New street medicine teams bring comprehensive health care to homeless people

SAN DIEGO — “Anybody home?” physician assistant Teagan Flint asks outside a tent on F Street in downtown San Diego.

She was hoping to find a patient she had been working with, but there was no answer at the tent. She would learn later he had been hospitalized.

Flint is part of a novel five-person street medicine team called Healthcare in Action, a nonprofit that includes physician assistants and social workers who have worked the streets of San Diego since July to provide on-the-spot and, more important, long-term health care to homeless people at no cost to the patients.

They aren’t the first to provide health care to homeless people in San Diego, but Healthcare in Action is the first to be on the street five days a week and associated with a for-profit managed health care provider.

“I think what we’re doing that’s a little different is that we’re nonprofit and trying to take a managed-care approach in terms of efficiency,” said Dr. Michael Hochman, who is based in Los Angeles County and leading the teams there and in other places as the program expands. “We’re thinking about an assigned panel of patients and applying that to street medicine.”

Many street medicine teams are funded by charitable groups, going out a few times a week or month to tend to wounds, check vital signs and attend to ongoing or urgent health care needs of people they come across.

It’s important work, Hochman said, but not sustainable for long-term care. By creating a reliable funding source through Medi-Cal, which provides health care coverage for low-income California residents, and a managed health care provider such as Molina Healthcare of California, the Healthcare in Action model can fund larger teams that work up to seven days a week, with a physician on call after hours. Once in their system, patients have the equivalent of a primary care physician who may prescribe medication, do important follow-up visits and even visit them in a hospital.

“The follow-up is really where we start to make progress and get their medical conditions under control,” Hochman said. “And we really do have a goal of getting them housed, because when the mental health conditions and substance use and

… physical conditions are under better control, that’s when the patient is better able to get a home.”

Patients with mental health issues can talk remotely with a psychiatrist who may prescribe medication for schizophrenia and bipolar disorder, Hochman said.

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