Sustainably Funding Street Psychiatry

Area of Science:

• Mental Health Services Research
• Public Health Policy
• Homelessness Research

Background:

• Unsheltered homelessness is linked to high psychiatric illness rates and significant care access barriers.
• Street psychiatry, a field-based outreach model, shows potential for improving care, facilitating housing, and reducing healthcare costs.
• Current funding for street psychiatry relies heavily on grants, with limited health plan reimbursement.

Purpose of the Study:

• To explore payment model reforms for enhancing street psychiatry services.
• To identify mechanisms for sustainable funding and scaled implementation of outreach-informed psychiatric care.
• To demonstrate the feasibility and effectiveness of reimbursement reforms for serving the unsheltered population.

Main Methods:

• Analysis of existing payment innovations in street medicine and related care models.
• Review of potential reimbursement strategies for payers, including new service codes and interdisciplinary team compensation.
• Examination of funding programs for non-billable essential services like care coordination and housing support.

Main Results:

• Limited health plan reimbursement is a key barrier to street psychiatry implementation.
• Payment innovations can support street psychiatry by facilitating use of outreach codes and compensating outreach activities.
• Direct funding or incentives for care coordination and housing support are viable options for payers.
• Sufficient fee-for-service rates, risk adjustment, and streamlined Medicaid access are crucial.

Conclusions:

• Payment model reforms are essential to scale evidence-based street psychiatry.
• Successful programs demonstrate the feasibility and effectiveness of proposed reforms.
• Improved reimbursement for street psychiatry services will significantly benefit patients experiencing unsheltered homelessness with psychiatric needs.