Operating a Street Medicine Program within New York City's Public Health Care System

New York City has the largest homeless population of any city in the United States, with thousands of people experiencing unsheltered homelessness on its streets. These individuals have poor health outcomes and limited connection to care. To better meet their health and social needs, New York City Health+Hospitals, the largest public hospital system in the United States, has implemented the Street Health Outreach and Wellness (SHOW) initiative to bring unsheltered New Yorkers health care, material goods, and connections to transitional housing. This article documents the evolution of the program - from its first iteration as an external contractor-staffed initiative during the coronavirus disease 2019 pandemic to its integration into the health care system in January 2023 - while also highlighting how it is currently operationalized. Since its integration, teams have completed more than 46,000 street engagements, including more than 10,000 clinical visits, 1700 connections to substance use services, and more than 500 connections to homeless shelters. The authors provide key lessons about trust-building, navigating complex organizational hierarchies and partnerships, and the importance of community-based interventions to provide homeless health care.