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Though limited and informal, existing literature on mobile SM suggests it is a high-value service. While at first blush such an approach might seem impractical, SM providers report enhanced engagement of PEH, likely by reducing barriers to care and SM’s person-first approach in prioritizing patients’ self-identified needs, experiences, readiness, and well-being. SM services typically emphasize behavioral healthcare, addiction treatment, social services, and immediate physical health needs to a greater extent than primary care in standard medical offices, though programmatic structure may vary considerably across SM settings.
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2 Rather than expecting PEH to come to a traditional medical office-or even community-based clinics-SM brings care to patients where they are. The term “street medicine” (SM) describes a mobile approach for delivering medical outreach to PEH where they reside, often in encampments in the streets, as well as in shelters and interim housing units. 1 This article describes how “street medicine” can more effectively meet the needs of PEH, articulates value-based payment strategies that could sustain such programs, and provides recommendations to further evaluate their cost-effectiveness. Consequently, PEH commonly fail to receive basic primary healthcare services, leading to avoidable downstream emergency department (ED) and hospital utilization costing billions of dollars per year. On the provider side, clinicians report that PEH are among the most challenging to care for given their interwoven health and social needs. Traditional medical office settings are often unwelcoming and difficult for PEH to navigate due to social, logistical, and health-related barriers. Yet poor health is both a cause of homelessness and an effect, and the healthcare system is poorly suited for PEH. This epidemic has triggered calls to bolster housing and social services for persons experiencing homelessness (PEH), with less attention to the complex medical needs of these patients.
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More than half a million people experience homelessness in the USA on a given night.
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