As of 2024, approximately 14,000 people living in the Los Angeles neighborhoods of South LA, Compton, Lynwood, and Paramount — collectively known as Service Planning Area 6 (SPA 6) — are experiencing homelessness. This area also faces a significant burden of behavioral health conditions, with 25 percent of unhoused individuals in SPA 6 reporting serious mental illness and 22 percent reporting difficulties with substance use.

In the SPA 6 neighborhoods, the rates of homelessness, untreated mental illness, and substance use highlight the urgent need for equitable medical and behavioral health services for unsheltered individuals. In response, Akido Labs, a health care delivery organization, and the Homeless Outreach Program Integrated Care System (HOPICS), a homeless services agency serving SPA 6, are partnering to address this need through an innovative street medicine program. The team chose to start their efforts in South LA neighborhoods of SPA 6 because of the high density of people experiencing homelessness. The Akido Labs-HOPICS collaboration was piloted under the Partnerships for Action: California Health Care & Homelessness Learning Collaborative, led by the Center for Health Care Strategies (CHCS) and made possible by the California Health Care Foundation. This profile explores lessons from the partnership to help inform other street medicine programs in California and nationally.

Partnership Overview

During the two-year Partnerships for Action initiative, the Akido Labs-HOPICS team developed a street medicine program to address the physical, behavioral, and social needs of people experiencing homelessness in the South LA neighborhoods of SPA 6. This partnership uniquely integrated clinical health services into an existing community-centered street outreach model. HOPICS provided the foundation for the street medicine model with its longstanding, culturally informed social outreach program, while Akido Labs helped elevate the outreach program by providing enhanced clinical care where people experiencing homelessness live. Exhibit 1 shows what staff and services each organization contributes to the street medicine program.

Exhibit 1. Akido Labs-HOPICS Street Medicine Program

*HOPICS outreach staff refer patients in need of medical care to the street medicine program.

Takeaways from an Innovative Street Medicine Program

The Akido Labs-HOPICS partnership yielded key early insights on building and sustaining a street medicine program across organizations and can inform stakeholders seeking to launch a similar model.

1. Hire a Full-Time Physician to Deliver Behavioral Health Care

The Akido Labs-HOPICS street medicine program was initially piloted with a part-time provider who primarily delivered services via Akido Lab’s telehealth platform. To address the increased need for behavioral health services more consistently, the program later transitioned to include a full-time internal medicine physician, board-certified in addiction medicine, who offers care in clients’ lived environments and via telehealth appointments. The addition of a full-time addiction medicine provider to the street medicine team allows the program to reach and effectively treat a larger number of individuals with both physical and behavioral health conditions. Through this partnership, the physician cares for HOPICS-referred clients living on the streets, providing treatment for stimulant use disorder, opioid use disorder (including medications for addiction treatment (MAT)), depression, heart failure, and other chronic conditions. The physician also determines and documents disability status, which enables eligible individuals to access benefits such as Social Security Disability Insurance and Supplemental Security Income.

2. Share Data to Ensure Adequate and Continuous Patient Follow Up

A key component of the partnership’s success is the ability to share data across organizations. After seeing patients referred by HOPICS, Akido Labs shares weekly encounter data via a secure file transfer protocol, which includes diagnosis, care plan, treatment, and referral and medication recommendations. This process allows for a more transparent approach to providing care across organizations, while still maintaining Health Insurance Portability and Accountability Act (HIPAA) and 42 Code of Federal Regulations (CFR) Part 2 compliance. Also, clinical teams from both organizations meet and communicate regularly, including through case conferences to discuss client progress and setbacks. Akido Labs also developed a patient follow-up tracker module within its electronic health record system for patients with serious mental illness and/or substance use disorder. This module ensures the Akido Labs-HOPICS team has the information necessary to issue prescriptions on time, such as the treatment type, medication, and critical dates for compliance with treatment protocols, among other information.

3. Formalize the Relationship to Secure Continued Partnership

As part of their goal of a long-term working relationship, the Akido Labs-HOPICS team sought to formalize their partnership early in the two-year pilot. Akido Labs and HOPICS created a multilateral services agreement to serve as an umbrella for all future collaborations. This ensures that administrative delays do not hold up future work while new contracts are executed.

To establish clear roles and responsibilities, the partnership developed internal workflows and protocols. During the pilot period, team meetings were held to ensure that members across both organizations understood information relating to program design, funding, and other relevant areas. Clinical teams from both organizations use regular case conferences to prepare for fieldwork. Leadership from the organizations meet monthly to discuss administrative issues, share data, and plan the natural progression of their collaborative efforts.

4. Plan for Sustainability to Maintain Financial Viability

Aligning funding was a key component to sustain the partnership between Akido Labs and HOPICS. The partners achieved this by collaborating on various funding streams through joint applications. They applied for and received funding from the California Department of Health Care Services’ Housing and Homelessness Incentive Program, which is designed to improve health outcomes and access to whole-person care by addressing housing insecurity and instability. With this funding, Akido Labs and HOPICS expanded the street medicine team from part- to full-time operations. Akido Labs also contracted with local Medi-Cal (California Medicaid) managed care plans, LA Care Health Plan and HealthNet, for Enhanced Care Management (ECM) to pay for provider time.

Looking Forward

The partnership between Akido Labs and HOPICS has been an iterative process. They assessed the pilot program along the way and made changes to roles, staffing, services, and structure to ensure they are enhancing health care access and services for unsheltered individuals in their community. This cross-sector partnership serves as a model that other street outreach/medicine programs looking to expand services to provide a higher level of clinical care can follow. Akido Labs and HOPICS are continuing the program following the two-year pilot. They are adapting and expanding the model to provide care in other settings, such as shelters, interim housing, and permanent supportive housing.

While the team originally focused the pilot on South LA, they want to expand the street medicine program to other areas of SPA 6. To do this, HOPICS is determining the feasibility of contracting for ECM and Community Supports and will continue to collaborate with Akido Labs in a number of ways, such as including the lead Akido Labs street medicine physician in other field-based MAT programs. This will provide additional HOPICS clients with access to substance use disorder care. To sustain this care approach, Akido Labs will continue to seek contracts with managed care plans in Los Angeles.