Analysis: Taking healthcare to the street is effective for patients and reduces healthcare costs

• Street medicine involves sending teams of physicians, nurses and other healthcare providers to where the homeless are living, according to an NPR report.
• The Street Medicine Institute describes street medicine as representing “the intersection where evidence-based medicine and reality-based medicine meet.”
• People experiencing homelessness are five times more likely to be admitted as inpatients and usually stay longer in the hospital, according to an AHA report.

A recent story from NPR highlights “street medicine,” which is an approach taken by Mercy Care to deliver healthcare services to individuals experiencing homelessness in Atlanta.

Street medicine involves sending teams of physicians, nurses and other healthcare providers to where the homeless are living — under viaducts, on the streets, in parks, according to the NPR story. These teams deliver behavioral and medical healthcare services including medications, vaccinations, primary care as well as providing items like clothing and supplies. The goal is to establish connections that lead the patient to wellness and eventually housing. 

The Street Medicine Institute describes the care as representing “the intersection where evidence-based medicine and reality-based medicine meet” and as a form of intermediate home-care with the goal of transitioning patients into a more comprehensive primary care relationship. 

By bringing primary and preventive care to homeless patients, street medicine removes barriers to care such as lack of money or transportation or even fear of stigmatization. The hope is to address medical issues before they become an emergency and the patient is seen in the emergency department, thereby lowering the cost of care for these patients.

According to the NPR piece, Mercy Care’s investment for the street medicine program is $900,000 per year and pays for treatment of 300 people, helping to relieve the burden of local hospitals. While the article doesn’t estimate cost savings, according to a report from the American Hospital Association, people experiencing homelessness are five times more likely to be admitted as inpatients and usually stay longer in the hospital.  Investing $3,000 per patient, per year, and avoiding lengthy and costly in-patient stays at $2,000-$4,000 per day likely saves money on total cost of care for this population.

Takeaway

The subsequent medical and social costs of delayed care for the homeless population can be difficult to quantify. I had the opportunity at one point to work with the homeless, ill and injured at a shelter that provided temporary housing for those recovering from an inpatient stay. The facility offered patients the medical and social care follow up in temporary housing rather than recovering on the streets.

This NPR article has me reflecting on one patient at the shelter who suffered an infection due to a diabetic ulcer resulting in his leg being amputated. Although the facility was an excellent resource for those being discharged from the hospital, if medical care had been available to homeless individuals in this area earlier, this patient’s amputation and subsequent hospitalizations may have been avoided, saving on costs and maintaining his mobility and a better quality of life. One of the basic tenets of social work is to start with where the client is. The street medicine approach, providing mental, medical and social care in the patient’s environment is an example of how the healthcare delivery system can reorganize around the patient, deliver care that is patient-centric and wholistic.

The recent partnership between VillageMD and Walgreens to embed primary care clinics in their stores is another example of designing care delivery around the patient — with 78% of the U.S. population within five miles of a Walgreens, this makes primary care accessible and convenient with a co-located pharmacy.

The hospital-at-home model as detailed in Chad Mulvany’s Nov. 20 blog, the integration of behavioral health and primary care, and delivering care through telemedicine are other examples of meeting clients where they are. By removing barriers, establishing relationships and engaging patients with interventions that begin where the patient is, healthcare can be more medically effective as well as cost effective.