To reach homeless individuals in need, NYC Health + Hospitals expands tele-behavioral health to shelters, mobile street clinics

NYC Health + Hospitals plans to launch and integrate a new tele-behavioral health service into its virtual urgent care platform focusing on the needs of vulnerable and homeless New York residents, a chronically underserved community.

The platform is supported by a three-year grant totaling $3.9 million grant from the Leona M. and Harry B. Helmsley Charitable Trust, which announced the award in late July. NYC Health + Hospitals will collaborate with the NYC Department of Homeless Services to create a tailored version of the new service, offering telehealth to treat patients at 25 homeless shelters and six mobile street outreach clinics in the first year.

In the grant’s second year, NYC Health + Hospitals, the largest municipal healthcare system in the U.S., will use the grant to increase the use of the virtual urgent care platform, called ExpressCare. The goal is to evaluate behavioral health engagement strategies targeted at some of the hardest-to-reach patients.

“We’re excited and can’t wait to leverage the grant to really help more New Yorkers, particularly those experiencing homelessness,” Erfan Karim, executive director of NYC Health + Hospitals/ExpressCare, said in an interview.

ExpressCare is available 24 hours a day, 365 days a year to meet New Yorkers’ physical, mental, emotional, or other health needs. “We’re a convenient, easy, on-demand access point,” Karim said, adding that the goal is to address health equity gaps affecting a population that often lacks the elaborate technology needed for telehealth visits. “We built ExpressCare to alleviate those concerns.”

In 2020, NYC Health + Hospitals debuted its virtual urgent care program, enhanced by a two-year grant from Helmsley totaling $500,000, tailoring the service for homeless patients in partnership with the Collaborative for Homeless Healthcare, a Helmsley-funded provider initiative established in mid-2018. The ExpressCare platform swiftly filled a critical healthcare gap facing vulnerable residents, particularly throughout the COVID-19 pandemic. To date, it has served 75,000 New Yorkers with a 95% overall patient satisfaction score, according to the health system.

The collaborative, which includes healthcare providers and members of the Department of Homeless Services, launched the nurse triage line, which is designed to respond specifically to the full range of shelter residents’ health needs. The line is currently active in more than 60 NYC shelters and already refers urgent care calls to ExpressCare. This behavioral health ExpressCare service will be a new specialization offered via that line, as well as through direct calls from shelters or anywhere else a patient can make their connection. 

“We’re trying to make it as easy as possible and eliminate as many barriers as we can to full access to care,” Karim told Fierce Healthcare, citing the importance of meeting a difficult-to-reach population where they are, despite a “knowledge gap and distrust in technology or systems that haven’t really worked for them in the past."

"The system is difficult to navigate," Karim noted.

Working with DHS staff on the ground, NYC Health + Hospitals hopes “enhance the experience and to ensure that individuals are taking advantage of the clinical care that’s available to them.”

The new three-year grant will aim to expand ExpressCare’s current reach by including much-needed services for consultations or refilling medications, which will help to address some of the challenges that unnecessarily send high-needs patients to the emergency department. The project also tests the impact of lifting barriers that patients may encounter in seeking behavioral care when they are homeless or unstably housed, such as difficulties accessing and navigating the service and prohibitive cost-sharing requirements.

With a diverse workforce of more than 43,000 employees, NYC Health + Hospitals serves more than a million New Yorkers annually in more than 70 patient care locations across the city’s five boroughs, including 11 essential hospitals. It also has a robust network of outpatient, neighborhood-based primary and specialty care centers, anchoring care coordination with the system’s trauma centers, nursing homes, post-acute care centers, home care agency and MetroPlus health plan.

The grant will cover the costs to plan, implement and evaluate a tailored version of this new behavioral telehealth service, including staffing, technology, communications efforts and materials, Tracy Perrizo, program officer of the Helmsley Charitable Trust’s New York City Program, told Fierce Healthcare.

NYC Health + Hospitals is “building a holistic range of services from assessments to prescriptions consultations to psychiatric services by collaborating with NYC Department of Homeless Services’ Medical Director’s office and homeless service providers to build delivery mechanisms that are most adaptable for the setting, which could include private terminals, iPads or even cell phones,” Perrizo said.

The project also involves patient navigators, who will promote the platform with shelter staff and offer technical assistance to foster connections, which will be vital for the rollout and uptake of the service, particularly in the early days. It also will test engagement strategies to draw more people into behavioral healthcare and deliver that service rapidly where it’s most needed, she said. 

“Ultimately, through this partnership, high-needs patients will have access to around-the-clock support for various mental health conditions, including psychiatric support and substance abuse treatment, and can avoid costly trips to the emergency room,” Perrizo said, adding, “Many people experiencing homelessness also live with multiple chronic conditions, mental health concerns and other unmet social needs — all difficult to address without stable housing. Without good access to care, they can become some of the highest-needs patients.”  

Department of Homeless Services’ Medical Director Fabienne Laraque said in a statement that “DHS is thankful to Helmsley for supporting this program and appreciative of NYC Health + Hospitals’ efforts to broaden and facilitate access to much-needed services for persons experiencing homelessness. This program will improve health by increasing access to behavioral health specialists around the clock for those who would like to connect to the ExpressCare tele-urgent care service.”