain on the health care delivery system, and grow overall community vitality and stability.
The private sector has the means to contribute meaningful capital to fund the development and rehabilitation of affordable housing and corresponding community resources, but it is also important to consider the long-term sustainability plans for these investments.
Successful, sustainable models that UnitedHealth Group has participated in have included cross-sector coalition-led, state-sponsored outcome-based financing investments in supportive housing programs, and county-led, Department of Housing and Urban Development-sponsored permanent supportive housing programs. It is critical for these types of sustainable programs to be scaled and replicated across the country. However, as successful as these models are, program design should go beyond permanent supportive housing models. Newly introduced Medicaid funding mechanisms in certain states have created a path to increase coordination of essential housing services and supports, but sustainable funding and program coordination for those covered by Medicare and employer-sponsored plans remains unaddressed.
Perhaps that will be another area of focus for collective thought leadership within the next 10 years.
