Address Your Toughest Care Gaps With Mobile Health Clinics

Healthcare organizations are using RVs, vans, and buses to deliver care to underserved communities

Editor’s note: This article appears in the October-December 2023 edition of HealthLeaders magazine. Two accompanying stories, accessible here and here, offer brief profiles of 11 such programs across the country.

Healthcare organizations looking to connect with underserved populations on their own turf—literally—are taking a closer look at mobile health clinics.

Roughly 2,000 mobile health clinics exist around the country, according to a March 2023 study published in the American Journal of Accountable Care. They come in a variety of shapes and sizes, from trucks and vans to specially designed RVs and EMS units, and offer a variety of services, including primary and specialty care, population health, and health and wellness resources.

Many have launched over the last decade to give healthcare organizations, especially children’s hospitals, a new channel to connect with underserved communities. Aside from addressing access challenges, they address key public health concerns (e.g., maternal mortality, substance abuse, and sexually transmitted disease) and offer health systems an opportunity to expand outreach, boost vaccination and testing programs, and even reduce ER traffic.

Their attraction is their mobility: They can go where they’re needed most, in rural and remote areas where healthcare resources are limited to urban neighborhoods and where access is hampered by transportation, income, or a lack of trust in the healthcare industry. They can set up in a location where people come to them, sometimes discreetly, to access care or resources or even just talk to a friendly face.

“One of the benefits of mobile health clinics is their adaptability,” Elizabeth Wallace, executive director of the Mobile Healthcare Association (MHA), the leading membership organization for mobile health professionals in the U.S. and Canada, told HealthLeaders. “They’re designed to turn the traditional healthcare relationship on its head … and create a new model of care.”

The Family Van Story

An example of this is The Family Van, launched in 1992 out of Harvard and Beth Israel Deaconess Medical Center in Boston to address high infant and maternal mortality rates among women of color.  The van was initially designed as a resource for women who had access to prenatal care but no shoes to visit a doctor.

“Most of our patients have a primary care provider but they don’t go to them or they don’t tell [their doctors] the whole truth,” says Mollie Williams, DrPH, MPH, a lecturer on global health and social medicine at Harvard Medical School and executive director of The Family Van and the Mobile Health Map, a resource for mobile health clinics with more than 700 members.

Williams says the program sought to break down this barrier by staffing the van with health workers who were familiar with the community. Also on hand were a midwife, dietitian, and children’s welfare specialist.

The only problem? Most of the van’s patients during the first year were men.

“What we found was that people didn’t really want to get their prenatal care from a mobile clinic,” says Williams.

So The Family Van did a quick pivot and broadened its scope to cover chronic care and “whole person, whole family” services. The organization now describes its offerings as “community-based care” and “preventive services, education, and referrals.”

“It’s all connected,” Williams says. “We realized we have to focus on the whole life course of events.”

That’s not unusual. Many mobile health clinics have gone out into the world intending to attract a specific population, only to find things are different on the streets. A program may look great on paper but fall apart when put into practice, for reasons that may never have been considered. Williams says she and her team quickly understood that mobile health clinics have a tremendous advantage in being convenient, but they still need to find that sweet spot that will compel or convince people to take notice and stop by.

Williams says the men stopping by The Family Van were seeking help for minor health concerns, or to get information. And while those issues were minor, they could have gotten worse if not addressed. And men may not have gone to a doctor’s office, clinic, or hospital otherwise.

“There’s a difference between saying you’ll go to a doctor and going to a doctor,” she says.

And that’s how mobile health programs across the country are making a difference. They’re showing up in parking lots and other locations, perhaps next to schools, libraries, community centers, malls, and/or parks. Their mission is to be both visible and invisible, there to remind people to mind their health and stealthy enough to attract those who need help with a sensitive issue.

“You need consistency and familiarity,” says Williams, who notes the Family Van has a scheduled routine and will only go into a community if they’re invited by officials.

Williams says mobile health clinics like hers need that connection to the community to succeed, especially at a time when the public mood tends toward skepticism, if not outright hostility. That’s why it’s important to staff these programs with nurses and others who know the neighborhoods and the people who live there.

And it’s not just about providing healthcare. More important is establishing trust and directing people to the resources they need to improve their health and wellness. She notes that The Family Van operates under a health promotion license, which prohibits them from providing many healthcare services. They can do some things like pregnancy tests, blood pressure checks, and diabetes care, then guide patients to the care they need.

That’s why partnerships are integral to success. Alongside working with local health systems, mobile health clinics need to create connections with community health centers, primary care providers, and others, including social service organizations and even other mobile health programs. Their value lies as much in being a conduit to care as in providing care.

“We can connect people to [community health centers and FQHCs] and even walk with them over to clinic,” Williams says.

“A more sustainable model”

On the issue of sustainability, Williams says Harvard Medical School covers about 20% of the program’s budget, and much of the rest is covered by philanthropic donations from a variety of sources, including foundations. The city of Boston and some health systems often donate supplies, such as condoms. And the program doesn’t ask visitors for insurance coverage.

“There are so many hospitals and players in the healthcare system that it’s hard for them to prove ROI, the value, is there,” she says. She’s hoping that the program can build on relationships with accountable care organizations (ACO) and payers to create “a more sustainable model.”

“I’d spend all day talking to potential partners,” she says.

The value of mobile health programs like The Family Van is that they provide services that often fall between the cracks, either because people don’t have the time, energy, or resources to go to a clinic or they don’t want to. Yet without those services, public health outcomes suffer, and people wind up in an emergency room or urgent care clinic for health crises that could have been avoided and that now cost so much more for both patient and provider.

“It’s as much an access issue as it is an empowerment issue,” says Williams. “We’re here in their communities to support them.”