Creating equitable healthcare is a huge challenge. But sometimes, the solutions can start in a single community.
Pair Team is a tech-enabled healthcare resource that supports local healthcare providers so they can better service their community. Pair Team recently launched its Enhanced Care Management program in partnership with the Metropolitan Family Medical Clinics in San Bernardino, California, helping independent primary care clinics partner with local homeless shelters to provide quality healthcare to the area’s most underserved populations.
“This means we’re able to support individuals with high or complex needs,” says Cassie Choi, registered nurse and co-founder of Pair Team. “Those include patients experiencing homelessness, severe mental illness, substance use and those who are transitioning from incarceration.”
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Through its partnership with Metropolitan Family Medical Clinics, Pair Team is working with six community clinics, making a suite of solutions available to community members. A lead care coordinator — who has lived experiences and can help those in need get their social and medical needs met — can be assigned to those in need. Nurse care managers can coordinate clinical case management needs, while social workers provide behavioral health support, and same-day access to primary care and telemedicine are available.
Community-based team members can be reached around the clock, helping individuals with transportation barriers access and travel to care when needed.
“These members of our team are visiting homeless shelters and emergency rooms and food banks and even working with school nurses to meet members of the community and help enroll them into our services,” Choi says. “They also help the members who are enrolled in the program connect with our care team when they might be encountering any barriers.”
Unlike the work Pair Team conducts nationally — which focuses on ensuring that clinics and healthcare providers are well supported by taking on administrative tasks like scheduling and coordination — this initiative prioritizes supporting potential patients who may easily fall through the cracks of the healthcare system.
“There are a lot of high-needs individuals who need more support than just the administrative or clinical support that we were providing at the time,” Choi says. “And with California’s recent investment to enhance Medicaid, we really found an opportunity to make an investment of our own in our care team and expand our capabilities to meet the needs of the community.”
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They’re already seeing the impact of this expansion. Recently, a mother and her four young children were left homeless following a house fire in March in Riverside county, forcing them to live out of a motel while simultaneously trying to tend to the healthcare needs that resulted from the accident. A regular healthcare provider couldn’t help with stressors like transportation, child care and food needs, but with the help of Pair Team’s Enhanced Care Management program, the family benefited from various support systems that treated the situation well beyond just physical care.
“We are able to provide the social support for her family and the medical support,” Choi says. “Our team has been able to connect her with motel vouchers in order to extend her stay in the motel and get her on a waitlist for more supportive housing and we’ve connected her with food pantries on a recurring basis so that she has access groceries that are appropriate for providing food for her family while living in a motel.”
Choi and her team recognize that these needs don’t just exist within San Bernardino and hope to one day be able to expand the offering nationwide along with their other services with the help of more funding and a larger staff.
“Looking at how to fund a whole person approach really can make a huge difference for a family,” she says. “And we’ll be able to bring a workforce and skill sets from other areas into communities that lack those resources as they are today.”