LOS ANGELES — They distribute GPS devices so they can track their homeless patients. They stock their street kits with glass pipes used to smoke meth, crack, or fentanyl. They keep company credit cards on hand in case a patient needs emergency food or water, or an Uber ride to the doctor.

These doctors, nurses, and social workers are fanning out on the streets of Los Angeles to provide health care and social services to homeless people — foot soldiers of a new business model taking root in communities around California.

Their strategy: Build trust with homeless people to deliver medicine wherever they are — and make money doing it.

“The biggest population of homeless people in this country is here in Southern California,” said Sachin Jain, a former Obama administration health official who is CEO of SCAN Group, which runs a Medicare Advantage insurance plan covering about 300,000 people in California, Arizona, Nevada, Texas, and New Mexico.

“The fastest-growing segment of people experiencing homelessness is actually older adults,” he said. “I said, ‘We’ve got to do something about this.’”

Jain’s organization three years ago created Healthcare in Action, a medical group that sends practitioners onto California’s streets solely to care for homeless people. It has grown rapidly, building operations in 17 communities, including Long Beach, West Hollywood, and San Bernardino County.

Since its launch, Healthcare in Action has cared for about 6,700 homeless patients and managed roughly 77,000 diagnoses, from schizophrenia to diabetes. It has placed about 300 people into permanent or temporary housing.

Street medicine in most of the country is practiced as a charitable endeavor, aimed at serving a challenging patient population failed by traditional medicine, its proponents say. Living transient, chaotic lives, homeless people suffer disproportionately from mental illness, addiction, and chronic disease and often don’t have health insurance — or don’t use it if they do.

That makes designing a business around caring for them a risk, insurance executives and health economists say.

“It’s really innovative and entrepreneurial to take all this energy and grit to try and improve things for a population that is too often ignored,” said Mark Duggan, a professor of economics at Stanford University who specializes in homelessness and Medicaid policy. “Financial incentives matter massively in health care. It’s everything.”

An estimated 181,000 people were homeless in California in 2023 — about 30% of the nation’s total. The number living outside, more than two-thirds of California’s total, increased 6.9% over the previous year.

The state’s leaders, including Democratic Gov. Gavin Newsom, have struggled to make inroads against the mounting public health and political crisis — despite marshaling unprecedented taxpayer resources.

“We have a huge problem on our hands, and we have a lot of health plans and municipalities saying, ‘We need you,’” Jain said.

On the Streets

On a cloudy April morning in Long Beach, Daniel Speller navigated his mobile medical van among the tents and tarps that crowded residential streets, searching for a couple of homeless patients. A physician assistant for Healthcare in Action, Speller said he was particularly worried about the badly infected wounds they developed on their limbs after they used the street drug xylazine, an animal tranquilizer often mixed with fentanyl.

“These wounds are everywhere. It’s really bad,” Speller said. If infections progress, they can require toe, foot, or arm amputations.

“Man, this one is still so deep,” Speller said as he peeled denim pants from the swollen leg of Robert Smith, 66.

After cleaning and wrapping Smith’s leg, Speller asked him if he needed anything else. “I lost my food stamps,” Smith replied.

Within the hour, Speller’s team of social workers and nurses had summoned an Uber to take Smith to a state office, where he received a new CalFresh card.

Speller then turned his medical van onto a side street lined with more tents and cars-turned-shelters. Nick Destry Anderson, 46, was sleeping on the sidewalk and badly in need of wound care.

“I was so scared. I thought I was going to lose my leg before I met them,” Anderson said, grimacing as Speller sprayed his leg with antibiotic mist. “These people saved my life.”

Anderson reported feeling lightheaded, so Speller asked another team member to use the company credit card to get him a cheeseburger and a Sprite.

Many homeless people languish on the streets, so entrenched in mental health crises or addiction that they don’t much care about seeing a doctor or taking their medication. Chronic diseases worsen. Wounds grow infected. People overdose or die from treatable conditions.

Part of street medicine is bandaging infected sores, administering antipsychotic injections, and treating chronic diseases. Street providers often hand out drug paraphernalia such as clean needles and glass pipes to reduce sharing and prevent infections. Perhaps more importantly, these workers build trust.

Getting homeless patients established with primary care doctors and nurses — who visit them on the streets, in parks, or wherever they happen to be — can prevent frequent and expensive emergency room trips and hospitalizations, potentially saving money for insurers and taxpayers, Jain argues. Even though shelter and housing are scarce, Healthcare in Action’s goal is to get patients healthy enough to live stable, independent lives, he said.

But that’s easier said than done. In West Hollywood that week in April, Healthcare in Action clinical coordinator Isabelle Peng found Lisa Vernon, a homeless woman, slumped over in her wheelchair at a busy bus stop. Vernon is a regular at nearby Cedars-Sinai Medical Center, Peng and her colleague David Wong said.

When Peng and Wong attempted to examine her swollen leg, Vernon shouted at them and declined aid. “Antibiotics aren’t going to save my life!” Vernon yelled as a mouse scurried for the potato chip shrapnel at her feet.

They moved on to their next patient, a man they were tracking with a GPS device they sometimes affix to homeless people’s belongings. Use of the devices is voluntary. They work better than cellphones because they less often get taken by law enforcement during encampment sweeps or stolen by thieves.

“Our patients really move around a lot, so this helps us go find them when we have to get them medication or do follow-up care,” Wong said. “We have already developed rapport with these patients, and they want us to see them.”

Growing Revenue

Street medicine teams are in demand, largely because of growing public frustration with homelessness. The city of West Hollywood, for instance, awarded Healthcare in Action a three-year contract that pays $47,000 a month. The nonprofit can also bill Medi-Cal, California’s Medicaid program, which covers low-income people, for its services.

Mari Cantwell, a health care consultant who served as California’s Medicaid director from 2015 until early 2020, said Medicaid reimbursements alone aren’t enough to fund street medicine providers. To remain viable, she said, they need to take creative financial steps, like Healthcare in Action has.

“Medicaid is never going to pay high margins, so you have to think about how to sustain things,” she said.

Healthcare in Action brought in about $2 million in revenue in its first year, $6 million in 2022, and $15.4 million in 2023, according to Michael Plumb, SCAN Group’s chief financial officer.

Healthcare in Action and SCAN’s Medicare Advantage insurance plan generate revenue by serving homeless patients in multiple ways:

• Both are tapping into billions of dollars in Medicaid money that states and the federal government are spending to treat homeless people in the field and to provide new social services like housing and food assistance.
  
  For instance, Healthcare in Action has received $3.8 million from Newsom’s $12 billion Medicaid initiative called CalAIM, which allows it to hire social workers, doctors, and providers for street medicine teams, according to the state.
  
  It also contracts with health insurers, including L.A. Care and Molina Healthcare in Southern California, to identify housing for homeless patients, negotiate with landlords, and provide financial help such as covering security deposits.
• Healthcare in Action collects charitable donations from some hospitals and insurers, including CalOptima in Orange County and its own Medicare Advantage plan, SCAN Health Plan.
• Healthcare in Action partners with cities and hospitals to provide treatment and services. In 2022, it kicked off a contract with Cedars-Sinai to care for patients milling outside the hospital.
• It also enrolls eligible homeless patients into SCAN Health Plan because many low-income, older people qualify for both Medicaid and Medicare coverage. The plan had revenue of $4.9 billion in 2023, up from $3.5 billion in 2021.

“There’s been an incredible market fit, unfortunately,” Jain said. “You can’t walk or drive down a street in Los Angeles, rich or poor, and not run into this problem.”

Jim Withers, who coined the term “street medicine” decades ago and cares for homeless people in Pittsburgh, welcomed the entry of more providers given the enormous need. But he cautioned against a model with financial motives.

“I do worry about the corporatization of street medicine and capitalism invading what we’ve been building, largely as a social justice mission outside of the traditional health care system,” he said. “But nobody owns the streets, and we have to figure out how to play nice together.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

The post A California Medical Group Treats Only Homeless Patients — And Makes Money Doing It appeared first on Medika Life.

Doug is a self-professed drug addict (his words, not mine). And his poison of choice is crack cocaine. Several years ago, he owned and operated a tooling company and befriended someone who gave him the rock to sample. In a rapid turn of events, his life spiraled downward fast.

My biological dad and I met for the first time when I turned 40 after I requested a search through a Private Investigator. He, and my biological mom, placed me up for adoption as a newborn baby. Fast forward to today, I count my blessings that I didn’t endure the hardship and uncertainty of what it must have been like to grow up under Doug’s influence.

Despite the addiction, I find Doug utterly fascinating; how he continues to live is beyond me. Physically, he looks like he’s been warped through a blender; the man has one leg, a dangling colostomy bag, and one eye. Yet he manages to wobble around on a cane and remain mobile — with a cheeky smile!

Although we don’t get a chance to talk often, given his penchant for dialing relatives at 3 or 4 AM, I see glimpses into his true self and where some of my unique personality traits originate. Doug is a visionary, a big-picture thinker. When he dreams, he shoots for the stars, the moon, and beyond. Although my bio-dad (as I affectionately call him) is a storyteller on auto-repeat, he shares his desire to create the “Billy Fund,” a billion-dollar charity designed to eradicate poverty and pay for educational expenses for Canadian children. A noble aspiration. Doug wants to accomplish his goal by walking across Canada, following in the footsteps of Terry Fox. Whenever dad shares his heart with me, I feel the realness of his intention, despite Doug’s reality being a fantasy.

Doug is a man of the people, and they like him too. He learned the art of the street hustle, evident in the amount of loot the man brings home. Christmas is an especially lucrative time for filling the coffers with coins, bills, and snacks. The real draw is his infectious sense of humor; he’s hilarious and loving while existing on an entirely different planet. What I love about Doug is his unwavering faith in other humans, his family, his adoration of animals, and his belief in God almighty.

No amount of rehab will bring Doug back to his original form. I believe he has suffered too much damage to return to normalcy. And this is why on the stifling hot Saturday, I arrived at the shelter, and Doug was nowhere to be found — despite my brother Chris informing him I was going to visit. Doug didn’t pick up his phone when I called twice, nor did the shelter staff know where he was.

In the heat of the moment, I felt a flush of anger arise from the depths of my stomach. Didn’t he know Saturday is my only day off? That I drove two hours just to see him? Why can’t he be where I need him? Of course, Doug can’t; he exists on an entirely different plane of consciousness.

On the drive home, I had time to process my emotions and come to terms with our loss of missing each other:

• In my first wave of emotion, I was overcome by selfishness, focusing on “I” rather than “We.” For some time, I allowed my feelings to be, observing the ebb and flow within my body. Over time, I asked myself — what did I expect would happen? That Doug would be standing at the entrance of the homeless shelter with flowers in hand?
• Doug is a creature of habit, on a mission to panhandle, source funds, and procure his next fix. Deviating from the normal routine is not in Doug’s repertoire; his addiction will always trump familial relationships. And knowing Doug is consumed by his own needs, my rage melted into compassion towards his restless soul.
• Through the newfound sense of empathy regarding Doug’s absence, I was able to switch my mindset and consider all the magnificent qualities I see in my dad; the beautiful shards of his soul shining through the darkness.

My story resembles the multi-millions of others affected by long-term heavy substance abuse. All we can do is try. I showed up to be with my dad, even if he couldn’t.

And here lies a choice as to how we respond when people don’t appear how we want them to. Either we allow anger, resentment, and abandonment to construct a permanent hornet’s nest in our hearts, or we can choose to “see” and “accept” people for who they are moment to moment, with all their glorious blemishes, flaws, and impurities. I choose love. What about you?

The post How To Respond To A Family Member Steeped In Addiction appeared first on Medika Life.