Cathedral Square outlines SASH expansion and pilots, cites Medicare savings and eviction prevention

Kim Fitzgerald, chief executive officer of Cathedral Square, and Liz Genge, director of SASH, briefed the Health Care Committee on the program—s 15-year history, current scale and new pilots that extend supportive services beyond congregate older-adult housing.

Fitzgerald said SASH began as a resident-driven pilot in 2009 at Cathedral Square—s Heidenberg property and expanded after that initial demonstration showed reduced emergency-department use. The program pairs a SASH coordinator and a wellness nurse for panels of roughly 70 to 100 people; the pilot levels were about 40 hours of coordinator time and 10 hours of wellness nursing per panel. The program later joined the Blueprint and received Medicare funding through the multi-payer advanced primary care demonstration, and it now operates under the state—s payer arrangements.

Fitzgerald said SASH panels were historically capped at 54 panels statewide and modest payment updates over time allowed expansion to 57 panels; SASH now serves about 5,000 participants and Cathedral Square estimates more than 12,000 people have engaged with the program since inception. A third of participants are Medicare, a third Medicaid and a third commercial payer mix in recent reporting, Fitzgerald said.

Fitzgerald and Genge cited an independent evaluation that found average Medicare savings of about $1,400 per participant and an estimated Medicaid savings of roughly $400 per participant in the study period. The pair emphasized that SASH serves a medically complex population: more than 85 percent of participants have three or more chronic conditions and the program—s average participant age is in the early-70s.

Genge described ongoing pilots: integrating mental-health clinicians into panels (multiple counties) and a SASH-for-All model in Brattleboro that serves multifamily, mixed-age affordable housing. In Brattleboro the team prevented 19 evictions to date, ran more than 160 social-connection activities, and logged over 1,300 clinician visits in the first year of embedded behavioral-health staffing. Genge said 87 percent of adults in the Brattleboro pilot qualify for Medicaid and 87 percent reported food insecurity.

Fitzgerald said SASH—s accessible, in-home approach allows wellness nurses to do Medicare annual wellness visits under a OneCare participation waiver pilot and to coordinate with partner primary-care practices using shared electronic records in those pilots.

Committee members asked about funding sustainability and threats. Fitzgerald said long-term funding has been a recurring challenge because the program relies on multi-payer PMPM payments that have not always increased with costs; modest historic increases and sequestration-era cuts reduced per-panel funding, and SASH leaders said they need predictable increases to expand successful pilots. She urged that the AHEAD model or state budget include steady support to protect and scale SASH operations.

Fitzgerald closed by noting SASH—s replication in other states and the program—s potential fit under future statewide payment models, while warning that funding uncertainty poses the biggest threat to sustaining and expanding proven services.