Physician viewpoint: Homeless people need more than houses — they need healthcare solutions


Homelessness is beyond a housing problem; it is, in part, a healthcare crisis, and treating it as otherwise can stunt leaders from tackling the problem, an April 17 Forbes article reported.

Sachin Jain, MD, is the president and CEO of SCAN Group and Health Plan. He is also a physician at the U.S. Department of Veterans Affairs, a professor of medicine at Stanford (Calif.) University School of Medicine and the co-editor-in-chief of a healthcare journal.

Dr. Jain said that while affordable housing puts a roof over the head of someone unhoused, it does little to address root causes like substance use disorder or physical illnesses.

The solutions he envisions provide housing-insecure individuals with more and better healthcare. He said in Medicare Advantage there is a financial model of care whose incentives align with the needs of homeless people and that has the funding to make meaningful strides toward the problem each day.

America's homeless population is larger than any other advanced country, with more than 580,000 people experiencing homelessness on any given day and one-third of them residing in California.

Many who struggle with homelessness may cite the root of when their troubles began as when they lost their jobs. However, Dr. Jain said, this doesn't account for why they lost their jobs and that it often starts with illness.

Diabetes, heart disease, HIV and hypertension are all diseases common among the homeless population. Additionally, at least 30 percent of homeless Americans suffer from serious mental illness, and more than 50 percent have issues with excessive substance use.

After the start of the pandemic, homeless individuals who contracted COVID-19 were 30 percent more likely to die than the general population. In Los Angeles County, they were 50 percent more likely to die.

Homeless individuals often use emergency department services for their healthcare needs, with nearly one-third of emergency department visits being made by homeless individuals. In Boston, a research team found it cost Massachusetts $16 million per year to care for 6,500 homeless people in emergency rooms.

Dr. Jain suggested the following three healthcare pillars to address homelessness problems:

  1. Outbound care: Mobile medical teams should go to homeless populations to provide them with healthcare instead of waiting for them to seek it in the most costly environments.

  2. Coordinated care: Highly coordinated teams need to work together, as well as with other organizations, to address the broad challenges homeless individuals face.

  3. Specialty care: Medicare and Medicaid often don't address the specific needs of homeless individuals like behavioral health services, transitional or recuperative care. Additionally, these plans do not cover eye glasses and vision care, hearing aids or dental care.

The three pillars combine comprehensive health and social services with a funding model to meet each patient's unique needs.

"With this in mind, SCAN Group, the organization I lead, is poised to launch, in the next few months, a new medical group dedicated to providing comprehensive care to homeless adults," Dr. Jain said. 

He explained: "We'll do it by bringing together professionals to work on care teams providing homeless individuals with the physical, behavioral and social support that they need. We'll fund this effort through Medicare Advantage, which gives us the flexibility to provide homeless individuals with a broad array of services while delegating the authority and accountability for their care to our clinical and social services teams."


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