Mobile Health Clinics:
Increasing Access to Care in Central and Eastern Contra Costa County
In urban, suburban, and rural communities across the United States, approximately 2,000 mobile health clinics help address the diverse health needs of some 7 million low-income, underserved individuals (Source: Mobile Health Map). Primary care, dental care, mental health care, and preventive care are among the services such clinics offer.
These are important services at a time when a stumbling economy is spilling more people into the ranks of the uninsured, health care reform proposes to expand Medicaid in 2014, there is a nationwide shortage of primary care providers, and budget cuts are decimating the ability of safety net providers to meet existing needs.
Unfortunately, there is little credible research about the best ways to deploy mobile health clinics (MHCs) within a community's overall health care delivery system. That was certainly true in Central and East Contra Costa County, in California's San Francisco Bay Area. Yet in this region with its pockets of extreme poverty and escalating rates of chronic disease, the use of mobile health clinics has been expanding.
With that in mind, the John Muir/Mt. Diablo Community Health Fund (CHF) and The East and Central County Access Action Team (with representatives from John Muir Health Community Health Alliance, Kaiser Permanente, Sutter Delta Medical Center, Planned Parenthood Shasta Pacific, La Clínica de La Raza and Contra Costa Health Services) commissioned La Piana Consulting to create a research-based report that could inform Contra Costa County decision makers about how MHCs might improve health access and health care in the county. The CHF funded the report.
Among the report's key findings and recommendations:
- Increasing numbers of patients use MHCs as default medical homes, a shift that is challenging the original premise of MHCs. The medical home is a national model – some define it with very specific standards – for improving the quality of health care services by strengthening patient-physician relationships and better coordinating care.
- The use of multiple MHCs is most effective when operated as part of a coordinated health delivery system. Ongoing community need and asset mapping should continually inform decision making about MHC deployment, including ideal geographic locations and days and hours of service.
- At least 20% of visits in Central and East Contra Costa emergency departments (EDs) are for minor or low/moderate acuity health issues, implying some people are using EDs for primary care. It is critical to better understand the nature and extent of avoidable ED use, and the role MHCs can play in averting these visits – though averting ED visits is not the only role MHCs should play.
- Social workers, physician assistants, and other health “navigators” should regularly share information, build relationships, and identify assets and gaps in the referral system and how MHCs can fill those gaps.
- It's important to inform the public about health care resources for low-income and uninsured residents, including MHC locations and schedules.
- Providers should engage in collaborative planning efforts to seek new ways of mobilizing collective assets and capacities that can meet the needs of poor and uninsured residents.