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Partnership in Action: Helping Virginia’s Most Vulnerable Find Home and Health

At Housing Virginia’s Most Vulnerable Conference, Upside’s Julie Isaacs joined Elizabeth Ramsey of Anthem HealthKeepers Plus to show what true partnership looks like in practice. Together, they illustrated how shared accountability, speed, and trust transform housing referrals into lasting stability for Virginia’s most vulnerable members.

Housing Is Healthcare and It Works When We Work Together

Anthem HealthKeepers Plus, a Medicaid Managed Care Organization serving members through Virginia’s Cardinal Care program, has made housing stability a cornerstone of its health equity work. The logic is simple but profound: stable housing leads to better health outcomes.

Upside complements that mission as a tech-enabled housing partner—a single-source solution connecting members to safe, affordable homes through a proprietary network. By integrating directly with plan systems, Upside delivers end-to-end navigation, placement, and stabilization, ensuring every referral is more than a transaction—it’s a pathway to health.

The Anthem–Upside partnership in Virginia demonstrates how collaboration can move from promise to proof.

A Coordinated Path from Referral to Stability

Housing instability touches everything: chronic conditions, behavioral health, emergency care utilization, financial stress, and care continuity. That’s why the Anthem–Upside model builds coordination into every phase:

1. Initial Contact & Intake – Outreach begins within hours of referral, combining speed with empathy to establish early trust.
2. Housing Plan Creation – Each member receives a tailored roadmap, identifying barriers like income verification, credit issues, or accessibility needs.
3. Active Navigation & Support – Care Guides walk members through applications, deposits, documentation, and move-in logistics.
4. Care Facility Placement (when needed) – For members transitioning into assisted living or group homes, housing and medical needs are aligned from the start.
5. Safer at Home – For those aging in place, Upside coordinates safety modifications to prevent falls, ER visits, and readmissions.

What Makes It Work

1. Speed Matters. Early engagement builds trust before crises escalate.
2. Shared Accountability. Both partners own the outcome—housing stability as a shared success metric, not a handoff.
3. Precision Intervention. Stratification helps match the right intensity of support to each member’s readiness.
4. Human-Centered Methods. Motivational Interviewing, SMART Goals, and Acceptance and Commitment Therapy (ACT) techniques help members overcome fear, rebuild confidence, and act on their own motivation.
5. Flex Funds. Modest financial support—like help with deposits or arrears—often closes the final gap between crisis and stability.

Stability You Can Measure

• Reduced ER visits and hospitalizations through housing-first stabilization.
• Improved STARs and HEDIS performance by addressing social drivers at their root.
• Faster time to move-in—an average of just over two months from referral to stabilization.
• Member satisfaction at 100%, with nearly nine in ten reporting improved quality of life after engagement.

These outcomes don’t happen by chance—they happen through structure, integration, and relentless collaboration.

Lessons for Health Plans Everywhere

• Housing is healthcare. Treat it with the same urgency as any clinical intervention.
• Invest in human connection. Empathy and follow-through drive engagement better than algorithms.
• Measure what matters. Beyond data, tell the human stories behind each metric.
• Share the work and the wins. True partnership means shared ownership, shared insight, and shared success.

Looking Ahead

The Anthem–Upside partnership in Virginia is more than a case study—it’s a model for what’s possible when health plans and housing partners work as one system. Together, they’re proving that when housing interventions are integrated, responsive, and human-centered, health equity isn’t just an aspiration—it’s achievable.