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Break Bread, Build Trust, Honor Humanity

Blue Shield Promise Health Plan’s Street Health pilot reaches thousands of unhoused neighbors.
Street Health_Tent.Belongings_GettyImages-1367103823

Between August 2023 and February 2024, Blue Shield Promise Health Plan launched “Street Health, Hygiene and Nutrition,” a six-month pilot to address unmet needs for people experiencing homelessness in San Diego County. Early results of the pilot, which was launched with five other local Medi-Cal managed care plans, show that providing health and wellness services in the field can build trust and efficiently reach hundreds of people who are currently unhoused with the medical, food and hygiene services they need. And it can produce remarkable health outcomes. 

“Combining access to hot, nutritious food with compassionate healthcare services at specific locations with regularly scheduled mobile medical and food vans helped build trust and engagement among a population that typically has not trusted the medical community,” said Manisha Sharma, MD and senior medical director, Blue Shield of California Promise.  

Blue Shield Promise led a communitywide team to build a program that distributed thousands of meals, medical and hygiene services in collaboration with community-based nonprofit Father Joe’s Villages and food vendor Refined Management. Blue Shield Promise members of the team included Dr. Sharma; Susan Mahonga, director, California Advancing and Innovating Medi-Cal (CalAIM); Leah Barrett, program manager principal; and Jessica Delaney, program manager. 

Three mornings a week, vans from the two organizations fanned out across downtown San Diego to deliver food, hygiene products, and medical and social services to hundreds of people experiencing homelessness. Father Joe’s provided medical care for wounds and infections, as well as care for lice, prescription refills and more. Refined Management delivered dietitian-approved, culturally sensitive, nutritious meals, and hygiene items such as toothpaste, underwear, sun-blocking hats and hand sanitizer.

“The healthcare system should be creating a space and place that make our communities feel protected, that creates a condition of health for all people,” said Dr. Sharma. “As a society, we must stop asking ‘What is the matter with people’ and ask instead ‘What matters to people’ and ‘What happened to people,’” she said.

“By focusing on the human being, we can be part of the story of our communities, its people, and what medicine, health, and care mean to them,” she said.

“Strong local relationships were paramount to the success of this pilot,” she added. “By working together, we not only exceeded our collective goals; we were able to strengthen a model that combines health, hygiene and nutrition care to engage people who are experiencing homelessness most effectively. Instead of offering numerous services from multiple organizations and different locations, we took the most needed services directly to the people, meeting our neighbors where they are.”

Results for key health metrics reached by Father Joe’s medical vans significantly improved during the six-month program. Before the pilot, Father Joe’s Villages reached approximately four to six people a week. The pilot enabled Father Joe’s street medicine team to build capacity and infrastructure to scale quickly. They reached more than 660 unique individuals who used multiple services over six months. These are sample results compared to the prior year:

  • 906 medical encounters, prescription refills, PCP/specialist referrals - 134% increase
  • 742 harm reduction supplies and education - 275% increase
  • 561 referrals to Substance Use Disorder services - 274% increase
  • 210 referrals to psychiatry – 1,009% increase

Warm meals, hygiene and hydration products were distributed by Refined Management:  

  • Culturally appropriate, organic meals: 31,025 (425 meals per day)
  • Hygiene products: 33,122 (e.g. underwear, socks, T-shirts, dental kits, etc.)
  • Portable refreshments: 31,025 (e.g. bottled waters, granola bars, juices, apple sauce)

“Relationships were paramount to the success of this pilot program,” said Susan Mahonga, who provided logistical oversight of the pilot in her role as director of Blue Shield Promise’s CalAIM program. “We worked closely with San Diego elected officials, the Regional Taskforce on Homelessness, the Chief of Police, San Diego County agencies and the other Medi-Cal managed care plans. It does take a village to do this work.”

Next steps? Dr. Sharma and Mahonga are hopeful that the managed care plans and different government agencies will see this pilot’s blueprint of building trust as a stepping stone to expand and continue efforts in San Diego and other areas of California.

For more on Blue Shield Promise, visit Blue Shield Promise Health Plan or the Blue Shield Promise News Center.