Healthcare in Action takes primary care to the streets

“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.