Healthcare in Action takes primary care to the streets

Healthcare in Action, a not-for-profit medical group, doesn’t pay rent. It pays for parking.

Using a fleet of Mercedes-Benz Sprinter vans, the organization provides primary and behavioral healthcare to homeless residents of Los Angeles, with plans to expand to San Diego in July.

Social workers and medical personnel meet those who are homeless in encampments, under overpasses or on the streets to provide treatments such as wound care, antibiotics for infections and chronic disease management. Exam space in the vehicles offers privacy, but most patients prefer to receive care outside, Healthcare in Action CEO Dr. Michael Hochman said.

After treating patients, Healthcare in Action workers offer them cell phones or GPS trackers providers can use to locate them for follow-up care.

SCAN Group, the parent company of not-for-profit Medicare Advantage carrier SCAN Health Plan, debuted Healthcare in Action in January. Within its first four months, the organization had served about 200 patients.

Hochman formerly treated homeless patients in community health centers and county clinics. He recalls complaints about difficulties accessing care in those locations, particularly because patients lacked adequate transportation and child care, Hochman said.

“I was always struck that the setting wasn’t well-matched for this population,” Hochman said.

The Centers for Disease Control and Prevention has linked homelessness to higher rates of mental and physical health problems, including HIV infection, alcohol and drug abuse and tuberculosis. The Los Angeles Homeless Services Authority estimates there are about 66,400 unhoused people in the county.

Healthcare in Action is not the first organization to offer street-based medicine or to use mobile vans to deliver care. But the initiative’s aim to be financially sustainable sets it apart, Hochman said.

The group primarily treats homeless adults who have coverage from SCAN or other insurance companies. For the uninsured, Healthcare in Action connects them to community health centers for care, including by setting up appointments.

Healthcare in Action received seed funding from SCAN Group and has enough money on hand to maintain operations for the next year and a half, Hochman said.

The program rests on the premise that devoting resources to early interventions will reduce costs over time, said Dr. Sachin Jain, president and CEO of SCAN Group and SCAN Health Plan.

“We spend a lot on the care of people experiencing homelessness,” Jain said. “For this population, the kinds of care we’re spending on represent a major misallocation of resources. It’s far less efficient to pay for emergency room visits, ICU stays and readmissions than it is to pay for robust street-based primary care for people who otherwise wouldn’t have access to it.”

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Typically, most of those who are homeless receive care through emergency departments, which results in hospitalizations that could’ve been avoided, Jain said. Under the Healthcare in Action model, those dollars are instead shifted to primary and behavioral healthcare.

A new venture from Medi-Cal, the state’s Medicaid program, also supports Healthcare in Action’s mission, Hochman said. California Advancing and Innovating Medi-Cal, or CalAim, provides funding and resources for those who are unhoused, which helps cover the cost of patient care.

Healthcare in Action is developing partnerships with local hospitals and health systems too. The first, Cedars-Sinai Medical Center in Los Angeles, began collaborating with the organization this year. Clinicians identify homeless patients who require ongoing care and, with their consent, consult with Healthcare in Action about whether it can help. The hospital then pays to provide care for 30 days and to refer patients to healthcare providers that can serve them over time.

The partnership has been “terrific” so far, said Dr. Sharon Isonaka, the hospital’s chief value officer and vice president of clinical efficiency and value. Cedars-Sinai has referred two dozen patients over a two-month period to the street medicine provider, she said.

“We didn’t want this to just be a stopgap without connecting the patient to longitudinal care,” Isonaka said.

Isonaka hopes the partnership reduces reliance on the ED for care better provided in other settings, she said. “This isn’t a money-making opportunity, but it’s an investment we think in the long term is going to pay off in better healthcare for our patients,” Isonaka said. “The more people in established care, the more unnecessary emergency room visits we avoid.”

Carole Fisher, president of the National Partnership for Healthcare and Hospice Innovation, said Healthcare in Action is bridging gaps and improving equity. Her organization recently recognized Healthcare in Action with an award for its innovation.

“They’re embracing and creating access for patients who are complex and often regarded as impossible, as the most difficult to work with,” Fisher said.