Upstate NY Health System Finds Strong Demand for Mobile Healthcare

The Hudson Headwaters Health Network is seeing significant interest in its new mobile health unit, a specially designed vehicle to take healthcare right to the people.

A network of community health centers in upstate New York has started using a mobile medical unit to help remote patients—including students at a small college campus—access care. And officials say the fledgling program could eventually lead to a mobile health fleet.

The Hudson Headwaters Health Network, based in Queensbury, rolled out its first van shortly before winter, with scheduled stops in three small communities (a fourth stop, at the SUNY Adirondack campus, has since been added). The 40-year-old network of 21 community health centers used a $1 million grant and added close to $2 million in fundraising to support the service.

The mobile unit addresses a growing problem in rural areas like northern New York, where healthcare providers are scarce and health insurance is often a luxury. FQHCs and rural health clinics (RHC) are often the only resource for residents' basic healthcare needs if they can the time and make the effort to travel to a clinic.

But a clinic that can travel to these small towns makes a big difference.

Jessica Rubin, vice president of philanthropy and communications at the Hudson Headwaters Health Network. Photo courtesy HHHN.

"The idea was to do what we do best," says Jessica Rubin, HHHN's vice president of philanthropy and communications. "We provide primary care, and when you can't build any more brick-and-mortar [locations], mobile is the best way to reach people."

The idea of putting healthcare on wheels isn't necessarily new, dating back to the first house call. But the advent of digital health technology and an emphasis on taking healthcare to people who normally can't or don't access care is giving these programs added value.

According to research published in 2020, there are roughly 2,000 mobile health clinics operating in the U.S., providing an average of almost 3,500 annual visits. Slightly less than half are federally funded, and about 30% are affiliated with a health system (about a third are independent and 24% are affiliated with a university). They focus on primary care and prevention, and serve an equal mix of insured and uninsured patients.

Nowadays mobile health units can be seen in many large cities, offering everything from primary care to specialty services like behavioral health, substance abuse care, and sexual health information in underserved neighborhoods. And they're starting to show up in small towns and rural areas where providers are scarce and travel to the nearest clinic or hospital can be tough.

These vehicles are often repurposed or specially designed RVs to replicate the clinic or doctor's office, and containing the technology necessary to conduct exams and some tests, connect virtually with healthcare providers, and link with the electronic medical record.

Rubin says HHHN worked with a company that manufactures food vans—an industry that faces similar regulations regarding delivery vehicles—to design the mobile health unit. It includes two exam rooms, an area set aside for tests, some telehealth capabilities, and a refrigerator for storing medications.

John Dudla, CIO of the Hudson Headwaters Health Network. Photo courtesy HHHN.

"It operates pretty much as if we were in a brick-and-mortar building," says John Dudla, the health system's chief information officer. "Although when you take something on the road, there are a bunch of challenges to think about."

For example, HHHN must work with each community it visits to find a good location to park the van for the day, allowing visibility and easy access for patients. In Salem, New York, it's parked at the courthouse, while in Lake Luzerne the van sits outside town hall.  In Whitehall, it is parked next to the town's recreation center. The vehicle can't be parked overnight, at least during the winter, when low temperatures might damage the medications stored inside. That's why HHHN chose its first sites within an hour of the home base.

While HHHN looks for sites with Wi-Fi access, the vehicle does have a mobile hotspot for backup and makes use of cellular services when it can. Internet connectivity must be worked out well in advance, as many small towns don't have reliable broadband capability, and the mobile crew can't just pull into the parking lot of a Starbucks or McDonald's and tap into their Wi-Fi.

Rubin says it's important to meet with the community prior to setting up shop—not just to sign all the necessary paperwork, but to push the narrative that a mobile health unit is just the thing for people who can't or don't want to go to the doctor's office.

"We'll be asked, 'Who is this for?' It's for anyone and everyone," she says. "It's important to get that word out so that [people] know we're here and what we do."

What the mobile unit doesn't have is a waiting room, which is not a big problem during the warmer months, but can be a hassle during winter. Dudla says HHHN is encouraging people to schedule appointments through its mobile devices. Using the devices, people can register and submit needed information on-site through a digital health platform developed by Florida-based Qure4u.

The services offered through the mobile medical unit focus on primary care: family and internal medicine, pediatrics, well child services, gynecological care, screenings and immunizations, voluntary family planning, care management and health education, along with some scheduled lab tests.

The van has become an important resource during the pandemic, giving these small upstate New York communities access to both testing and some vaccinations. It was especially helpful last autumn, Dudla says, in providing testing services for several apple orchards, where Jamaican immigrants are often employed during harvest season.

Rubin says the mobile health program's future offers lots of options and opportunities, provided the program can secure long-term funding. And by the growing number of patients HHHN is seeing at each of the four locations, she knows the need is there.

"In one word, it's all about access," she says, adding that HHHN is fielding calls all the time from other communities interested in hosting the mobile unit. "It's the next generation of access in healthcare. It literally drives our mission. And I feel like every day we're learning something new about it."

"Primary care is shifting all the time," adds Dudla, who's crunching the numbers to see what services and locations are generating demand. "We can use this to fill in the gaps."