AI-Based Platform Supports Community Health Workers in Street Medicine Program

Several California-based organizations are coming together to use AI technology and community health workers to bolster street medicine programs. An initiative started in Southern California using Akido Labs’ tech-supported care model will launch in the Bay Area in March. Several stakeholders spoke with Healthcare Innovation about the potential impact. 

The nonprofit Future Communities Institute (FCI) will serve as the convener of the group, working with the provider network Akido Labs as well as community-based organizations Five Keys and ReImagine Freedom. Five Keys focuses on people experiencing homelessness, with about 25,000 people in their network. Reimagine Freedom serves formerly incarcerated women. As the convener, FCI is co-designing an evaluation framework that prioritizes the expressed needs of each community and provides consistent data reporting across partners. 

Emma Mayerson, the co-founder and executive director of Future Communities Institute, stressed the role of CalAIM in this work. California’s Medicaid transformative initiative is centered on how the needs of vulnerable communities were not being met by traditional healthcare reimbursement systems. CalAIM has created a reimbursement system around whole-person care, which includes medical case management, she said. People in vulnerable communities are the highest acuity patients. Their complex needs are profound. Are they housed? Do they have access to food? 

“Whole-person care is a promise that we can serve all of the above in a single model,” she explained. “The issue has been that there are very few models that are leveraging CalAIM that have achieved financial sustainability and achieved scale. There's a huge administrative burden associated with CalAIM reimbursements and it's a very complex model to implement. What FCI is really excited about is CalAIM’s promise being met with an innovative company like Akido, which is bringing AI into the picture to be able to make it financially sustainable and scalable without sacrificing quality.”

Akido describes itself as an AI-native healthcare provider network. It has 500,000 patients across the country, 240 providers, 100-plus clinics, and 25 specialties. The company also has a major street medicine presence in California. It is using AI from the ground up in how it delivers care, to expand access to patients who struggled to get care in the traditional healthcare system.

Akido also can shift a lot of the reporting and documentation burden of CalAIM off of the street medicine providers, who are overstretched. The harmonization of records and the tracking of their ongoing engagement is critical, the partners say. 

Matt Siegler is Akido’s chief network officer. Previously he served in roles at Kaiser Permanente and most recently as chief growth and strategy officer at NYC Health & Hospitals.

Street medicine providers are a special breed, Siegler noted. It’s difficult to find people who are committed enough to do this work, and it's difficult to sustain the work, he said. “You have to enable people and support them with a broad team of caregivers. You have to provide them with ways to reach these patients and follow up on their needs in an ongoing way. Doing that with paper and pen and physically out in the street every day as an M.D., going from tent to tent or shelter to shelter, can be very challenging and is not sustainable from a financial perspective for most providers,” he added

Akido’s model involves enabling community health workers and others with lived experience and cultural competency to reach people. The information they gather is sent to the physician’s device and they review it. They can then order through the EHR and decide the next step that the patient needs in their journey. Its use of technology paired with the clinical rigor and commitment to do this work is what Siegler says is the secret sauce. “Lots of people have technology, but they don't want to deploy it for this population.”

So where does AI come into it? 

Siegler said the AI is on a tablet or laptop that a community health worker or other care manager is walking around with as they conduct a patient visit. It is prompting them with questions and completing a record for the physician to then review and have a more informed  conversation with the patient. It’s also powering Akido’s electronic health record and the longitudinal tracking of these individuals’ needs. “I think the transformative piece is really that the community health worker can collect a lot of the information that's needed,” he said. 

The model is already active in Los Angeles and Kern County, and the partners are building capacity for up to 10,000 patients in the Bay Area. 

Siegler mentioned some of the early results: 65% of the patients see a provider on the first day of enrollment. “It’s often a long, drawn-out administrative process of enrolling people and maybe someday in the future they can see a doctor. We make it happen in real time,” he said. 

Patients are seeing their providers more often. They see them for 2.2 visits a month, with high-acuity folks doing four or five visits a month, which is significantly higher than the primary care access that these patients typically have, he said. The retention rate is very high— over 67% of patients remain in care. The turnaround time for prescriptions for critical life-saving medicine, particularly opioid abuse reduction prescriptions, is about 24 hours, and providers are seeing 2.5 to 3 times the number of patients that they've been able to see before we deployed the technology. "So we’re really thrilled to see those results,” he said. 

Mayerson said FCI is also interested in this model because it has the potential to help the state improve CalAIM. 

“I think that we have to be documenting and amplifying the examples that do exist of being able to effectively achieve the promise of CalAIM,” she said. “I think that the use of technology to create that force multiplier is a key component, and we need to be embracing its potential and its impact. Part of FCI’s job is to be documenting, to be offering accountability to vulnerable communities in terms of not just their long-term health outcomes, but even improved experience in the healthcare system, improved trust, as well as the kind of service outcomes that Matt was describing earlier. We are making sure that we are coming to legislators, locally, statewide and nationally, to share what we're seeing and to advocate for the proliferation of what works.”