Sustainably Funding Street Psychiatry

Importance People experiencing unsheltered homelessness face high rates of psychiatric illness and substantial barriers to care. Field-based psychiatric services built on direct outreach (known as street psychiatry ) may improve care and facilitate housing while possibly reducing total health care spending, but inadequate funding limits implementation. Observations Literature shows that street psychiatric services are currently financially supported by a variety of sources, though with outsized reliance on public and private grants and contracts. Health plan reimbursement for this care remains limited. Existing payment innovations that support street medicine and other care models illustrate the spectrum of possible reimbursement mechanisms available to payers. Payers could ensure that services are reimbursed by facilitating use of the new outreach site/street place of service code, compensating necessary activities of outreach and reimbursing activities of peer specialists and other interdisciplinary team members. To pay for services outside the scope of billable encounters, payers could develop programs to directly fund or incentivize care coordination, housing support, and other services. Sufficient fee-for-service rates and risk adjustment may encourage and support care for this population. Maintaining or expanding Medicaid eligibility and limiting administrative barriers to coverage for people experiencing homelessness are essential. Conclusions and Relevance The need for outreach-informed psychiatric care continues to grow. Payment model reforms may enable practitioners to deliver evidence-based street psychiatry at scale. Successful programs and states demonstrate that the described reforms are likely feasible and effective. Patients experiencing unsheltered homelessness, some of whom have substantial psychiatric care needs, are likely to benefit greatly from improved reimbursement for these services.