For years, health plans have acknowledged that housing instability plays a major role in poor health outcomes and increased costs. But despite pilot programs, partnerships, and SDOH initiatives, the reality on the ground hasn’t changed much for the people who need support the most.
Most housing efforts fail not because plans don’t care but because the way they’re structured doesn’t reflect how housing instability actually plays out in real life.
In my work with health plans across the country, I’ve had countless conversations with leaders who say some version of the same thing: “We tried a housing program. It didn’t work.” And what they often mean is, “It was too hard. There wasn’t enough inventory. Our members didn’t engage. We didn’t see results.”
But when you peel that back, it’s clear that many of these programs never had a real chance to succeed because they were built on assumptions that don’t match the lived experience of vulnerable members.
When housing comes up in healthcare conversations, most leaders instinctively jump to a supply-side mindset. They picture waitlists, zoning challenges, and the monumental task of building new units. So the thinking becomes: housing is important, but it’s not fixable in the near term.
But in most regions, the issue isn’t the existence of housing, it’s the accessibility of it. I’ve seen this firsthand. Members who could technically qualify for an apartment still struggle to secure one because they don’t have a phone, can’t navigate an application portal, or need someone to advocate on their behalf with a landlord.
The support they need isn’t infrastructure, it’s navigation, trust, and practical assistance. Most housing is out of reach not because it doesn’t exist, but because we’ve underestimated what it takes for someone in crisis to move into it.
Health plans are generally strong at identifying risk. They’re screening members for housing instability, flagging SDOH barriers, and routing people to community-based organizations. But what happens next is often a black hole.
What I saw early on was a pattern: highly vulnerable members were being “screened and referred” into a fragmented system. Maybe to a food bank. Maybe to a shelter. Maybe to a nonprofit doing its best with limited resources. But there was no consistency. No follow-through. No accountability. And no data coming back to the plan.
What was missing was intervention.
When we started working directly with these members, something powerful happened. Because we were hands-on and persistent, members started opening up. We’d uncover untreated conditions, missed diagnoses, transportation barriers, things the health plan didn’t know because they’d never been able to establish that kind of relationship.
It became clear that housing isn’t just one problem among many it’s the gateway to engaging the rest.
The binary logic of many housing programs, someone is either housed or unhoused, doesn’t reflect reality. Every member comes into the process at a different point. Some are ready to move tomorrow. Others have significant mental health or substance use issues, no income, no documentation, and no support system.
In those cases, putting someone into housing isn’t just about placement, it’s about building a pathway. Sometimes that pathway is long. And sometimes, the most important success metric isn’t “Did we get them into an apartment this month?” but “Did we move them one step closer to stability?”
That perspective shift is crucial. Otherwise, plans end up designing programs that serve the easiest-to-house, while the most complex, highest-cost members fall through the cracks.
There’s no universal blueprint for a successful housing program, but there are patterns I’ve seen work consistently. It starts with identifying which members are most likely to benefit not just based on housing status, but based on readiness, complexity, and long-term potential for stability.
From there, it’s about engaging regularly and consistently. Not one-touch referrals, but ongoing relationships. And critically, it’s about recognizing that housing strategy isn’t separate from care strategy. If a member is unhoused, their chances of managing chronic illness, making preventive appointments, or staying out of the ED drop dramatically.
Housing can’t be siloed. It has to be integrated.
Not because you didn’t care. Not because you didn’t invest. But because housing instability is fundamentally different from other social needs it’s dynamic, it’s relational, and it demands more than a transactional response.
In every successful case I’ve seen, it’s not one intervention that works, it’s a coordinated, persistent approach rooted in human connection, practical support, and a deep understanding of what it really takes to move someone from instability to stability.
If you’re rethinking your housing strategy, start there. Don’t just ask, “Who’s unhoused?” Ask: “Who needs a path? And what will it actually take to walk it with them?”
Because once housing is stabilized, everything else – engagement, outcomes, trust – starts to unlock.
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