A hardware breakdown prompted Deborah Heart and Lung Center to outsource its data storage services. How do other health systems decide if and when to make that move?
Health systems have different motivations for migrating to the cloud. A catastrophic disk failure may be the best reason.
That’s what happened at the Deborah Heart and Lung Center, an 89-bed New Jersey-based hospital that focuses exclusively on cardiac, vascular, and lung disease. In 2015, the hospital’s systems pretty much shut down for close to two days after a drive ceased to function on its in-house electronic health record (EHR) system.
As the healthcare industry embraces more technology (especially digital health tools) and ramps up its data collection and analysis capabilities, how that data is stored and protected becomes critical. A July 2021 online survey by the College of Health Information Executives (CHIME) found that more than 80% of health system executives are conducting at least some services in the cloud, while nearly 10% are fully invested in the cloud and some 60% are adopting a hybrid approach.
The reasons for moving to the cloud are numerous. According to KLAS, roughly half of health systems are doing so to reduce costs and capital expenses, while 40% see the cloud as an opportunity to expand resources they don’t have on-site. Almost 30% are using the cloud to enhance services or capabilities, while 11% are looking to improve system performance and 9% see opportunities to improve data security.
That was the motivation for the Deborah Heart and Lung Center.
“It took everything down,” says Rich Temple, the hospital’s vice president and chief information officer, who’d come onto the job just six weeks prior. “It kind of came right out of the blue. We were struggling mightily to try to get backup [up and running]. It was the longest two days of my life.”
Temple says the health system had backups in place just for this occurrence, but the initial disk failure was so profound that some of the backups were corrupted as well. Ultimately, a backup file was restored and, two days later, the system was finally brought back up.
Shortly thereafter, leadership decided to outsource data storage and management for its EHR to CloudWave, healthcare data security experts.
Rich Temple, vice president and chief information officer, Deborah Heart and Lung Center. Photo courtesy Deborah Heart and Lung Center.
Moving to the cloud isn’t cheap—that’s the top concern and barrier that health system executives cite in making the decision whether to outsource those services, though studies have suggested it doesn’t take long for a health system to recoup those costs in savings. In a tight economy, with many health systems struggling to stay in the black, giving the green light to a costly capital expenditure isn’t easy.
“We knew then we couldn’t risk that happening again,” Temple says. “But you don’t do this as a money-saver. You do it for risk-avoidance.”
Aside from the initial cost, many health systems struggle with the operational changes required to make the switch. Every department is affected by the transition, requiring the C-Suite to get out ahead and develop a comprehensive change management strategy.
“It’s truly a multi-dimensional project,” says Temple. “We knew there were going to be a lot of twists and turns, and there were even more twists and turns than we expected.”
One familiar problem, he says, was getting buy-in. Despite the chaos caused by the disk failure, some providers were hesitant to want to adapt to a new system and expressed worries about what are commonly called “last-mile issues,” or problems unforeseen and encountered just as the new system is turned on.
“We’ve always done down-time drills, but everyone is so dependent on electronic health records,” says Temple, noting the health system has been using EHRs since 1998.
Temple says the health system worked long and hard to make sure the transition from on-site to cloud was as seamless as possible. That meant identifying everyone who would need access to the system and determining what they could and couldn’t access, creating licensing and multi-factor authentication and understanding the bandwidth needed to support back-and-forth operations, even understanding all the different platforms within the health system that have some interaction with the EHR.
In addition, he says, the fallout caused by the disk failure gave the Deborah Heart and Lung Center’s leadership the opportunity to look more closely at how the hospital handles its technology at a time when things aren’t working. What should a disaster recovery and business continuity model look like? And how should that model be adjusted when outsourcing certain operations to the cloud? Additionally, how does a health system create a plan to stay up and running after a data breach or a ransomware attack?
“Make sure your eyes are wide open before you start,” Temple concludes.
HealthLeaders Innovation and Technology Editor Eric Wicklund talks with Marcus Perez, president of Altera Digital Health, about the healthcare information technology landscape and the company's goals going into 2024.
Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers.
Editor’s Note: This is part 1 of a two-part story. Part 2 will be published on Wednesday, December 20.
To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.
Here are some of the ways that CNOs are improving teamwork going into 2024.
For more information, check out the full article here.
Violence is on the rise, but so is technology that can turn the tide, as long as those on the frontlines lead the way.
It’s a sobering reality across healthcare: Workplace violence is on the rise.
And nurses, who are at the heart of care, are at especially high risk. In a 2022 National Nurses United survey, nearly half of hospital-based respondents reported an increase in workplace violence, a 57% increase from the rate reported in their previous survey in late 2021.
“The examples, what people describe—years ago, you would never have heard of these kinds of incidents,” says Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, founder and CEO of Innovation Advantage, a healthcare innovation consultancy specializing in virtual nursing care delivery models. She recalls being in a hospital earlier this month when a patient who had just given birth punched a nurse following a communication breakdown over discharge plans.
It's an alarming escalation of a longstanding issue.
“Healthcare in general is an emotionally intense kind of field,” says Sharon Pappas, PhD, RN, NEA-BC, FAAN, chief nurse executive at Emory Healthcare in Atlanta, who co-chaired the American Organization for Nursing Leadership committee on evidence-based approaches to combatting workplace violence in 2014. “So even prior to the pandemic, it was something that of course we were concerned about.”
The pandemic brought with it a host of new challenges, like visitation restrictions that ratcheted up stress during an already fraught time.
“It predisposed us to more emotional reactions by family members, and maybe even patients themselves, because they were among strangers,” Pappas explains.
Beyond rising violence, nurses’ workplace expectations are evolving. Younger nurses tend to be “less tolerant of bad behavior,” Clipper says.
“I don’t think they’re wrong," she says. "We have to figure out how to make it comfortable and safe for everyone. Being a healthcare professional doesn’t mean we have to tolerate violence.”
That figuring out needs to happen fast—and at scale—to avoid sweeping loss.
“If we don't protect healthcare professionals, our numbers, turnover, is only going to accelerate,” Clipper says.
Nursing-Focused Tech Can Help
Two-thirds of U.S. chief nursing officers are already interested in, researching, or deploying a virtual nursing care model, Clipper says. And the involved solutions provide strong bones for safety strategy. For example, patient rooms wired with cameras, speakers, microphones, and more offer extra eyes and ears attuned to threats.
“We're on the precipice, and we’re starting to use some of those things to help us,” Clipper says.
And yet, the current crisis calls for even swifter uptake.
“We really have to have more of a sense of urgency in adopting these technology solutions that are going to help us not only provide better patient care, but also protect our caregivers more,” she says.
Beyond just-in-time tools like wired rooms and badge alert buttons, technologies with emerging safety applications run the gamut in terms of size, complexity, and point of intervention. AI solutions, while still baking, show potential for predicting and preempting behavioral risks, while virtual reality can make de-escalation training more resonant. Seamless incident reporting, meanwhile, can incentivize uptake and produce more insights to shape prevention strategies.
But before beelining to the latest innovation, consider the broader strategic context to avoid doing more harm than good, nurse executives and experts advise.
Some considerations Clipper addresses with her virtual nursing clients include:
What’s the real, underlying problem that needs to be solved?
What’s the model going to look like in the organization?
What are the specific use cases?
How are nurses being brought in to help identify solutions?
Then, design with humans in mind. That means tapping diverse disciplines—security who respond to threats, AI and data experts who can explore predictive applications, and, of course, nurses who are at the fore, Clipper says.
“They're the ones that have to be involved to say, ‘Hey, here was the trigger of this event,’ or ‘there was no warning whatsoever, and here’s what happened,.’” she says. And on the other end of the spectrum, they can share ideas for “proactively identifying precipitating events to predict and thus avoid violence in the first place."
Pappas agrees with the importance of an interdisciplinary approach.
Emory convened a group to probe workplace safety performance and implement structures to facilitate daily discussion on incidents and improvement opportunities.
“That's how you learn, and that’s how you get better and get safer,” Pappas says.
The health system named two co-chairs, a chief nurse and an operations leader, who in turn recruited a behavioral health expert to help guide the effort.
The diverse representation was intentional.
“This isn’t something that you do top down,” Pappas says. “We wanted to get people as connected and oriented toward the first line of workers as we possibly could.”
It’s working. The two inaugural co-chairs are still at the helm today, and Emory’s foresight to form the group “prepared us very well for the increase in some of those workplace safety issues that occurred during and following the pandemic,” Pappas says.
Keep An Eye On AI
With sound safety strategies and decision-making frameworks in place, nurse executives can explore specific technology applications.
Using AI during the intake process, for example, could help identify factors like diseases, conditions, substance use disorder or withdrawl, traumatic events, and family dynamics that could make patients more prone to violence, Clipper says.
It could also preempt fallible decision-making in charged situations, she says, like when the person being violent is a patient who needs care, and their behavior is the result of an underlying condition.
“If we have ways to identify, predict, and prevent, that's way easier for us to deal with than the more subjective, moral, and value-based conversations that nurses struggle with such as 'Do you press charges?' or 'Do you issue a criminal trespass warrant?'” she adds.
Of course, there are risks in relying on hyped, fast-evolving technology for weighty predictions.
“We don't want to bake in bias into our algorithms or into our predictive systems that might inaccurately identify someone that may potentially be at higher risk to behave poorly,” Clipper says. “We have to make sure that we're building these systems in a way that’s equitable."
Make Training Safe (And Sticky)
Technology can also enhance training on how to recognize and respond to violence. VR, for example, can produce realistic, scalable simulations for high-stakes skills like de-escalation and crisis prevention, Clipper says.
Plus, she adds, “the beauty of VR is that’s a failure-safe environment.”
Earlier this year, UT Southwestern Medical Center and UT Dallas designed a VR training tool that places clinicians inside a virtual hospital exam room and presents a series of realistic patient encounters so they can practice proven de-escalation tactics in a real-feeling environment, complete with a headset, vest, and gloves that mimic the sensation of being touched (or hit).
Given this capability, VR is a useful—and increasingly popular—tool for improving problem solving and “muscle memory,” Clipper says.
“When you go through those scenarios, you get to test over and over again what you should do, what you should say, how that works,” she says.
Technology can also make training more accessible and consumable in the course of a busy day.
“It's important that we look at training and newer ways that are more bite-sized as opposed to a three-day class,” Pappas says. “Technology can help with that by [creating] little vignettes, something you can access on your cellphone.”
Meet the Moment
With virtual nursing on the rise, many CNOs already have tools in place or in the works that they can weave into their safety strategy.
Such solutions range from simple, Clipper explains, such as a tablet that allows a virtual nurse to admit, discharge, or educate a patient, to sweeping: a room wired with cameras, speakers, microphones, and even sensor-enabled ambient computer vision and sound.
In the high-tech setups, the devices can act as an occasional or ongoing “extra set of eyes and ears observing what's going on or listening for things that might trigger someone’s interest,” she says.
One organization on Clipper’s radar has developed a safe phrase, “something along the lines of ‘there’s birthday cake in the breakroom,’” that “perks up” the virtual nursing system and prompts “no questions asked” action like a security visit.
It can “expedite that time it typically takes to get someone into the room to further investigate and check it out,” she explains.
Create a Strong Reporting Culture
Emory has found great success, Pappas says, using tech to improve ease of incident reporting so “you have information that you can use to understand it better and actually start to devise strategies to make the workplace safer.”
They’ve integrated reporting with their EHR to automate as much of the process as possible.
“If you can make reporting really easy, people are more prone to do it,” she explains.
As a result, Emory has seen tremendous, across-the-board improvement in levels of reporting thanks to their targeted interventions.
“We were able to detect, by operating unit, that we were having increases at just about every site in the amount of reporting that they do,” Pappas says.
It’s additional information they use daily to make the workplace better, which in turn fuels more reporting, she explains.
“The positive feedback system has helped us to continue to increase reporting and to improve safety,” she says.
To synthesize and act on findings, Emory has implemented a five-tiered huddle system, which runs from the frontlines all the way to operating unit leadership. Every day, the top tier comes together to share what they’ve learned from their own tiered huddles.
“It’s made people say, ‘Wow, if we report it, that means that people are going to talk about it, and I get a chance to improve this,’” Pappas says.
Know That Tech Alone Can’t Save You
An “aha moment” in Emory’s stepped-up reporting came from an unexpected setting: ambulatory clinics.
“The stakes aren’t quite as high [because] the patients aren't quite as sick,” Pappas explains.
And yet, their reporting revealed that some patients experiencing long wait times “would exhibit behaviors that threaten the staff,” she says. “It just was a real surprise to us.”
So they tapped their strong professional governance network, clinical nurses and other caregivers who come together on a regular basis to review competencies and patient outcomes, to review the safety reporting and help devise a response. Following these time-tested decision-making and discussion frameworks produced “some of our best interventions.”
Those interventions included targeted de-escalation training for staff in areas where patients had been demonstrating aggressive behaviors and lots of “very good discussions” about applying low- and high-tech solutions strategically, especially in high-risk areas like the emergency department.
Based on group deliberation, Pappas says, Emory installed metal detectors at certain—but not all—key entrances. They also explored the idea of placing alert buttons on badges but decided to instead voice needs and check on each other rather than introducing and keeping track of another new gadget.
“The key there is just involving the people that it impacts and getting the best direction from them about how to use devices and systems to improve safety,” Pappas says.
It's a testament to technology’s ability to augment but not replace human ingenuity and camaraderie. Safety is “everyone's job,” Pappas says. That means success comes from a shared responsibility and commitment to “take care of each other.”
Federal officials say 28 provider and payer organizations have signed on to voluntarily adhere to federal guidelines around the responsible and ethical use of AI in healthcare
As questions arise over who should be in charge of AI governance, the Biden Administration is focusing on collaborating with some of the biggest health systems and payers.
The administration this week unveiled voluntary pledges from 28 organizations “to help move toward safe, secure, and trustworthy purchasing and use of AI technology.” The announcement, coming on the heels of President Biden’s November 30 Executive Order on AI, sets the stage for what’s expected to be lively debate over whether the federal government or the healthcare industry should set the ground rules. Many within healthcare, still hurting from the thorny rollout of electronic medical records and “meaningful use” criteria, are arguing that the industry should be able to police itself.
The administration’s response, authored by National Economic Advisor Lael Brainard, Domestic Policy Advisor Neera Tanden, and Arati Prabhakar, director of the Office of Science and Technology Policy, is focused on working together.
“The commitments received today will serve to align industry action on AI around the ‘FAVES’ principles—that AI should lead to healthcare outcomes that are Fair, Appropriate, Valid, Effective, and Safe,” they wrote. “Under these principles, the companies commit to inform users whenever they receive content that is largely AI-generated and not reviewed or edited by people.”
“They will adhere to a risk management framework for using applications powered by foundation models—one by which they will monitor and address harms that applications might cause,” the three advisors continued. “At the same time, they pledge to investigating and developing valuable uses of AI responsibly, including developing solutions that advance health equity, expand access to care, make care affordable, coordinate care to improve outcomes, reduce clinician burnout, and otherwise improve the experience of patients.”
Those organizations voluntarily committing to that framework are Allina Health, Bassett Healthcare Network, Boston Children’s Hospital, Curai Health, CVS Health, Devoted Health, Duke Health, Emory Healthcare, Endeavor Health, Fairview Health Systems, Geisinger, Hackensack Meridian, HealthFirst (Florida), Houston Methodist, John Muir Health, Keck Medicine, Main Line Health, Mass General Brigham, Medical University of South Carolina Health, Oscar, OSF HealthCare, Premera Blue Cross, Rush University System for Health, Sanford Health, Tufts Medicine, UC San Diego Health, UC Davis Health, and WellSpan Health.
“We have collaborated with these innovative providers and payers to define a set of voluntary commitments to guide our use of frontier models in healthcare delivery and payment,” Paul Uhrig, Bassett Health’s chief legal and digital health officer, said in a LinkedIn posting shortly after the announcement was made.
“We applaud the efforts to convene a diverse group of healthcare organizations to coalesce around landmark voluntary commitments that will be fundamental to the future of AI and allow us to responsibly advance the use of these technologies for the benefit of those we serve," added Sanford Health President and CEO Bill Gassen. "As the largest rural healthcare provider in the country, we were honored to help lead this effort on behalf of our patients, two-thirds of whom live in rural communities in America's Heartland. It has been energizing to collaborate over the last several weeks with colleagues across the healthcare ecosystem on a framework that reflects our shared commitment to harnessing large-scale AI and machine learning models safely, securely and transparently. Such swift progress following the signing of President Biden’s executive order on AI underscores our collective acknowledgement of the myriad ways in which these technologies could help to improve healthcare quality, access, affordability, equitable outcomes, patient experience, clinician well-being and industry sustainability – likely in ways that we cannot fully anticipate today. Protecting our patients who place their trust in us is paramount as we move forward. We look forward to continuing to work with industry leaders, elected officials and the Administration on these critically important efforts.”
Those organizations have pledged to:
Develop AI solutions to optimize healthcare delivery and payment by advancing health equity, expanding access, making healthcare more affordable, improving outcomes through more coordinated care, improving patient experience, and reducing clinician burnout.
Work with their peers and partners to ensure outcomes are aligned with fair, appropriate, valid, effective, and safe (FAVES) AI principles.
Deploy trust mechanisms that inform users if content is largely AI-generated and not reviewed or edited by a human.
Adhere to a risk management framework that includes comprehensive tracking of applications powered by frontier models and an accounting for potential harms and steps to mitigate them.
Research, investigate, and develop AI swiftly but responsibly.
The administration is also highlighting pledges secured earlier this year from more than a dozen technology companies, including Microsoft and Google, to toe the line on developing and using AI responsibly.
“We must remain vigilant to realize the promise of AI for improving health outcomes,” Brainard, Tanden, and Prabhakar wrote. “Healthcare is an essential service for all Americans, and quality care sometimes makes the difference between life and death. Without appropriate testing, risk mitigations, and human oversight, AI-enabled tools used for clinical decisions can make errors that are costly at best—and dangerous at worst. Absent proper oversight, diagnoses by AI can be biased by gender or race, especially when AI is not trained on data representing the population it is being used to treat. Additionally, AI’s ability to collect large volumes of data—and infer new information from disparate datapoints—could create privacy risks for patients. All these risks are vital to address.”
As outlined in Biden’s Executive Order, the federal government’s efforts to govern AI are being led by the Health and Human Services Department. Alongside HHS, other departments have taken action on AI concerns, including the National Institutes of Health (NIH), US Food and Drug Administration (FDA), Office for Civil Rights (OCR), and Centers for Medicare & Medicaid Services (CMS).
“The private-sector commitments announced today are a critical step in our whole-of-society effort to advance AI for the health and wellbeing of Americans,” the three advisors wrote. “These 28 providers and payers have stepped up, and we hope more will join these commitments in the weeks ahead.”
Here’s a sampling of some of the mobile health programs across the country
Editor’s Note: This list accompanies this story. Part 1 of this list can be found here.
With help from the Mobile Health Map and The Family Van at Harvard Medical School, HealthLeaders has compiled short profiles of 11 mobile health programs around the country.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
OhioHealth Wellness on Wheels (WOW) is just like a normal doctor’s office, but it meets our patients where they are, delivering primary care, women’s health services, and prenatal care regardless of ability to pay. We have three mobile units, each with two full-service exam rooms and the capabilities to provide prenatal care, primary care, and ultrasound lab services as other wellness services. All mobile clinics are staffed with a provider, nurse, medical assistant, social worker, community health worker, and driver.
Our program is unique from many other mobile unit programs as we offer a patient-centered medical home through a team-based approach, led by a provider, to ensure comprehensive and continuous medical care to patients. WOW serves as a connection point for patients who are seeking services to address various social determinants of health, such as education, food, housing, insurance, and transportation, as well as needing pediatric care, resources to address abuse and behavioral health issues, and much more. To date, 59% of WOW patients screened positively for a social need and were referred to community resources for support.
Our program currently serves vulnerable communities throughout central Ohio. The care model focuses on scheduled appointments (rather than walk-ins), community engagement, chronic disease management, and the use of a community health worker to help understand and meet the needs of our patients.
Amid rising infant mortality rates across the state, WOW has provided comprehensive prenatal, postpartum, and women’s healthcare to women residing in Franklin County’s infant mortality “hotspots.” As a result, WOW programs have an infant mortality rate of 5.3 per 1,000 live births, below the Center for Disease Control and Prevention’s Healthy People 2020 targets and the infant mortality rate in Franklin County, which is 6.7 per 1,000 live births. Our programs also demonstrate impact through reduction in neonatal intensive care unit (NICU) admissions in the communities across central Ohio and helping babies reach their first birthdays.
Wellness on Wheels Primary Care also demonstrated a positive impact on access to care through significant reduction in emergency department use. Over the last five years, visits to the ED by WOW patients have decreased 50 percent within 90 days of establishing care through WOW.
Q. What kind of technology do you use?
Our mobile units are resourced with the same registration and clinical technology seen in our brick-and-mortar clinics. Our team uses Epic as their electronic medical record platform, and our ultrasound images are digitally transferred to the EMR for interpretation and storage, as are EKG and spots vitals units. For connectivity our mobile units use a wireless WAN and jetpacks. Additionally, we have security cameras on the outside of the mobile units to ensure safety of patients and staff. To assist with fleet management our units are equipped with the Verizon Connect Fleet Tracking system.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
In 1993, Wellness on Wheels was created to provide comprehensive prenatal and postpartum care to high-risk and underserved women, especially teens, in central Ohio to improve birth outcomes and prevent NICU admissions. This project was originally referred to as Wellness on Wheels/Project to Reduce Infant Mortality (WOW/PRIM).
WOW was designed as a mobile doctor’s office to provide prenatal care, health education, and psychosocial counseling to pregnant women ages 12 to 44 in the low-income areas. WOW enabled pregnant women to have the quickest available prenatal care appointment, thereby offering early prenatal care that they might not have otherwise had. At that time, appointments with WOW were made by calling directly or through StepOne, a dedicated phone service for scheduling appointments with non-profit prenatal care clinics, a convenient scheduling method that continues today.
Over the years, it became evident that there was a shortage of primary care providers across the United States, and Columbus was no different. OhioHealth noted several areas with limited access to primary care and a tendency to overuse emergency room services for primary care needs. OhioHealth had extensive experience in mobile outreaches, but none that were focused on primary care. Through a partnership with Huntington National Bank, we started Wellness on Wheels Primary Care. This outreach has been serving the Hilltop and Linden communities of Columbus for the past five years and provides a care team focused on embedding themselves within the community and gaining the trust of those who may not otherwise seek care.
Q. What are the biggest challenges this program faces?
The biggest challenge OhioHealth Wellness on Wheels faces is ensuring that our programs can be sustained due to rising operational costs, the increased cost of healthcare, and the augmented need seen throughout the community. Additionally, in staffing our driver/registration position it has become a challenge trying to find CDL-A qualified drivers with the desire to serve the community.
Q. How is this program supported so that it is sustainable?
OhioHealth Wellness on Wheels has a mixed funding model of philanthropic, grants, and sponsorship support. We use grant funding and generous support from OhioHealth to operate as a physician office for those patients without insurance.
Q. How are patients charged for healthcare services? Do you work with payers?
Wellness on Wheels is a no-barriers-to-care model and will serve patients no matter their ability to pay. Our program does register patients who have insurance under their provider, while for the uninsured and underinsured we have a fund through the OhioHealth Foundation that supports the cost of their care. We provide physician visits, ultrasound and lab work to patients without insurance at no cost to them. One key initiative of our community health workers is to identify all patients who qualify for insurance and assist them with the enrollment process.
Q. How do you let people know when and where you'll be located? How do you market your services?
We use OhioHealth’s website for an external audience (Wellness on Wheels | OhioHealth) that promotes our programs and lists our contact information as well as clinic locations. Additionally, our team does grassroots marketing through site visits to community-based organizations, community partners, and events. We distribute brochures, hot cards, and flyers to promote and build awareness of our programs. We also find that word of mouth from our established patients is our best form of marketing.
Q. Do you partner with local health systems, primary care providers, health clinics, or other programs?
Yes. Wellness on Wheels mobile programs are part of the OhioHealth enterprise care system. Our comprehensive primary care uses a medical education model with a family medicine resident and attending physicians from three residency programs working in collaboration with the WOW team. Since 1993, community partnerships have been key to the success and sustainability of Wellness on Wheels. Columbus City Schools, Columbus Public Health, Directions for Youth, Central Ohio YMCA, and the Center for Healthy Families are just a few of our committed local partners.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
We would like to expand the use of sprinter vans to support community health workers and social services and expand our geographical reach. Additionally, we would like to implement addiction medicine and behavioral health services into mobile programs, especially after testing a few successful pilot programs.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
Over the years, the WOW team has been heartened to see how women have trusted the comprehensive care team to support their birth experience enough to return for multiple pregnancies and prenatal care. This example demonstrates the impact of years of trust building and how the care team ensure every patient is treated with dignity and respect.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
The Night Ministry’s Health Outreach Program brings free healthcare and supportive services directly to Chicago residents who are unhoused or experiencing poverty. The program is unique in its mobile approach to serving patients who face many barriers accessing traditional healthcare and social services. Through consistent outreach, the provision of resources such as food, clothing, tents, and harm reduction supplies, and a compassionate, nonjudgmental approach, the program staff build relationships with patients, earning their trust as a gateway to providing care and connecting them to such resources as primary care clinics, substance use disorder treatment, and more stable housing.
There are three main components to The Night Ministry’s Health Outreach Program: The Health Outreach Bus, Street Medicine, and CTA Outreach.
The Health Outreach Bus visits Chicago neighborhoods with disproportionate rates of homelessness and poverty during the evenings and the weekends, when clinics and social services agencies are generally closed. Street Medicine visits encampments and other areas of the city where unsheltered individuals are living. The CTA Outreach component connects with unhoused individuals who ride public transit for shelter by bringing health care and outreach services twice weekly to select CTA train stations.
The Night Ministry’s Health Outreach Program direct-service staff include two-full time and one part-time nurse practitioners, three volunteer physicians, three case managers, a substance use specialist, and several outreach professionals.
In the last fiscal year, the program’s medical professionals provided more than 2,000 free health assessments. More than half of those assessments resulted in a patient being treated for a medical condition that would have otherwise been untreated. The program also prevented more than 380 trips to the emergency room, saving the public health system an estimated $350,000.
Q. What kind of technology do you use?
Our medical and case management professionals use the AthenaPractice electronic health records system to document their work. Efforts to Outcomes is another platform we use to document outreach data.
With regard to medical technology, conducting outreach in mobile units can be limiting compared to a brick-and-mortar setting. We have recently acquired EKG machines and have an emergency defibrillator. If more extensive equipment is needed for patient care, individuals are referred to primary care, specialty care, or the emergency room.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
The Night Ministry launched and continues to expand its Health Outreach Program because the patients it serves face multiple barriers to accessing traditional healthcare services, from lack of healthcare insurance and transportation to discrimination during previous encounters with the healthcare system. Bringing care directly to where patients live helps address some of these barriers.
Q. What are the biggest challenges this program faces?
The biggest challenges stem from patients not having housing or being unstably housed, which can hinder the ability for them to recover from or manage their health conditions. Inadequate rest, limited access to hygiene resources, polluted living environments, and the loss of medications are among the conditions that compromise patients’ health. In addition, follow-up with patients can be difficult due to their lack of a permanent, fixed address.
Q. How is this program supported so that it is sustainable?
The Health Outreach Program is supported through various revenue streams, including grants from private foundations and government agencies and donations from corporations and individuals. The Night Ministry’s Philanthropic Engagement Department is responsible for ongoing cultivation and stewardship of these funders and securing the funding necessary to operate the program.
Q. How are patients charged for healthcare services? Do you work with payers?
The Night Ministry’s Health Outreach Program operates as a free and charitable clinic and does not charge for its services.
Q. How do you let people know when and where you'll be located? How do you market your services?
Consistency of presence is one of the key tools in connecting with patients. The Health Outreach Bus follows a set schedule, visiting locations on the same day and time on a weekly basis. The CTA Outreach Program also operates at the same public transit stations every week. While the Street Medicine Program operates with more flexibility in its schedule, it regularly visits areas where patients are located, and often coordinates visits by communicating directly with patients. The vehicles used by the program, including the Health Outreach Bus and Street Medicine Van, advertise the services provided. In addition, The Night Ministry builds relationships with agencies and organizations across Chicago that refer patients to our Health Outreach Program.
Q. Do you partner with local health systems, primary care providers, health clinics or other programs?
We regularly refer patients to other healthcare clinics and service providers for further care. We have also established relationships with teaching hospitals in the Chicago area which allow for medical residents to further their training and gain experience in caring for unhoused populations while enhancing the capacity of The Night Ministry to provide services.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
The Night Ministry’s Health Outreach Program continues to evolve in many ways, from substance use programming to hiring practices to mental health and programmatic service expansion. We are growing substance use programming by building referral relationships for supportive services, distributing harm reduction supplies, and educating our clients on safe drug use. And for the first time, we are hiring a psychiatric nurse practitioner to bring mental healthcare directly to our clients.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
We are sometimes the only way that people access medical or housing support. We always ask clients where they would go if The Night Ministry wasn’t there to provide services. We find that people avoid seeking support for many reasons, including prior mistreatment, lack of transportation, fear of having their belongings stolen, or separation from a pet or partner. By going directly to clients and establishing trust, clients are more likely to work with us for the long term in navigating the often challenging housing system and securing long-term solutions.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
Since 1993, the Yale Center for Clinical and Community Research (YCCR) has operated the Community Health Care Van (CHCV, a 40-foot mobile medical clinic that functions alongside a minivan and storefront office to provide harm reduction and other medical services in New Haven, Connecticut.
The CHCV has long delivered accessible and barrier-free harm reduction and healthcare services at the doorsteps of the community, with an emphasis on New Haven’s most vulnerable neighborhoods. The CHCV served 1,574 clients in 2021. A rotating trio of providers staffs the CHCV throughout the week, alongside two medical assistants and several office staff.
The CHCV serves a significant population of unstably housed/homeless individuals and people who use drugs (PWUD), as well as individuals transitioning from incarceration or treatment programs back to the community. More than 30% of CHCV clients report unstable housing or homelessness, and nearly half experience food insecurity. The CHCV is positioned to meet the needs of these community members, offering services in primary and preventive healthcare, flu and COVID-19 vaccines, HIV care, substance use disorder treatment, and care coordination to stabilize those in crisis or in need. Additionally, the CHCV operates one of the largest overdose education and naloxone distribution programs in the state.
In response to the COVID-19 pandemic, the CHCV expanded its mission to create the Mother-Infant Program (MIP), a mobile unit providing postpartum care for birthing parents and infants with health-related social needs. The MIP addresses health inequality, maternal mortality, substance use, and access to care, and seeks to address the burden of social determinants of health. The MIP aims to decrease adverse maternal and infant outcomes while simultaneously increasing basic needs support.
Q. What kind of technology do you use?
Our 40-foot CHCV has a modem allowing internet access in the van. We use three desktop-style computers on the van, as well as a laptop, which provides us with access to our Epic electronic heath record (EHR) platform. We leverage a working agreement with American Medical Response (AMR), an emergency medical services company, to rent one of their box trucks, which we have retrofitted to provide a space in which to service MIP clients. On the MIP van we use a cellphone hot-spot in order to access our EHR.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
The CHCV has a trusted relationship with the New Haven community, a city profoundly impacted by poverty, substance use, homelessness, and incarceration. It is the 7th poorest city in the US for its size, with more than 25% of its residents living in extreme poverty, often geographically remote from traditional healthcare settings. The mobile nature of the CHCV and minivan allow our team to frequent underserved areas, such as homeless encampments, shelters, hotels known for drug use, residential neighborhoods, and business districts.
We have found that low-barrier access to healthcare increases the use of services amongst our patients. With specific reference to postpartum care, 40% of women do not attend their traditional brick-and-mortar six-week post-partum visit. By comparison, mothers who are seen by the MIP demonstrate an appointment no-show rate of about 4%.
By taking a focused approach on meeting patients at their doorsteps, providing nuanced care, and assisting them in navigating the healthcare system, the CHCV and MIP provide an innovation in service delivery that directly confronts traditional barriers to healthcare access.
Q. What are the biggest challenges this program faces?
Long-term funding and hospital system buy-in.
Q. How is this program supported so that it is sustainable?
The CHCV team continually applies for a mix of research and service grants to support our program. Including federal, state, and philanthropic sources, we piece together various funding to support our staff and the costs of running the CHCV. Clinical billing offsets a small percentage of this but we could not operate the program without grant and philanthropic funding.
Q.How are patients charged for healthcare services? Do you work with payers?
Patients are never charged for CHCV or MIP services. If they have insurance, a bill for services will be sent to their carrier, but patients are never responsible for services provided by CHCV. We work closely with a CHCV-specific billing team to ensure that services are properly billed. Our medical case managers help patients access patient assistance programs to pay for medications when necessary.
Q. How do you let people know when and where you'll be located? How do you market your services?
The CHCV is a longstanding fixture in New Haven, with most of our clients having accessed our services for many years. We keep the same weekly schedule, at the same locations. Print schedules are handed out in our storefront location and posted on our Instagram page. Many of our patients have learned about services through word of mouth.
Q. Do you partner with local health systems, primary care providers, health clinics or other programs?
We partner closely with several community-based organizations and health clinics. Referrals are often placed to two federally qualified health centers (FQHCs) in New Haven. All referrals to the CHCV MIP program come from a local FQHC. Additionally, we refer to behavioral health services, dental services, and other specialty services as needed.
In the summer months, the CHCV services partner with Power in a Shower, which provides showers for individuals experiencing homelessness. We also collaborate often among our non-profit peers, such as the Community Alliance for Research & Engagement, Junta for Progressive Action, Downtown Evening Soup Kitchen, and Integrated Refugee & Immigrant Services. These non-profit connections allow for a clear “window” into the needs of the community. Without the added bureaucracy that often accompanies larger entities, our non-profit peers can facilitate timely conversations around community needs, allowing dynamic responses from entities such as the CHCV and MIP.
The CHCV and MIP serve as vehicles for Yale Medical and Nursing students to see first-hand the challenges to healthcare access experienced by many New Haven community members. Student precepting allows the CHCV and MIP teams to engage the health professions schools in community-based healthcare.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
The CHCV continues to represent an intersection of community-based healthcare, harm reduction, and clinical innovation. In the face of New Haven’s profound opioid overdose epidemic, the CHCV (and our brick-and-mortar-based office) have begun using a Fourier-transform infrared spectroscopy (FTIR) machine, which provides a novel mechanism for identifying and tracking harmful adulterants in the drug supply. We combine FTIR testing with real-time delivery of results to our clients and community response teams. Results from testing are accompanied by discussions surrounding safer use and other harm reduction messaging.
Additionally, our MIP team has begun providing dyad-focused care for pregnant and postpartum women (and their children) in SUD residential treatment through Connecticut’s largest provider of addiction treatment services. From the program's inception in January 2022 to March 2023, the MIP completed a total of 157 visits (35 individual moms and 27 individual children). Women living in residence have access to MIP services throughout their 3-8 month stay, and many use the services multiple times for follow-up and personalized care coordination.
The expansion of CHCV and MIP services demonstrates the dynamic nature and nimble response of mobile healthcare. Our vans have flexed to respond to pressing community issues like the COVID-19 epidemic, providing vaccines, hand sanitizer and masks, as well as providing basic primary care, Narcan, and now specific FTIR testing and drug supply alerts.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
Agile Orthopedics provides in-place amputee services including prosthetic limbs through the use of intentionally designed mobile clinics. This care model is unique in that it addresses the intersection of physical disability and social determinants of health. People dealing with amputation and in need of prosthetic services are often limited in their ability to make it to clinic appointments due to transportation and financial constraints. By providing in-place service, these barriers are eliminated, and access to these services is significantly improved.
The population served is anyone in need of these services, but over time the alignment between our service model and the patient population as a whole has become focused on the underserved. The outcomes we track and have seen are increased speed between amputation and ambulation, which in turn leads to overall improvements in physical health. We are also studying how our intervention affects hospital readmission rates. We suspect that our in-place model, which also includes case management, reduces hospital readmissions following amputation surgery.
Q. What kind of technology do you use?
Mobile healthcare is all about trial and error and continuous improvement. After a bit of experimentation, we landed on a system of adjustable modular prosthetic components designed in Iceland that provide an amazing amount of versatility and options for assembling and fitting prosthetic limbs in the field. We also use 3D scanning to capture detailed dimensions of patients’ limbs and changes over time. We are always improving and expanding the capabilities of our specialized mobile clinics that house all the equipment and machinery required for comprehensive on-site prosthetic services.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
After many years of leading traditional outpatient programs, it became clear that the no-show rates were very high, sometimes up to 50%. I took a deep dive into this issue and found that patients are faced with overwhelming barriers to engaging in the requirements of traditional clinics. Social determinants of health, like access to healthcare and economic stability, combined with the real challenges of physical disabilities make it impossible for many amputees to be provided with the prosthetic management they need. Using mobile services for those in need surfaced as a viable solution to remove barriers and improve access and equity to these services.
Q. What are the biggest challenges this program faces?
Recruiting practitioners who are suited for and truly understand mobile healthcare has been a challenge. The requirements to be highly organized, incredibly creative and improvisational, and to operate in variable, unpredictable situations, take a special person with unique perspective.
Q. How is this program supported so that it is sustainable?
We partner with hospitals, physicians, and surgeons to promote patient choice of providers and raise awareness that mobile care is an option. The differentiation and truly patient-centric approach has gained traction over the last several years, which has led to the sustainability of the organization.
Q. How are patients charged for healthcare services? Do you work with payers?
All services we provide are covered through Medicaid, Medicare, and private insurance carriers. We also work with a non-profit organization in order to cover those without insurance or resources.
Q. How do you let people know when and where you'll be located? How do you market your services?
We generally market our services directly to hospitals, physicians, and physical therapists who get the word out about our services. We also attend events and support other organizations that serve the underserved.
Q. Do you partner with local health systems, primary care providers, health clinics, or other programs?
Yes, partnerships are critical, as amputee services require a team approach.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
In an effort to provide more community-based amputee care, we have begun to offer amputee-specific physical therapy. This has improved the comprehensive approach to our services. In the future, we plan to add occupational therapy and case management, as these are needs that are predictable within the population we serve.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
I’ve been surprised by how our services have aligned with specific populations over time. So much of our identity has changed since the initial design and marketing of the organization toward anyone in need of prosthetic services who might require or just prefer the mobile model. We have come to align closely with certain underserved communities, like the unhoused, and those within the state and federal department of corrections systems who particularly need mobile services. This type of alignment has driven innovation in our programs to serve very specific needs of those populations.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
The Sidney Kimmel Cancer Center (SKCC) Mobile Cancer Screening Van offers multi-cancer screening opportunities tailored to the risk of communities, as well as additional social services to reduce adverse social determinants of health. The van services a seven-county catchment area spanning the Greater Philadelphia region in Pennsylvania and New Jersey.
The van offers breast, prostate, skin, head and neck, and colorectal cancer screening; cervical cancer screening is being onboarded in 2023. The unit also offers services such as hepatitis B screening and vaccination, connection to primary care, and chronic disease screenings for hypertension and diabetes. Services to reduce adverse social determinants of health have included connection to free Internet and technology (tablet computers) and food pantries, as well as assistance in registering to vote. All screenings and services are offered free of charge. For patients who are uninsured, a fund at SKCC covers the cost of screenings and any diagnostic testing needed.
Q. What kind of technology do you use?
The mobile screening van is fully equipped with Epic, our health system’s electronic medical record, to record patient screenings and evaluate impact over time. For breast cancer screening, the mobile van is equipped with state-of-the-art 3D tomosynthesis for screening mammography.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
The SKCC launched a mobile cancer screening van as one way to reduce cancer disparities in our catchment area. Cancer incidence and mortality rates are higher in our catchment area than state or national rates and disparities exist within our populations. Philadelphia County, at the heart of our catchment area, has the highest levels of poverty of any large city in the US, and a majority of residents are battling adverse social determinants of health in their everyday lives.
Innovative care delivery models are needed to overcome traditional barriers to care experienced by our residents, such as lack of transportation, lack of time for medical care, and unfamiliarity with preventive care and cancer screening. By bringing healthcare to residents, mobile cancer screening reduces many of the known barriers to care.
Q. What are the biggest challenges this program faces?
Every cancer screening event is held in conjunction with a community partner; therefore, our team is engaging with hundreds of community partners each year. Some community partners, like primary care clinics, are used to hosting clinical events like a screening day, while others, such as church groups, are less familiar with and unaware of the nuances in patient insurance, screening eligibility, and mobile van requirements.
Also, staff turnover at community partners makes consistency in planning sometimes challenging. Patients who are not engaged in the healthcare system often present at the mobile screening van with multiple healthcare needs and require additional care beyond screening. While this is an opportunity to connect patients to other care, it can be taxing at times on the screening van staff.
Q. How is this program supported so that it is sustainable?
The mobile screening van was launched with generous philanthropic donations that continue to sustain key portions of the program. Additional funds from grants, sponsorships, and government funds support the mobile screening van, as does revenue generated from billing insurance for guideline-recommended screenings. The diversity and combination of these funds ensures that the mobile screening van is sustainable well into the future.
Q. How are patients charged for healthcare services? Do you work with payers?
Patients who have health insurance and receive reimbursable cancer screenings are billed for their care. All payers who have contracts with our healthcare system are accepted on the mobile van. For those who do not have health insurance, screening and follow-up care, if needed, are free of charge.
Q. How do you let people know when and where you'll be located? How do you market your services?
We market our cancer screening events in multiple ways. The community partner often takes the lead on marketing to the individuals in their network; as a trusted community partner, their name and reputation in the community are important for getting the word out. Also, all screening events are posted on our website and anyone can register to attend an event. Lastly, sometimes we do targeted outreach to communities and individuals about particular screening events that need a boost in awareness.
Q. Do you partner with local health systems, primary care providers, health clinics, or other programs?
Yes to all of the above. We also partner with churches, non-profit organizations, public libraries, community colleges, local health departments, employers, and coalitions. We will partner with anyone who wants to bring the mobile cancer screening van to their community.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
The program is always evolving to meet the needs of the communities that we serve. For example, we started with a mobile van that only offered breast cancer screening; we are about to onboard our sixth cancer screening exam. There is still more that we can do in cancer prevention and control, such as bringing awareness about lung cancer screening to the community, promoting smoking cessation programs, and providing other cancer prevention services, like HPV vaccination.
We can also do more to combat the adverse social determinants of health of our residents by offering more wrap-around services to meet their needs and better connections to other aspects of healthcare for them and their family members. We are also working to improve the data analysis and evaluation aspect of our program to ensure that we’re offering the highest quality of care in the most culturally sensitive manner possible.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
The demand for the mobile cancer screening van is so much higher than we anticipated. The COVID-19 pandemic caused many people to go without cancer screening for a significant amount of time, coupled with people who are simply disconnected from healthcare for numerous reasons. Communities are looking for ways to bring quality healthcare to their neighborhoods in a way that is convenient and not cost-prohibitive, and mobile cancer screening fills that need.
With help from the Mobile Health Map and The Family Van at Harvard Medical School, HealthLeaders has compiled short profiles of 11 mobile health programs around the country.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
Project Vision Hawai‘i is a mobile health and human services organization that operates solely out of mobile clinics and mobile service units. We bring services directly to communities with access to care issues such as lack of insurance, geographic challenges, cultural barriers, and limited to no income.
Q. What kind of technology do you use?
We use laptops, printers, and mobile hotspots as far as hardware goes, and have expanded to include an electronic health records platform, which also allows us to bill for services.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
Since Hawai'i is made up of several islands, it can be challenging to access certain services on certain islands and even the terrain can be very different on different parts of each island. For example, The Big Island is the largest island, so large, that all of the other islands can fit onto it. Residents living on the south or north parts of the island may not be able to drive to access services in the main cities of Hilo and Kona. Thus, Project Vision brings traditional services directly to communities, and furthermore to peoples’ doorsteps. This has allowed us to reach populations of people who would otherwise never have access to basic and preventative health services.
Q. What are the biggest challenges this program faces?
The biggest challenges our organization faces are the costs of staffing and travel and the challenges of managing data. With the rising cost of gas and other expenses, we have to carry the burden of those expenses. Additionally, the organization is developing a capacity to collect, manage, and analyze data, while handling numerous requests for data from funders and partners.
Q. How is this program supported so that it is sustainable?
We always look to sustain our programs beyond just grants. While we apply for private foundation grants as well as state, county, and federal funding, we also try to bill for as many services as we can. Our nonprofit also hosts multiple annual fundraising events and pursues corporate and individual philanthropy. We do our best to diversify our revenue streams so that we can sustain our ever-growing programs.
Q. How are patients charged for healthcare services? Do you work with payers?
Project Vision bills insurance when possible and never turns anyone away because of an inability to pay or lack of insurance. We are contracted by the State of Hawaii Department of Human Services to assist clients with SNAP (food stamps) and Med-QUEST (Medicaid).
We focus on establishing care between local providers and patients. We never want to take patients away from their established primary care providers. If they have established care, we will refer them back to their doctor. If they do not have any established care, we partner with local providers to receive our referrals. If they absolutely need services and would not be able to access traditional care, then we will partner with local providers to bring services directly to them.
Q. How do you let people know when and where you'll be located? How do you market your services?
A lot of our success is due to the wonderful work that our dedicated team of outreach workers do in building partnerships with other organizations, as well as the regularity in offering our services. Outreach teams try to return to the same locations on a weekly or monthly basis so that people know where to find us. We also publish our schedules on our website. We use a combination of the website, social media, and our partners to market our services.
Q. Do you partner with local health systems, primary care providers, health clinics or other programs?
Yes. We are strong believers in partnerships and collaboration. We always want to establish care between our clients and our local providers, hospitals, and community health centers.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
We are always looking at ensuring that our programs don’t become stagnant and just put “bandages” on the problem. We want to make sure that we always come from a holistic perspective when looking at our programs. We are looking at a housing component which would allow us to not just provide services, but actually assist clients with a place to live.
In growing our team, we look for ways to employ technology to become more efficient. This will enable outreach workers and healthcare providers to spend more time helping clients, rather than at their desks doing administrative tasks.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
A pleasant surprise, especially during COVID, was the level of trust that we have gained from the legislature, the state, the city, hospitals, community health centers, and our many partners. We are so grateful and honored that our colleagues would provide us the trust that they have shown us to work together to increase access to health and human services for the people of Hawai‘i.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
The WVU Cancer Institute provides state-of-the-art care to West Virginians close to home. While growing our network and increasing access to clinical services, we are also taking cancer screening to communities throughout the state that need it most. Mobile cancer screening provides our state’s most rural residents the highest quality of care without the need for them to travel long distances.
Working with local clinics, businesses, and healthcare providers, Bonnie’s Bus mobile mammography unit and LUCAS (Lung Cancer Screening), our new lung cancer screening unit, travel to 42 counties across the state to offer screening services where it is convenient for the patients. Both units are led by the WVU Cancer Institute's Cancer Prevention and Control staff and are operated by WVU Hospitals. Together with local communities and medical providers, we are striving to reduce the impact of cancer in West Virginia through early cancer detection.
Our approach to patient care is innovative because we strive to serve residents across the entire state to be as inclusive as possible. Other mobile models for service focus on a geographic region within 1-2 hours of their headquarters. West Virginia has a population of less than 2 million people spread over 24,000 square miles, and we would miss the population that we are trying to serve the most: Those without easy access to care.
For patients who meet national guidelines for lung cancer screening through low-dose computed tomography (LDCT), our program bills Medicaid, Medicare, and private insurance. However, no eligible West Virginian will be turned away due to lack of insurance or the inability to pay. Grant funds and donations are available to pay for lung cancer screening for those without insurance coverage.
Another aspect that makes our approach unique and innovative is that we do not only screen at sites within our health system. We partner with many different clinics, health systems, and organizations. Results and recommendations are sent to each patient and their ordering provider, typically their primary care provider. This allows patients to communicate and follow-up with a provider with whom they are familiar. If a patient requires follow-up services, we can work with the ordering provider to help identify resources that best meet the patient’s needs.
All of the reasons listed above were implemented to best serve the needs of the patient. If someone is going to be diagnosed with cancer, we want it to be as early as possible when it is most treatable.
Q.What kind of technology do you use?
LUCAS is equipped with the latest AI technology from Cannon, offering patients an ultra-low dose of radiation that is less than half of the standard of care. A large part of our success lies in the fact that we can transmit the LDCT images in real time back to our radiologists at the Mary Babb Randolph Cancer Center in Morgantown, West Virginia. This allows the images to be read and results sent to the patient and their ordering provider in the fastest possible time. Many times, providers receive patient results the same day as the patient’s lung cancer screening.
LUCAS also travels with its own generator (the size of an SUV) to power the LDCT scanner. LUCAS is the only mobile unit for lung cancer screening in the nation that travels statewide without the need for facility-based power, making it truly mobile.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
Lung cancer is the second most common cancer in both men and women, accounting for 18% of all new cancer cases in West Virginia. Smoking is linked to 80% to 90% of lung cancers diagnosed. West Virginia leads the country in the prevalence of adult smoking at a rate of 25.2%. West Virginia is also the only state that lies entirely within Appalachia; it is considered the third most rural state in the nation, with 61.8% of the state’s counties designated as rural. More than half of the state's residents live in rural areas where lack of reliable transportation and lengthy driving times contribute to delays in health screening and follow-up care.
In 2009 the Bonnie Wells Wilson Mobile Mammography program began providing mammograms to the most rural parts of the state. Bonnie's Bus has traveled over 200,000 miles, found more than 125 cases of breast cancer, and screened more than 25,000 women from all 55 counties. In the summer of 2021 we expanded mobile screening to include lung cancer screening, thus creating the WVU Cancer Institute Mobile Cancer Screening Program. The need for LUCAS emerged as Cancer Prevention and Control was working to strengthen the infrastructure for lung cancer screening in West Virginia.
LUCAS is the only mobile unit for lung cancer screening in the nation that will travel statewide without the need for facility-based power. LUCAS provides LDCT screening close to home, refers those in need of follow-up to facilities nearest to them, and has so far screened more than 1,200 patients. Patients are often not able to travel for cancer screening. Travel barriers exist beyond just the time it takes to travel to a screening site. Additional concerns include the cost of travel, patients who don't drive, taking time from work and family responsibilities, etc. LUCAS provides lung cancer screening in a comfortable, convenient environment for women, men, transgender, and gender-diverse people.
LUCAS is a complement to our standing or traditional lung cancer screening program at the WVU Cancer Institute. It’s not that one is better than the other because they are both providing a valuable service. The mobile unit is just able to reach patients that are unable to use a traditional setting.
Q. What are the biggest challenges this program faces?
One of the biggest challenges we have faced and keep facing is the lack of education about lung cancer screening and the lung cancer screening continuum. We are constantly educating providers and the public about LDCT.
Q. How is this program supported so that it is sustainable?
We are committed to increasing the number of West Virginians who receive lung cancer screening. We bill Medicaid, Medicare, and private insurance. We also seek out donations and grant funding through local and national partners. This funding is used to not only support operational costs, but also to pay for lung cancer screening for West Virginians who are without insurance.
Q. How are patients charged for healthcare services? Do you work with payers?
Medicaid/Medicare will pay for those who go to a registered facility and that meet national screening guidelines. Private insurance covers the scan, but guidelines vary and may require additional risk factors or differ in the covered age range. For those who do not have insurance, no eligible West Virginian will ever be turned away. Grant funds and donations are available to pay for lung cancer screening for those without insurance coverage and that meet USPSTF screening guidelines.
Q. How do you let people know when and where you'll be located? How do you market your services?
LUCAS staff provide every scheduled site community flyers, press releases, and social media promotions. In addition, our schedule is posted on our Facebook page and the WVUCI events calendar.
Q. Do you partner with local health systems, primary care providers, health clinics, or other programs?
Community partners and patients are the keys to our success. LUCAS works with more than 150 clinics, hospitals, and healthcare providers each year to coordinate visits and patient care.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
The program can evolve with further connection/integrations with communities to increase the number of patients screened.
We would like to assist in increasing lung cancer screening nationally by being a part of national conversations about the future of lung cancer screening. This has already started with national and international organizations asking the WVU Cancer Institute Mobile Cancer Screening Program for technical assistance and resources as they work on their own mobile lung cancer screening units. Continuing in these larger conversations and sharing of best practices can help build the momentum for significant changes in lung cancer screening and survivorship.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
The greatest experience is the wave of people that have embraced our program, the unit, and our drivers. Breast cancer screening has been around for so much longer and there is so much media attention to it, so it’s not surprising when communities embrace our mobile mammography unit. But for lung cancer screening, it’s relatively new, there is a stigma associated with it, and there is still a lot education needed to ease fears and increase acceptance. It is amazing when we come into town and the community, the clinics, and the media get excited. It is truly remarkable that we can take this highest quality service to a rural community and that we are able to serve our fellow West Virginians in this way.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
The Durham Tech Mobile Health Lab makes vision and general medical services accessible to members of low-income communities within the surrounding counties in central North Carolina. The program has three primary goals: 1) Deliver cross-disciplinary health education and outreach to the community; 2) Provide clinical training to the workforce in an effort to expand their view of healthcare and see community health issues firsthand, resulting in better prepared and empathetic practitioners; and 3) Engage the community in health career education and recruitment opportunities to broaden awareness about healthcare careers.
Thanks to a grant from Blue Cross Blue Shield, the Mobile Health Lab launched three years ago and is led by one full time mobile health lab coordinator and one part-time mobile optical services coordinator. The program’s target population is members of the surrounding communities facing health disparities because of financial barriers or insufficient access to care. Students of various levels serve on the mobile health lab, ranging from resident medical students to first-year college students.
This model is different because there is no other community college in the US that we are aware of that provides this type of service while including so many student learners in the process. It is improving not only healthcare access to those who otherwise wouldn’t have been able to receive care, but it is having a lasting effect on our student learners, so they will be better future providers.
Q. What kind of technology do you use?
We have a complete optical doctor’s lane inside our health lab, which includes everything you would see at a brick-and-mortar eye doctor’s office. For example, an autorefractor, lensometer, phoropter, retinoscope, and slit lamp, to name a few. We use a portable EKG machine for preventative care and iPads and hotspots for documenting while we are out and about. We also have a TV monitor for health education.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
There was a need in the area to help children who are unable to receive vision services due to the lack of access or cost. The program was initially launched to fulfill that need. We have since expanded to offer other preventative care options as well.
This works better than a brick-and-mortar clinic because we bring the service to the people who lack the transportation and resources. Since a majority of our patients are children, their parents lack transportation or are not able to take off work to get them to an eye doctor or receive a sports physical. By providing our service to children while they are at school, we solve both problems for parents.
Q. What are the biggest challenges this program faces?
The biggest challenge the program is currently facing is a lack of funding for sustainability and finding physicians or advanced practitioners willing to donate their time to help provide the services.
Q. How is this program supported so that it is sustainable?
At the moment this program relies heavily on grants and private donations/sponsorships. We have recently added a partner fee, but because we provide all of our services for free, even that is hard to initiate. Other nonprofits struggle just as we do to provide services at no cost or a sliding scale.
Q. How are patients charged for healthcare services? Do you work with payers?
Patients are not charged for any healthcare services we provide. Some of the organizations that we partner with do pay a partner fee. Other than that, we work with no payers.
Q. How do you let people know when and where you'll be located? How do you market your services?
All of our events and trips with the Mobile Health Lab are planned in advance. Our model works by partnering with other organizations or agencies and going to them. They assist in the coordination of our efforts. We use social media and word-of-mouth to market our services. We have found that word-of-mouth travels far and fast. We have a long waiting list, unfortunatel,y for those needing some of our services.
Q. Do you partner with local health systems, primary care providers, health clinic,s or other programs?
We partner with the local health system, primary care providers, health clinics, and other universities in the area. We are also open to partner with any and everyone.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
This program looks at the need of the community and evolves along with it. One of the largest unmet needs in this area that we are repeatedly asked to provide is dental services, which is something that we do not provide at this time. In the future, with more funding for equipment and personnel, this could be a new facet to our program.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
What has most surprised me is the extent of the need and the lack of vision services children and adults are able to attain for themselves because of access or cost. The other thing that has most surprised me is the number of disciplines within Durham Tech that we have been able to incorporate into our program, including a community Spanish interpreter, occupational therapy, community health worker, cardiovascular tech, ECG tech, phlebotomy, biomedical equipment tech, nurse's aide, and medical assistant.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
The PanCare mobile program is long reaching. During the school year, we provide medical, dental, and optometry services to students in our local school district. We are on-site at schools offering the opportunity of medical care to thousands of students at no cost. We provide auditory, vision, and scoliosis screenings and school and sports physicals, as well as dental exams, cleanings, and sealants for no cost. In addition, we offer no-cost optometry exams and affordable eyewear. We also participate in a myriad of community events spanning 10 counties providing healthcare access to those regardless of health insurance status.
Q. What kind of technology do you use?
We keep our mobile teams connected by using Wi-Fi hotspots. They are able to securely connect to patient medical files and access our team page to stay in touch with updates from home base.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
The advantage of a mobile clinic is that it is mobile. Our units facilitate hands-on access to patients in rural and underserved communities. Our mobile programs are able to provide on-the-spot healthcare where a brick-and-mortar counterpart may be booked out for days at a time. Launching a mobile program allows PanCare to extend services to those who might not otherwise receive them.
Q. What are the biggest challenges this program faces?
The biggest challenge that we are faced with is also our greatest strength. This program is dynamic, in that we are often transitioning how we do things in order to meet the next need of our community. Nothing is constant for too long. We alter what we do or how we do it to best fit the task or situation presented to us. We are rooted in flexibility and change.
Q. How is this program supported so that it is sustainable?
Our program relies on grants and partnerships to remain sustainable.
Q. How are patients charged for healthcare services? Do you work with payers?
There are no out-of-pocket costs for the services provided on the medical and dental units. However, we will bill insurance if the patient has it. Our optometry bus completes no-cost exams for students in our partnered districts.
Q. How do you let people know when and where you'll be located? How do you market your services?
Our marketing team makes use of both social and local media outlets, allowing us the best possible turnout. For services provided on school campuses, students receive information pertaining to what will be provided at that specific location.
Q. Do you partner with local health systems, primary care providers, health clinics or other programs?
PanCare is a patient-centered medical home. Our mobile program often partners with our clinics to augment patient services. We also participate in events that are organized by the Department of Health and other local organizations. Such events allow us to bring services to local veterans, underserved community members, and those experiencing homelessness. We are partnered with the local school district to provide health screenings, physicals, dental services, optometry, and affordable eyewear to students. Our partnerships allow us to extend our reach beyond what we could do on our own.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
The advantage of a mobile program is flexibility. We can adapt and evolve to meet the needs of our community. During the height of COVID, our units were deployed to offer testing, vaccine, and monoclonal antibody services over a multi-county area. Our adaptability allows us to evolve in ways that are often unplanned, but crucial to making healthcare accessible to all.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
COVID-19 was a global pandemic with a level of severity and mortality that most did not expect to experience. The nature of a new and ever-changing virus coupled with nationwide shortages and production delays creates a host of unforeseen hurdles. Tireless and dedicated frontline and behind-the-scenes teams are what manifests progress in the face of the unknown. Our PanCare teams worked diligently to face each COVID barrier, which was sometimes as simple-yet-integral as “Where can we park the bus that can accommodate hundreds of patients?” One by one, we overcame challenges to bring desperately needed services to our neighbors.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
Stony Brook Cancer Center’s Mobile Mammography Van provides screening mammograms to women in the Long Island area by going directly into their neighborhood or workplace. It is helping our hospital reach women living in underserved areas that our hospital normally does not reach. For example, 79% of our patient population are classified as minorities, while only 9% visit in our brick-and-mortar breast center.
Q. What kind of technology do you use?
We use the most recent technology on the market, Selenia Dimensions 3D Hologic mammography equipment.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
Long Island covers a large geographical area. Its western-most border is the New York City borough of Queens, and it stretches east to both Montauk and Orient Points, spanning over 120 miles long. The further east one travels, the island becomes increasingly rural, which is a directly inverse relationship to the availability of public transportation. There are pockets of poverty on Long Island, and we realized that without reasonable access to healthcare, many residents would forfeit medical care altogether if we do not bring the services directly into their communities.
Q. What are the biggest challenges this program faces?
Upon inception of the program the biggest challenge was spreading the word about our services, going door to door, while simultaneously trying to build a positive reputation. Years later, we currently have an internal challenge with hospital administration hampering our efforts to reach the communities via social media, a free and easy way for more people to learn about the benefits of our program and how to book us directly for events.
Q. How is this program supported so that it is sustainable?
This answer was easier in the first few years of existence, as the program was fully covered by a state grant. Fast forward years later to the present time, we do have a healthy mix of screening insured and uninsured patients, which are both billable services in the counties which we serve. Aside from earning income for each mammogram performed, the program has been supported by various smaller grants along the way in various capacities. We also count on donations from philanthropists in our community.
Q. How are patients charged for healthcare services? Do you work with payers?
Our mobile unit is considered an extension of our hospital, so any insurance that is accepted by our state hospital is accepted by us. When registering the patient for an appointment, insurance is verified and billed according to the test being performed. The uninsured patient, which accounts for more than half of our patient population, is enrolled into a state program called Cancer Services Program (CSP), and all costs for the exam(s) are covered. The hospital receives payment for the rendered services.
Q. How do you let people know when and where you'll be located? How do you market your services?
On our website we list all the days and locations where we will be screening. Our partner and host site will promote the scheduled visit to their their members and community. We also work with community groups and organizations in the area to help us spread the word. Oftentimes our staff members will set up a table at the screening location one week prior to our arrival in order to register interested patients and answer any questions. Ideally in the future we would like to post our locations and information about how to book appointments on social media.
Q. Do you partner with local health systems, primary care providers, health clinics, or other programs?
We partner with local health systems and medical offices that do not offer mammography services. Our mobile staff schedules monthly trips to the same offices so that all of the patients in a particular office can be put on the schedule to get screened for breast cancer. This includes offices within our own hospital umbrella as well as offices outside of our own medical landscape, such as federally qualified health centers (FQHCs). We are constantly seeking more effective ways to promote our services.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
We are in the process of adding additional cancer screenings. The Cancer Services Program also covers the cost for uninsured patients to receive many screenings aside from mammograms, so the more we can offer, the more evolved our program can become. Since we are a part of a teaching hospital, we will continue to welcome medical students, PA students, and nursing students in order for them to learn about community healthcare, and we are collaborating with residents of the many departments within our own hospital who would like to offer their services to communities that they have been unable to reach.
Q. What is the one thing about this program, good or bad, that has really surprised you?Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
A pleasant surprise to our staff was the interest that local politicians take in our program, many of whom continue to be great community partners with us. These politicians host events within their jurisdiction and have their staff do the legwork to promote each event by mailing out their own flyers. Those events have become some of our most successful.
An additional treat is when our mobile staff encounter a community member who does not yet know about our services. Once our program is explained to them, the joy and excitement they exude is unmatched. Reactions like that energize our staff and serve as a constant reminder of the great work that is being done.
Something the staff never expected to experience is the amount of hugs and blessings they receive from patients they are screening. The staff make the patients feel so comfortable, and the uninsured patients who were scared to show up and unsure of how the screenings were being paid for are so thankful to the staff, they all say they cannot wait until they can return.
Q. Describe your program, why it's different or innovative, who it serves, how many care providers it features, and how this is improving healthcare access and/or clinical outcomes.
The Palmetto Palace was founded on May 30, 2006, to help support underserved individuals and families in South Carolina. Seeing a need in the local healthcare system, Dr. Youlanda Gibbs created the organization to originally provide lodging and resources to those supporting a loved one who was hospitalized. This quickly expanded to additional health and support services, as well as food distribution for communities in need.
As Dr. Gibbs and her team of volunteers served a growing number of people close to her home base in Charleston, she expanded the organization to include a mobile health unit to serve communities throughout the state, providing preventative medical and dental services to those in rural and underserved areas.
Through extensive fundraising and community support, the Palmetto Palace Mobile Health Unit made its debut on July 31, 2019. Shortly afterwards COVID-19 hit, and the Palmetto Palace pivoted quickly—providing masks, public education, and food distribution at first, then shifting to COVID-19 testing and eventually vaccines. To date, more than 8,000 COVID-19 vaccines have been delivered through the mobile health unit, making it one of the top 10% of COVID-19 providers in South Carolina.
The Palmetto Palace’s mission has always been to serve in the best way possible, offering help and hope through preventative and diagnostic care to underserved communities. Over the last several years our organization has provided additional services and resources to our community when they needed it most. Our goal is to continue increasing our reach and scope of services so that we can continue to provide top-notch healthcare, public education, and additional resources to our friends and neighbors across the state.
Q. What kind of technology do you use?
We use the athenahealth EHR platform and social media to promote our program.
Q. Why did you choose to launch a mobile program? How does this work better than a brick-and-mortar clinic or virtual program?
South Carolina has many rural areas and only three major cities—Charleston, North Charleston, and Columbia—with more than 100,000 residents. The southern part of the state, called the “low country,” includes some of the poorest counties, many without medical offices or even pharmacies. Allendale, one of the towns we serve, is the poorest town in the state, and there is just no way these residents can get to good care. We knew we had to come to them.
We feel it is our duty to make care accessible when transportation and payment are the biggest barriers. During the pandemic we used our mobile unit to ensure that those most in need could have access to vaccines. We just knew we couldn’t do this work solely virtually, nor could we reach our target patient population with a brick-and-mortar facility.
Q. What are the biggest challenges this program faces?
Operational support through funding and earning the trust of the community.
Q. How is this program supported so that it is sustainable?
We are set up to bill through the state Medicaid program and are seeking operational support through fundraising and grant opportunities. We also have a network of volunteers to help us reach our goal, enjoy a partnership with the city of North Charleston, and have an MOU with Roper Saint Francis Healthcare, which provides us with some supplies and takes our medical waste for processing. This helps drive down the cost of operations.
Q. How are patients charged for healthcare services? Do you work with payers?
We are credentialed with Medicaid and we do not accept commercial insurance. We do not charge patients who are uninsured or underinsured, and we're supported by Roper Saint Francis Healthcare, a low country not-for-profit health system that accepts patients through their charity program.
Q. How do you let people know when and where you'll be located? How do you market your services?
Our Executive Director, Dr. Youlanda Gibbs, is very active in the communities we serve. She attends county and city council meetings and church functions in the communities we serve to get the word out. We also use social media to advertise where we will be. We maintain a consistent schedule in each community to provide consistency and gain the community’s trust with our reliability.
Q. Do you partner with local health systems, primary care providers, health clinics, or other programs?
Yes. We refer patients to Roper Saint Francis Healthcare for specialty services and primary care if the patient can logistically get to those facilities. If not, we work with local federally qualified health centers and free community clinics to refer patients.
Q. How might this program evolve? What new technology or strategies would you like to employ in the future?
We have added three more buses to our fleet that are either in production to be upfitted or are waiting for the funding to start that process. One of those buses will be a dedicated education station and another will offer pharmacy services. We would love to be able to offer telehealth services in the future for those who truly cannot get to our mobile unit or other care facilities. We are actively seeking grants and partnerships to support telehealth services.
Q. What is the one thing about this program, good or bad, that has really surprised you? Something you didn't expect to see or experience, an unusual case or treatment, a challenge or barrier you didn't expect to face or didn't expect to be so tough, etc.
I received a call from a community member last month who had attended a county council meeting in a rural area near Allendale. She was retired from the state, and she told me she was completely blown away at the meeting listening to our executive director, Dr. Gibbs, speak. She wanted to know what she could do to get involved.
I was so surprised by the fire that Dr. Gibbs had ignited, in the best way possible: Here was this citizen who was at the meeting for another reason and then she heard Dr. Gibbs. This example and others of the willingness to get involved and help this little bus that could has really surprised me.
I have been a community health RN for 20 years and it is sometimes a struggle to get people involved. But the biggest surprise and struggle was of course, COVID. We were ready to move operationally in one direction, and then the pandemic changed all of that. We pivoted from providing primary and preventative care to testing and vaccines. Before the vaccine became available we struggled to find testing supplies (in the beginning of the pandemic, they were hard to come by). This has only shown how agile and organic the Palmetto Palace is. We pivoted to the needs of the community and, though challenging, it has proved to be so rewarding. Dr. Gibbs was honored by the state health agency DHEC for the Palace’s work in vaccinating those who otherwise would not have had access.
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.”
Healthcare leaders are looking for new ways to strategize and be proactive in the coming new year.
One of the largest pain points for healthcare executives is the workforce, and with healthcare comprising 10% of the U.S. workforce, there is no shortage of challenges.
Healthcare executives gathered at the HealthLeaders UpNext Exchange last week to discuss the workforce issues they’re seeing in the industry and figure out different ways to face those challenges going into the new year. Here are some of the key takeaways.
1. Need for Better Strategy
The up-and-coming healthcare leaders talked about some familiar pain points, ranging from strategy to staffing to implementing new technologies. Many said they are busy and missing time in their schedules to sit down and strategize for their organizations, so they’re looking for new ways to plan while accounting for high turnover and staff changes.
It’s clear that a five-year strategy no longer works. There are far too many disruptions in healthcare, and executives, including CNOs, need to be able to pivot accordingly. Some of the biggest disruptors, like Amazon and Walmart, are forcing traditional healthcare organizations to take a serious look at the competition.
2. Addressing Turnover
Also, turnover rates have been higher than ever, at 105%, in the last few years. Many factors are affecting this rate, including burnout, poor working conditions, and a physical worker shortage. Additionally, the workforce is aging, and there are not enough young people to replace the older generations of workers who will soon be retiring. This makes staffing hospitals extremely difficult, and will be a contributing factor to workforce issues for the next several years.
The same is true for nursing, CNOs everywhere are struggling to staff hospitals amidst a national nursing shortage. Even though there are efforts across the industry to streamline certification and attract more nursing graduates, new strategies for dealing with turnover rates will be a higher priority than ever going into 2024.
3. Streamlining Decision-Making
Another challenge is getting resources from the C-suite. Many executives at the Exchange brought up the disconnect of priorities between the C-suite and frontline workers, and between each department in their respective health systems. They also cited the slow pace of change in healthcare, and how narrowing focus and giving priority to certain challenges first would help speed up change and fix problems more efficiently.
To some of the executives, solving this issue could involve taking a look at who has a seat at the table in decision-making, and sending representatives to the discussion who can then disseminate information to their teams. This would help streamline the process to make progress in their organizations happen faster and more strategically. CNOs must be a part of these strategic discussions to make sure that their nurses have a voice and a seat at the table.
4. Being Proactive
So how do executives address these challenges?
The biggest takeaway from the Exchange was to be proactive. Healthcare executives, including CNOs, should focus on the following three solutions going into 2024:
Engage in strategic workforce planning;
Invest in professional development; and
Foster a supportive work environment.
Executives should consider using tools such as the business model canvas to define their business strategy and address the challenges caused by competition. Strategy tools can also help to identify areas in their health systems that offer opportunities for more innovation.
CNOs play a huge role in the development of nurses on their teams and in creating a healthy work environment where nurses can be seen as “whole people.” Going into 2024, there should be a focus on work-life balance to prevent burnout, and a push to continue the growth and education of nurses in each health system.
The 2024 HealthLeaders UpNext Exchange is sponsored by Collette Health.
Recent studies, surveys, and HealthLeaders coverage highlight patient experience drawbacks for healthcare organizations.
What are four things that detract from a positive patient experience at healthcare organizations?
HealthLeaders collected recent studies and surveys, and talked to healthcare leaders about what areas can negatively affect the patient experience, and what executives can do to solve these issues. Here are the four big pitfalls to avoid to create a positive patient experience.
1. Patient discrimination
Black parents are about twice as likely as parents who are White, Hispanic/Latinx, or of other races to experience unfair treatment in healthcare settings, according to a recent study.
Earlier research has documented discrimination or unfair treatment based on race, ethnicity, and other personal characteristics. In healthcare settings, discrimination or unfair treatment has been linked to negative consequences for healthcare quality, trust in the healthcare system, and treatment adherence.
The recent study, which was conducted by the Urban Institute, is based on data collected from parents with children under the age of 19. The data was drawn from the June 2022 Urban Institute Health Reform Monitoring Survey. That survey had a sample size of 9,494 adults.
The study features several key findings:
13% of parents said they were treated unfairly in healthcare settings based on race or ethnicity, language, health insurance type, weight, income, disability, or other characteristics
22% of Black parents said they were treated unfairly in healthcare settings, which was 10 percentage points higher than unfair treatment reported by parents who were White, Hispanic/Latinx, or additional races
3% of all parents said that their children were treated unfairly in healthcare settings because of the parent's or child's race, ethnicity, country of origin, or primary language
9% of Black parents said that their children were treated unfairly in healthcare settings because of the parent's or child's race, ethnicity, country of origin, or primary language
40% of Black parents and 30% of Hispanic/Latinx parents said they were concerned that they or a family member would be treated unfairly in healthcare settings in the future because of race, ethnicity, or primary language
Healthcare organizations can address patient discrimination by having robust diversity, equity, and inclusion programs. They can also provide clinicians and other healthcare workers with culturally competent care training.
2. Making patients coordinate their own care
Two-thirds of U.S. adults surveyed by The Harris Poll reported that managing healthcare is "overwhelming" and "time-consuming."
The survey was conducted by The Harris Poll on behalf of the American Academy of Physician Associates (AAPA). The survey, which features data collected from more than 2,500 adults, was conducted from Feb. 23 to March 9.
The survey was conducted to get the patient perspective on U.S. healthcare, AAPA CEO Lisa Gables, CPA, said in a prepared statement. "So much has changed in healthcare since the pandemic, and the focus has largely been on the strain that healthcare teams are experiencing. Certainly, we have to address that as we know it impacts the resiliency and strength of our healthcare workforce. However, AAPA wanted to understand from the patient perspective what is and isn't working in healthcare today."
The survey included two key findings:
Survey respondents reported that they spend the equivalent of an eight-hour workday per month coordinating healthcare for themselves and/or loved ones
The survey found 54% of adults reported that their health would improve if healthcare providers helped them figure out the healthcare system
The survey shows patients are struggling with the healthcare system, which can impact patient experience and health outcomes, John Gerzema, CEO of The Harris Poll, said in the survey report. "What struck me from the research we conducted on behalf of AAPA is how clearly the findings demonstrate how the system itself is getting in the way of people being able to take care of themselves as well as the ones they love. The system is costly, confusing, and it takes too long to get needed care."
To alleviate this, small hospitals and physician practices should assign nurses to navigate healthcare services, and health systems and hospitals can employ care managers, community health workers, and nurse navigators to help patients.
3. Failure to follow-up on diagnostic tests after telehealth appointments
Research finds that patients are less likely to get follow-up diagnostic tests after a telehealth appointment than after an in-person visit. To address this problem, health systems and hospitals need to provide better follow-up services.
A recent study published by JAMA Network Open found that diagnostic loop closures for colonoscopies, cardiac stress tests, and dermatology referrals were worse for patients after virtual visits than for those patients seeing their doctor in-person.
The research, conducted by affiliates of Harvard Medical School, Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Northeastern University, and Stanford, suggests that health systems are not providing the appropriate support after a telehealth visit to ensure follow-up tests are done. That includes sending messages to the patient after an initial visit to schedule and follow through on diagnostic tests.
Without that follow-up to close the loop, diagnostic tests are not taken and the care plan is interrupted. This could mean patients are not alerted to serious health concerns such as cancer or advanced cardiac disease.
"When investigating notable differences in loop closure for orders placed during telehealth visits, our findings suggest that differences in loop closure may be inherent to telehealth as a modality," the study team concluded. "One potential mechanism to explain this may be the lack of systems in place to help patients complete test and referral orders. During in-person visits, members of the support staff team sometimes help patients schedule their tests at checkout; however, this support is absent during telehealth visits. After the visit, patients do not receive any communication reminding them to schedule the test or referral, which may further limit loop closure."
"Other potential explanations include the possibility that it may be more difficult to remember information provided during telehealth visits, that telehealth may present unique communication barriers, or that it may be more difficult to engage patients in shared decision-making during virtual visits, thus decreasing patient engagement with test and referral orders," the study team added.
4. Extended lengths of stay
Length of stay is ultimately a key metric for how well hospitals care for patients, says Marjorie Bessel, MD, chief clinical officer of Banner Health. "When your length of stay is appropriate, it means that everything that sits under that—how well you take care of patients, how well you work them up, how well you treat patients once you understand what disease process they have, and how well you anticipate the patient's needs post-discharge—is functioning well."
Weak management of length of stay is a driver of emergency department boarding of patients, which results in a major hit to patient experience, says Peter Charvat, MD, MBA, chief clinical officer of the Bon Secours Richmond market. Bon Secours is part of Bon Secours Mercy Health, and the Bon Secours Richmond market features seven hospitals.
"Oftentimes, we find that some of the initial testing and treatment for patients may not be started when they are boarded in the ED. Boarding can also overwhelm an ED. As we discharge patients appropriately out of the hospital, we can free up inpatient beds and pull patients from the EDs to start their inpatient care," he says.
Bessel and Charvat offer six strategies to manage length of stay.
1. Preventive care: Health systems should encourage their patients to receive preventive care. During the coronavirus pandemic and in the post-pandemic period, many patients did not receive routine preventive care, which has led to sicker patients in hospitals and longer lengths of stay.
2. Operational efficiency: Hospitals need to focus on the efficiency of their internal operations, Bessel says. "How fast can you get things moving? How fast can you get a patient worked up to get a diagnosis? How fast can you get the right treatment for the patient? And how quickly can you help the patient recuperate so they are stable enough to be discharged to the next level of care?" she says.
3. Manage transitions to post-acute care: Sometimes, length of stay is extended because of limited access to post-acute care services such as skilled nursing or home health. "Post-acute placement such as with skilled nursing, inpatient rehab, and home health care can be problematic if our post-acute partners are not able to provide services on a timely basis," Charvat says. Hospitals need to start their discharge planning early and hold conversations with post-acute care partners as soon as possible, he says.
4. Managing high-demand services: Hospitals need to coordinate high-demand services such as MRI exams or move high-demand services to the outpatient setting when possible after a patient is discharged, Charvat says.
5. Embrace a team approach to discharge: Hospitals can use daily rounding on patients in the morning to identify barriers to discharge and work through those barriers, Charvat says. "We have the hospitalists, nurses, care management team, and other members of the care team going through each patient every day. The team looks at the goals for discharge, the expected discharge date, how the patient is tracking toward discharge, the tests and treatment needed, and successfully transitioning the patient from the inpatient setting."
6. Establish mobility: One of the more recent efforts to reduce length of stay at Bon Secours has been to establish early mobility of patients, Charvat says. "The sooner that a patient who is admitted can get up and start having mobility, we can identify a safe disposition for the patient and whether the patient needs any ongoing therapy or special services at home or in the post-acute setting."
Editor's note: This story was updated on 12/13/2023 at 10:40 a.m.
