that's where our health care and homeless programs help. >> it's interesting the first surgeon general a e mr. richmond developed a program so picture a cycle or circle s that has 3 equally dwbtd pieces and knowledge is only 1/3rd of the pie then there's strategic and political will be so 15 years ago when i got interested i think it was a question why don't home matter we know it matters we know what works and how to make people healthy and do supportive permanent housing. it's taking that piece of the pie we've got the knowledge now,

it's about the political and strategic it's wasn't i spend my time talking about that you care about child education there's a push for universal programs. i'll say that which would education isn't going 80 work with a situations where the child is moving under place to place. secretary jones was talking about the precondition to get health and economic security and get a job and the key position is home. that's what our political will and strategies have to be about. it's taking our knowledge and translating it. one of the strategies is echoing this wrong pocket you're a viper

how do we deal with that. as much as we know what works pause it works like this; right? if someone coming out of jail into housing and i nonetheless have to pay them to be in jail where don't this savings go. we see that whether it's medicaid a or human services. so one of the things dhs is looking at it is the social impact bond. people are looking at impact social bond then you attract private capital to visited in solutions and if those solutions work can government pay off the investors. we're interesting because it's

at the wrong pocket. those people who are looking at the initiatives from the bond whether in the governor office or driven out of the city administrators office and that's really important in addressing the wrong pockets issue because you have to have someone that sits overall those sources of fund 80 be able to say you know what we are going to take the savings and apply them over here >> one thing on that. my world view is a the first concert i want to was joan bias and if i had my way i'd district the waelth but that's not the world we live in. i read in new york times said

something like president obama wants 84 you 80 make money from the health care act and this gentleman sows the opportunity in the health care system where we can bring people from the hospital into the home and it's less expensive where it costs the government a huge amount of money he sis this on a in violation to make money for his strarldz but what's going to happen when a person can't go anywhere so maybe the managed care addition is lifeguard to pay will not only by a important

the navigation but pay for a home because it will be less expensive for the health care system if the health care system pony up and buy homes to quote for access to this treatment. the opportunity is really great to overcome this board pocket opportunity because we see the board population opportunity. some of you can figure this out. i thought it was out of 340i debt but i know someone what figure out how to connect those two not just do the right thing but reduce the costs and save money >> it's connecting the dots you have the knowledge to including

the will and strategy from a strategy standpoint let's talk about first of all, connecting the difficult between the federal government. so so 4ud and the federal have delivered each other autopsy report talking about the smoke free housing what's the changes? >> i think i want to step back i actually talk to housing folks a lot and in many ways i find those folks open to the conversation then my own medical fold. i ask you do you know where people get health care. almost never do they know. when you take a lot of information from them. you actually know what their income is you know a lot of

demographics and you don't know where they get their health care. you don't know who you should be partnering with the wrong pockets point of view. that's the simple strategy. it's the same thing when we talk on the health care side you should know who's in public housing. in boston 12 percent of all renters live in public housing. we think that 25 percent of our folks live in public housing. it's liquor a public housing program. we've had a wonderful relationship we've been blaesz blessed to have our administrator and they roll truly believe that this housing is a approach health.

so one of the things we really led the way on and something that's a coalition effort is the idea could you go smoke fro and what would that look like. and partner for the community of boston tenant and do tenant want this. the response was yes, they want to have smoke free housing and side how to put it in place. the federal government permission how to do that and we ought to do this more broadly human resources i'll often talk about we as physicians witness policy inadequacy on the bodies of our patient so i see the kid who is wheezing because their neighbor is smoking. the solution is trying to relocation those folks but it

make sense to 340e6 them then a treat every patient over and over again. i think population health is a buzz word in the health population. this is where the housing world if you can come to them and say half of my resident get health care in the system those are things that that are important to us. i'm a off site case manager and i have one on site why don't we partner together and pay for that physician that's the answer. >> a really important thing for us who practice this to house them and provide medical care the wrong pockets is one.

benevolence is one thing so 80 do things right. but there's a bump of people who are 2k0ik9d to nicotine. they go into smoke fro housing and smoke now we spend send them to the streets. so there's the ideologies and yet the person next to them, you know, might have asthma and they'd be exposed to second-hand smoke. so this is common in our work and on a exciting place to figure it out are the right answer is among the folks that are living there. can they came up what an answer a way that will be unique to the

community. request have to honor the strength of the people we serve by giving them those rolls but it's also a fun point >> it's an excellent point and some of you who are housing providers here how successive would you be in evoking someone in a court. in counties it would be different >> the legal community could solve this and figure out this problem we sitting around in this is this room we cannot figure it out. >> the opportunities right so in boston we host smoking classes on site at the housing development and the housing commission had 10 different languages of tobacco speciality that would talk to people.

it's one of the things you can use the glass half full or empty. we want people to quit smoking, smoking it bad. smoking is a better choice of things but we have 80 figure out a way to help people >> the 4 city's you talked about that's part of the socializati socialization. so whose our ultimate audience thinking about your social impact bonds and a philanthropy >> yeah. and you asked a question earlier do we need more research. in this area dhs felt we did. many community look at the supporting of housing there was

no coercion of those studies. or their health related outcome so with this new intuitively we'll have one coordinated evacuation to provide to the federal government. and so that would be proefr for government and hopefully we'll be able to point out that study and a kansas won't say we need our own study. i want to follow up on something megan talked about how houseers don't know that health care assets in the community that's so true. when you know, i looked at cross the country i can talk about any provider they wouldn't know with the kwuflgd health centers are in their community.

and noting this administration and congress made a several billion dollar investment in health qualified centers. one of the great opportunity if we can make this marriage of housing and health care provider interest work we can really leverage the assets of the health centers that have had to infuse investment of late. but the other opportunity is the affordable care act that josh mentioned. now the people we've think hell for a long, long time most of them are eligible for medicaid but the houseers have to know where the health care is it's noting good enough to know you have it we have to create an infrastructure to link.

on one hand it's an opportunity and a other than the other hand a challenge. the housing providers that want to work within the medicaid system and have 80 create their own infrastructure to do that and really build their own knowledge around the health care system and the word patient navigation is a buzz word >> california invest in the health navigators to enroll people in medicaid. people have to recidivist their tenant every year with the same information that needs to be taken to make sure that someone's enrolled in medicaid. we've talked about this in new england can you mayor those

dollars. people who show up for food assistance why couldn't the hours get the same grant to make sure that everyone in their unit as health care. health care educates matters. many the chrndz health care program we know that if you have ongoing health insurance your let's likely to have chronic diseases so your ability to answer the question of who our patient as health care insurance and make sure it's active maybe you having can help the tenant stay housed >> i think that's a great idea most of the folks are earning money but don't have the resources so there's less incentive to take on more

responsibility. it leads me to an issue how we can bring groups together you mentioned the business industry. in san francisco we have accident staff that is trying to use factors to work with businesses. can you talk about your experience maybe the 3 of you sectors outside of your own you speak to knows are there trade associations for example, the american medical association opened to to advocates >> deborah you want to start. >> yes. josh talked about manage care it's one of the must dodz and that's one of the areas a that's obey focused on managed care companies have the most to gain and loss.

they need to serve a vulnerable population and they all recognition housing asia scombeej but no one knows how to pay for it. they're looking at the board of housing groups to provide that knowledge to them. this is an opportunity for us to roll push the conversation with the manage care companies and over the support of housing sector as a partner to help them achieve the goal they need to k345u6 u achieve and the outcomes they need to servicing this how vulnerable and a high cost population. that also see means our housing scene of the accident e sector has to do a better job of creating an infrastructure. we didn't talk about there are two different lexicons the

hoursed talk a different way then then the other folks so we have to be sensitive to the matter of for each of the industries >> i'd like love to get venture capital involved there is a big deceased out there they didn't get treatment yet there's medication out there that can cure folks. there's a huge push in the pharmaceutical to market their incredibly rich in side effects shall we say. but this company is out of boston they have a new medication is now capitalized in one trillion dollars so someone has thought there's money to be made for people who used a

little bit of drugs in the 60s and now are or else with this disease they think this is a market they can expiate. i think there's a market to expiate expiate in getting managed care to invest in housing. i know the twittering have an i o oppose thursday but someone who is smarter than i am can really get united health care which is the largest managed health care agency. those are droifg our health care policies. liquor the san francisco health plan it's like the 70 accounting down there in the managed care there's huge amaze of money. i've given up on the argument if i want to get people that want to cross that aisle to start

moving to the extent we can get in done so my skids can only read about homelessness in history boxes we have to get outside your consist zone and get people really to invest in this the extent they can and should to make this a movement that will end homelessness in our time >> it's really interesting i love talking about pay off. i do trowel believe you can do well by doing go here you can house people and save money. i struggle i'm a pediatrician i care about kids zero to 3 that's the brain you're going to have with the rest of you're alive you put to death together what you're brain is going to be. the hoard thing about the group

the pave is 3r0u7bd but if the pave happens 20 years later and most people don't want to wait that long. the argument that viflt in housing matters for that group so i end up talking about things about the economic future people want 80 talk about people rode to learn at age 5 and i'm trying to accepting sell them on housing so that person showed up rode to learn. and that can be sometimes a harder argument to make but there's a huge will in the business community to talk about vats and investment in which would and having them think about housing as a precondition

to a making this other investments work is crimping - criticizing important. the ceo of a hospital would go up to a statehouse and talk about where affordable housing velocity is important to that hospital is a unique voice one that has been missing and more and more hospitals are going to have to think about it maybe part of what they do is invest in their highest risks patients it's better for their bottom line. they'll get punished for remissions and that's the only way to get them to stop them from come back to the hospital but the flip do if you're thinking about a population of people that are taken care of by health care system they're to have to start thinking about the

health care only changes our health by 10 percent your genetic code maybe about 10 percent but 50 percent of your health comes from your environment so what we know it being to have a small business talk about the social detriment being important is a game chairman >> if we tangle to one another in this room we won't have the kind of impact but from a statistic prospective home matters can capture people the difficulty is finding multiple brand for lack of a better word but children are good brand. i think it's a harder sell with the homeless in the general

population so maybe it's a straefbl conversation >> i think we have a problem with recall. everything they have a problem with brake systems and the brand gets diminished. we're in the health care sector inadequate in serving people that are addicted to alcohol, you know, and we have a gentleman here who can talk about that. we're not doing our job who are housing people not sober a single day in their lives. so if we can't attend to the folks who are really doing badly in your health care system despite the resources. so we need to make headway on

folks who are living with chronic clovm or have something that helps people get rid of alcohol. we need to make sure - i want to jump on the band would agner. i think when i went up to ott what and canada in may i saw those programs they take people off the streets all their lives they've been drinking everyday and dying at how rates and move them into a roaming system and give them alcohol to a minimum and they stayed housed it's

great. the joy for me as a physician is to do this. we can't do it halfway we have to do it all you tell way with the community and alcohol and we're not all dealing with this issue. unless we're all in our brand will be tafrnd and we'll not been able to move forward for people who are alcoholics >> i think we look for thingz that are common sense slukdz and it's hard to turn this around but it's effective and that's what we want to do at the end of the day. >> i tried more and more to help people understand why they

should care about home matters because it's easy to think of it as the other problem it's not my problem. part of the reason i use the vaccine analogy. so two an stent having people understand if myself kid is in school next to a child who's homeless my child w0e7b9 lien as well, because homeless kids need more attention and have a harder time paying attention so i would even argue that having homeless men off the street is good for a community for a lot of different reasons. our ability to view it as a collective good, i trowel

believe in now more and more thinking about the brand and he conversation. i think we've godfather gun control two deserved to it therefore we can't change. i end up being ri789d the division of insanity is doing the same thing over and over again expecting a different result >> just to piggy back what michael began said the cost effectiveness of getting someone out of the street instead of being in jail that's motivated self president's to invest resources into supportive howard's. we should all pause for a moment and take credit for the fact cross the country we've seen a thirty percent reduction in

chronology homelessness while at the same time homeless statistics haven't front yard and i think what'sizing is the conversation we've had together supportive jorge's is a priority and the people who are doing it, it's not been easy. they haven't had the tools or serve funding are access to health care. so today's conversation is really important we're having the conversation of how to marry the hours with the health care. we've only gotten to thirty percent not because there isn't enough housing there's a direct co- recollection between the units that have been created around the country we haven't gotten the thirty periods of time because we