After moving to Nashville 18 months ago, Dr. Chase Palisch has already made an impact through his involvement in the development of a new homeless healthcare program at the Vanderbilt University Medical Center.
Palisch’s interest has always been at the intersection of health policy and innovation. After earning his bachelor’s degree, he was a Rhodes Scholar and studied Health Policy at Oxford University, then worked for the Boston Consulting Group before he went on to medical school at Stanford University.
One of Dr. Palisch’s focus is to integrate what are called social determinants of health into his practice of medicine. Social determinants of health are non-medical factors that can positively or negatively affect health outcomes. These factors include conditions in which people live, work, learn, play, worship and age. Housing is one of the social determinants of health.
In your bio I saw that your title is Assistant Professor of Clinical Emergency Medicine. What do you do?
I work as an emergency medicine physician at Vanderbilt University Medical Center sites in the community and in downtown as well as at the Veterans Affairs Hospital in Nashville.
I work in the emergency room clinically, but in addition I am working medically and clinically on the street with street medicine to provide care directly to patients who are experiencing homelessness where they are and where they live. That could be in transitional housing, on the streets, or in encampments. In general, we first meet these patients in the emergency department and then try to follow up on the street to help make sure that their care is continued. Sometimes we also meet people on the street and provide care for them there for the first time. That’s in a nutshell what I do.
How often are you out on the streets?
I go out and provide street medicine every Thursday. I go with community outreach partners from The Contributor as well as with the Veterans Affairs Health Care for Homeless Veterans program who consists of case managers, social workers, nurses, and a psychiatrist that also see patients on the street.
Based on your background, you’re interested in innovative approaches to make healthcare more equitable and affordable to all. How do you do that in your daily work?
One of the big challenges to a problem as large as homelessness is that solutions require [the commitment of] many actors. And so, one of the things I do outside of my clinical work is to try to facilitate partnerships between the various organizations that are helping people experiencing homelessness in Nashville. That has led to a number of partnerships between Vanderbilt University Medical Center as well as other community organizations including The Contributor, Park Center and the Veterans Affairs Hospital.
One of the innovative ways that we’re approaching health care on the street is by following persons who come to us first through the emergency department. One of the great strengths and the relevance of the emergency department is that we’re always open, 24/7, and we encounter many patients experiencing homelessness. In fact, five percent of our emergency department encounters involve people who are experiencing homelessness.
I think we can do a better job connecting them with community resources and providing them with care after that immediate emergency care visit.
So, we’re trying to reach those patients both in the emergency department providing excellent care, making sure we provide follow up care where they live and connect them to many of the community resources to address some of the social determinants that are driving their health problems.
You are involved in the development and running of Vanderbilt’s new Homeless Health Service program including a new street medicine approach. Could you tell us what the goal is and where the project currently stands?
The Vanderbilt Homeless Health Service is a new program that is trying to provide medical care on the street to patients who are experiencing homelessness. The project began with Dr. Jennifer Hess. It really began in earnest two years ago with planning. That planning initially started with identifying what patients who are coming into the emergency department who are experiencing homelessness might need in terms of help and addressing [their condition] as a social determinant of health.
I joined a year ago, and then in the last year, we’ve been working to formalize community partnerships as well as our position in the Medical Center in order to provide care on the street. So, in the last year, we’ve been able to organize that process and starting in 2024, we’ve been actively seeing patients on the street weekly.
Previously, Vanderbilt University Medical Center had a different program that was also called the Homeless Health Service, which provided psychiatric care to patients on the street. This new Home Health Service is seeking to provide both medical and psychiatric care to patients on the street with a new iteration by a new team. We’re trying to leverage the learning and a lot of the experience that still exists with both our team members who were part of the previous iteration of the Homeless Health Service as well as some of the institutional knowledge that helped support that last effort.
Metro government has recently awarded over $760,000 for a two-year pilot project to The Contributor for a collaboration with Vanderbilt University Medical Center and Park Center to more efficiently serve people experiencing homelessness who enter Vanderbilt’s Homeless Health Service program. What are the outcomes you hope for?
Park Center and The Contributor were instrumental in helping us develop and design the Homeless Health Service at Vanderbilt. Working with them we realized that housing as a social determinant of health is the driving factor to provide healthcare to people experiencing homelessness. In the emergency room we provide medical care, but we are not specialized in addressing patients’ housing needs. We realized it would behoove us to enter formal partnerships.
So, we make sure once immediate medical needs are met, we offer to connect them to Park Center if they have an ongoing mental health illness or to The Contributor if they have ongoing medical illness that would qualify them for the SOAR program. (SOAR stands for SSI/SSDI Outreach, Access, and Recovery and links patients to social security income and Medicare/Medicaid, if eligible). The SOAR program could potentially provide them with a pathway to both housing as well as a pathway to insurance and social security insurance and disability supports.
The Contributor was awarded the recent grant from Metro government [to hire staff members to support the SOAR teams and serve as liaisons between the partners].
We had over 2,700 patients who were experiencing homelessness who encountered our healthcare system last year, and we think we can do a better job helping them access that next step. And so, creating this formal collaboration and getting this grant will allow us to connect those patients with the resources that exist in the community.
To sum it up, The Homeless Health Service’s goal is to meet the patients’ medical needs and provide continuity for patients who are entering the emergency department; provide care to them on the street; help with their continuity of care; and connect them on to specialized community partners — whether that’s Federally Qualified Health Centers through the ongoing healthcare needs or alternative supports that are provided by organizations like Park Center and The Contributor to help them address some of the underlying determinants of health factors such as their housing status, as well as social supports that they’re entitled to.
Can you speak to the importance of including people with lived experience in the process of developing this program?
A big part of developing this program was to recognize that all too often people experiencing homelessness are not included in how to address their own care. It can be paternalistic and come from the top down, and also often it doesn’t address the actual needs that patients and people with lived experience are facing.
So, our goal was to incorporate early on patients and people who were experiencing homelessness to help with the design and development of the Homeless Health Service at Vanderbilt in order to make sure that we’re actually targeting the needs. Furthermore, we are developing an Advisory Board of people with lived experience to help us continue to adapt and adjust based on their experiences.