New awareness, new law could boost homeless healthcare – Orange County Register
In January, medical teams in Southern California will step up treatment for older people struggling with homelessness, hoping that the expansion of this street medicine will translate into more health care, at a lower cost, for them. homeless people in the area.
Called Healthcare In Action, and backed by Long Beach-based health insurer SCAN Group, the initiative will work much like existing Medicare Advantage plans offered by private insurance companies; essentially, as HMOs that replace traditional fee-for-service Medicare coverage.
But Healthcare in Action doctors and nurses will treat people – Medicare-eligible adults – in all kinds of non-traditional settings: on sidewalks and in parks, behind dumpsters or in back alleys; wherever their needs can be met. The goal is to overcome the barriers that prevent homeless people from getting medical help until a crisis sends them to more expensive hospital emergency rooms.
And as SCAN Group accelerates its expansion into street medicine, California lawmakers are set to create new rules that could improve healthcare for homeless seniors.
Assembly Bill 369, or “Street Medicine Act: Bringing Care to the Streets,” was passed by both houses in Sacramento and is on Gov. Gavin Newsom’s desk. The legislation aims to facilitate health care and reimbursement under Medi-Cal, the state’s public health insurance program for the poor.
Many of California’s more than 150,000 homeless people qualify for Medi-Cal but are not enrolled. And among those who are registered, nearly three in four do not regularly see a primary care physician, according to background information in the bill.
Additionally, healthcare providers face a hurdle if they try to charge Medi-Cal for their treatment of the homeless. Under current law, the agency requires a billing address for the location where care is provided – typically a hospital clinic or doctor’s office – before processing claims.
While the Healthcare in Action project and state law are not related, they are pursuing independent avenues on the same issue; find ways to get more health care for people who live outside.
Dr Michael Hochman, a Los Angeles-based primary care physician who will serve as Managing Director of Healthcare in Action, said the main question for the SCAN group was how to improve the health and overall outcomes of those without. aging shelter – a rapidly growing segment of the street population – while reducing costs.
A recent homeless count in Los Angeles County found that between 2019 and 2020, the number of homeless people aged 62 and over jumped 20%. Hochman, who was an attending physician at Los Angeles County-USC Medical Center for 10 years, estimated that about 1 in 4 people who receive treatment there are homeless.
“These are among the costliest patients,” he said.
“Could we take better care of them?”
Medicine and social work
SCAN is trying to create a lower cost business model for street medicine.
In recent years, studies in parts of California, including Los Angeles and Orange counties, have shed light on the costs associated with healing the homeless. An analysis by researchers at UC Irvine, for example, estimated that in Orange County, the cost of treating chronically homeless people in local hospitals and emergency rooms was $ 77 million. dollars over a 12-month period that ended in 2015.
Most of the street drugs currently supplied to Southern California come from groups dependent on charity and money from city and county governments. Healthcare in Action payments will be managed by SCAN Health Plan, a not-for-profit Medicare Advantage subsidiary of the SCAN Group.
In addition, SCAN intends to provide more than medical care.
In addition to doctors, medical assistants and nurse practitioners, its street teams will include social workers, addiction counselors and others who can connect homeless people with services that can improve their lives. This support should include referral of homeless patients served by SCAN teams to housing.
For now, the funding provided by SCAN will cover two Los Angeles County teams, one based in Long Beach and the other in downtown Los Angeles, said Hochman, who will oversee the SCAN teams. Orange County is also under review.
“There are other very good providers of street medicine,” Hochman said. “What’s different is that they depend on charitable funding. We are trying to give street medicine a backbone.
While SCAN supporters hope to improve the financial side of homeless healthcare, the bureaucratic side of the puzzle could be changed by the Street Medicine Act.
Among other things, AB 369 would require Medi-Cal to recognize the street as a legitimate place to provide health care. It would also make it easier to register homeless people at Medi-Cal. And this could allow a person treated on the street to possibly be referred to a specialist.
The key to the legislation is what’s called “deemed eligibility,” which would allow people living on the streets to get medical treatment even if they apply on the spot for Medi-Cal insurance.
Legislation on street medicine was introduced in February now-Sen. Sydney Kamlager, D-Los Angeles. On Friday September 10, the invoice was sent to Newsom.
Even for homeless people already registered with Medi-Cal, real medical care is almost non-existent. The state enrolled a majority of homeless people in the Medi-Cal program, but some 73% of those enrolled “have never seen their health care provider,” according to the bill’s author.
If you are homeless, the barriers to obtaining medical care can seem endless. If you are missing any of the following – transportation, ID card, or mailing address – this can be a barrier to getting treatment. Other issues, such as mental illness, addiction, and a general lack of confidence, also explain why health care for the homeless is patchy at best.
The results are devastating and deadly. Homeless people are much more likely than others to suffer from chronic diseases such as diabetes and high blood pressure. This is also a reason why the homeless die younger than the general population – around 30 years old.
Advocates for the legislation include USC’s Keck School of Medicine and its director of street medicine, Brett Feldman, a medical assistant who started working in street medicine in 2007.
Over the years, Feldman has seen the movement grow. When he started, Feldman said, the main provider in Los Angeles County was the Venice Family Clinic, which had a pioneering program. Today, there are 28 street programs statewide, including several in the Los Angeles area.
In Orange County, the Wound Walk OC, run by volunteers, provides basic first aid to homeless people.
“There is huge interest,” Feldman said. “That is why the legislation must catch up.”
Three years ago CalOptima, the administrator of Medi-Cal in Orange County, began working with county workers and community health clinics to provide health care in shelters and other places where homeless people congregate.
Preliminary results from data collected between April 2018 and March 2021 revealed that when health services were provided, the number of homeless people who went to emergency rooms or were hospitalized fell by almost 25%. Separate data on a smaller group of homeless people found a 60% increase in specialist visits, while visits to primary care physicians increased by a more modest 10%.
Similar results could occur in the regions served by the Healthcare in Action project. Feldman, who works as a consultant on the project, describes the leader, Hochman, as someone who is “mission-oriented” and who knows the particularly vulnerable population well.
The project will also include peer navigators – people who understand the lives of homeless people and can serve as street guides for SCAN medical teams. And the person who runs the Peer Navigators is someone who was once homeless and since then has spent years working with the people of Skid Row in Los Angeles.
Feldman said this kind of first-hand experience could be critical to the overall success of the project and to help individual healthcare providers when working in non-traditional settings.
“Sometimes you’re not in the best neighborhoods, or you’re not seen as part of that neighborhood. When you’re on your knees healing wounds, you don’t want to worry about what’s going on around you.