UPMC Health Plan Collaborates to Address Housing as a Social Determinant of Health

The University of Pittsburgh Medical Center (UPMC) is a healthcare provider consisting of 40 hospitals and 800 doctors' offices and outpatient centers. Its health insurance division, UPMC Health Plan, is the largest medical insurer in western Pennsylvania. To meet the health system's obligations as a nonprofit entity, UPMC Health Plan has spent years addressing the social determinants of health through place-based actions. After making its first significant investments in community development in 2017, UPMC Health Plan recognized the need for a strategy to engage its widespread community partners and amplify the positive effects of its investments. In 2018, UPMC Health Plan, along with five other healthcare organizations across the United States, entered the 3-year Accelerating Investments for Healthy Communities (AIHC) initiative.

The Center for Community Investment (CCI) at the Lincoln Institute of Land Policy launched the AIHC initiative to help the healthcare organizations ensure that their affordable housing investments improve community health. The initiative sought to coordinate the goal of health institutions to improve health outcomes with the goal of community development organizations to improve community conditions. In particular, CCI used its capital absorption framework through which the organizations and their community partners developed a shared infrastructure to absorb investment capital. The framework begins with an understanding of the social determinants of health, preparing a community-endorsed set of priorities among the community’s most pressing health needs, and mapping the available stakeholders to address those needs. The next part of the framework involves identifying a pipeline of available stakeholder resources matched with specific actions and projects. The framework also calls for creating an environment of policies, relationships, and other resources that enable successful completion of the projects.

In applying the capital absorption framework, UPMC Health Plan focused on the city of Pittsburgh and sought out potential partners among organizations that were familiar with local conditions and needs and had working relationships with residents and local businesses. Ultimately, the AIHC team included Neighborhood Allies, a community development intermediary for neighborhood organizations; Bridgeway Capital, a community development financial institution that has been active in the region since 1990; and ACTION-Housing, the largest nonprofit housing developer in the Pittsburgh region. Rather than concentrating on neighborhoods near its campus, UPMC Health Plan and its AIHC partners looked at health "hot spots" and high-opportunity neighborhoods where affordable housing development would be an effective intervention.

In early discussions, the partners saw the need to address the social determinants of health, including homelessness, housing cost burdens, and wealth building. But preserving privately owned affordable housing, both subsidized and unsubsidized, arose as a critical need. The Preservation Working Group united nonprofit and for-profit developers, policymakers, data analysts, funders, and other new stakeholders, with Neighborhood Allies serving as the convener. The group created a database of at-risk affordable housing units in the city and monitored the approval and construction of new developments. The group also advocated for local and state funding and policies supporting preservation and worked directly with developers to obtain funding and other resources.

Preservation was the major goal for another AIHC team initiative, the Affordable Housing Loan Fund, which marked a significant commitment to create new housing in neighborhoods where development threatens to displace residents of color and low-income households. Overseen by Bridgeway Capital, the fund initially was set at $7.9 million, to which UPMC Health Plan contributed a $3 million low-interest loan. The fund's purpose was to assist approximately 330 units through the renovation of unsubsidized affordable housing and the construction of new rent-restricted units.

Bridgeway's first loan through the fund went to ACTION-Housing, which used the money to renovate 31 units, the first phase of its Stanton-Highland Apartments project. The completed project consisted of 54 units in 3 buildings for households earning between 20 and 80 percent of the area median income. That project includes units for people with disabilities and young adults aging out of foster care.

Since the AIHC initiative ended in 2021, UPMC Health Plan has built on the knowledge gained through the initiative as it continues to address the social determinants of health and support housing programs. UPMC Health Plan's Center for Social Impact has developed strategic plans to guide funding for community efforts to provide affordable housing. One of UPMC's recent funding endeavors has been a loan and grant to help the Urban Redevelopment Authority of Pittsburgh establish the Small Landlord Fund. To encourage landlords to accept housing choice vouchers, the fund offers no-interest, forgivable loans to landlords with 10 or fewer apartments; the loan may be used for repairs and upgrades in exchange for a commitment to rent to voucher holders or households with incomes of 80 percent of the area median income for the term of the loan, which can be 10 or 15 years.

Bridgeway Capital has extended the Affordable Housing Fund that was begun under the AIHC initiative. UPMC Health Plan has committed an additional $3 million to the fund, which is intended to provide $20 million to support the preservation or construction of 850 units reserved for low-income households. Neighborhood Allies continues to convene the Preservation Working Group and received an allocation of $22.8 million from the Pennsylvania Housing Finance Agency in 2023 to support affordable housing projects in Pittsburgh and Allegheny County, of which nearly 90 percent went toward preservation projects. Members of the Preservation Working Group, including ACTION-Housing, were among the recipients of this funding. Also in 2023, UPMC Health Plan helped establish a separate housing fund, Preserve Affordability Pittsburgh, to determine neighborhood housing needs and match resources and developers to address those needs. The $11 million loan pool funds the preservation of mixed-use buildings and family and senior housing containing at least 20 dwellings in Allegheny County communities where residents are at risk of displacement.