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The First Hippo Award for Healthy Multifamily Property Goes to…

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A lot of times, people don’t know what they want until you show it to them.  – Steve Jobs

Dateline – June 1, 2023. National Housing & Rehabilitation Association announces the inaugural winner of its Hippo Award for Innovative Design in a Healthy Multifamily Property is Hygeia Developments’ Galen Apartments. “We’re thrilled that our two years of hard work are being honored this way,” says Diane Kecht, Galen’s resident health officer. “It was a total commitment from the company, top to bottom, based on the three health pillars of Indoor Air Quality, free-fast-everywhere-everywhen-everybody (EveryFree) broadband, and most notably resident agency. We all pledged to tell our residents everything they wanted to know about the property’s healthiness, all the time, and to ask them to be our partners in making every nook and cranny of our property and their homes healthy for everybody. We built our systems around that pledge.”

Although Hygeia originally divided improvements into medical, physical, operational and informational, it rapidly became clear they had to be interconnected. Free-fast-everywhere-everywhen at-home broadband was the first step “a got-to-have-it-yesterday” mandate from the top. Under Hygeia’s first-in-the-nation Health Information Bill of Rights, all residents are entitled to ‘transparent building health disclosure’: real-time knowledge of indoor air quality (IAQ), airborne particulates, airflow rates, humidity, CO2 concentration and more. With touchless fobs largely having replaced locks and keys, eye-height Health Windows (with thermal imaging taking the viewer’s temperature) at doors or elevators display health information. Fob proximity allows users to access customized views in multiple languages.

Health Windows are powered by Hygeia’s homegrown Health Environmental Report Monitoring and Evaluation System, all of which data is speedily available to all residents via the company’s free downloadable Epione health app. Under Hygeia’s Informed Opt-In approach, residents can choose to link Epione’s reports with their phone’s health monitors, synchronizing building data with their blood pressure and heart rate. Residents always control not only which data they allow to be uploaded but what it can be used for. Many, especially the elderly, sign up for personal and confidential text alerts of localized building-environment changes or even individual biometric health prompts.

“All the necessary tech was already available when I came onboard two years ago,” says Dan Vantari, Hygeia’s chief health officer. “Most of it is cheaper than you think. We just had the vision to integrate the pieces at each property.” Vantari, a long-term veteran of HCO Asclepial, was lured away by the prospect of “moving upstream from the hospital,” as he puts it. “After a couple of decades seeing only customers sick enough to come to our hospitals or clinics, the opportunity to help them stay healthy on their own was irresistible.”

“Tech evolves faster than we do,” Vantari notes, “so we adopted a durable-design principle of tech improvability, engineering for continuous modular upgradeability and flexibility.” With EveryFree broadband, controls and performance of fans, filters, thermostats and air pressure could be easily, cheaply and seamlessly coordinated to maximize fresh airflow, including outside venting from kitchens, bathrooms and other high-particulate enclosed spaces. Weekly analyses of wastewater and sewage track listeria, vitamin deficiencies, influenza viruses and variants, and other broad indicators of health. All this is added to HERMES and available on a property’s Health Window.

Giving the residents EveryFree access to all the building information, stimulated resident-created networking activity that surprised even Hygeia. Residents rapidly developed their own etiquette around collective health measures, such as Spruce Up for Spring, which helps residents avoid excessive home clutter that can become a health hazard to themselves or to others. Peer-to-peer health pods or family health captains arose spontaneously and were replicated voluntarily in other properties. Hygeia residents also developed ‘adaptable health privacy’ protocols, for instance using their Health Window to request a private elevator ride (no one else in the cab) for those with colds or respiratory/immunological vulnerability. Groups also developed regular flu booster shot drives and on-premises pop-up free clinics funded by the HCOs. Twice a month, resident groups meet virtually with property and corporate health officers.

Once Hygeia rolled out the plan across its portfolio, finding the money one property at a time proved straightforward, if heavy on the documentary requirements and reporting. “We framed all our work as health infrastructure,” reports Hygeia CFO Dmitry Plutus. “Using the health-friendly language in both CARES and ARPA, healthy home pilots reported in the media, and the rapidly evolving innovation by cities and states in their use of funds, we presented every city and county where we have a property with a customized ask to fund 20 to 35 percent of the ongoing costs.” Hygeia similarly approached locally active HCOs asking them for a similar contribution, on a shared-subscription basis using the percentage of Hygeia residents for which each one had with Medicaid coverage responsibility. “With HERMES, we tie our work to demonstrable favorable trends in our residents’ real-time health data that translate into lower expected outlays for them.”  The rapid emergence of quantitative Health Scorecards facilitated benchmarking payments, and also motivated Hygeia’s site managers of properties into a virtuous circle competition.

Insurance—both liability and casualty at the property level, and employees’ group health across the company—proved to be another key area of quantifiable ongoing saving that boosted the health-retrofit ROI. Employee productivity rose with the company’s “do yourself a favor” policy, where employees whose morning biometrics report fever, congestion or other symptoms can flip to working from home that day, with other employees’ work schedules slightly shifted to compensate.

“It started as a business case,” says Vantari. “As we got into it, we discovered everyone had one question uppermost: Where would we want our mothers to live? We put everybody’s mother into the vision. It just took the capital markets and regulators a couple of years to catch up.”

David A. Smith is founder and CEO of the Affordable Housing Institute, a Boston-based global nonprofit consultancy that works around the world (60 countries so far) accelerating affordable housing impact via program design, entity development and financial product innovations. Write him at dsmith@affordablehousinginstitute.org.