Homeless people with SMI in the United States experience profound health disparities. Supportive housing models such as Housing First are working to end homelessness and promote recovery in this population. Combining on-site primary care and population health management with Housing First offers significant opportunities for improving the health of this severely marginalized group. The PTH-PA/Jefferson DFCM Partnership represents a community of solution and multiple measures provide preliminary evidence that this model is feasible. Ongoing research and program evaluation is underway to determine the effectiveness of the model and, importantly, to inform future policy and system changes to improve the health of formerly homeless people with SMI and create a sustainable, integrated medical home.