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Expand the Patient Services Department: In Personnel, and In Scope to Address More Social Determinants of Health: 3

The expansion of the Patient Services Department is important because Mobile Care is expanding. Mobile Care is expanding its reach, in terms of the services we provide, the regions we serve, and our patient population. By doing this we are able to offer our services to a greater number of families and address a greater need. Patient Services has hired additional staff and added indoor air quality monitoring to our home assessments. We’ve expanded our home assessment and physicals/immunizations programs, we’ve partnered with other organizations to address the COVID-19 pandemic and the opioid crisis. We’ve added additional school sites in the south suburbs and assisted with providing much-needed specialty care that had not been available in the area previously. Mobile Care is always looking for opportunities to meet the needs of our communities and to do whatever we can to improve health equity. As we expand, we will hopefully provide the best care for not only asthma, allergies and dental but also for primary care, mental health, violence prevention, etc. Perhaps one day, the name Mobile Care will ring bells throughout our region, because we created access regardless of financial status, social status, race, or geographic location. We paved new roads to quality care.

-Kamari Thompson, Director of Patient Services

When we speak in public health conversations about the Social Determinants of Health (SDOH), because it has become a buzzword for so many different things, I fear that we tend to abstract them into the realm of mystical complexity where they remain acknowledged but unaddressed, present in discussion but too all-consuming to affect. Healthy People 2030 lists five different sub-groups of SDOH, and any one of these categories would require us to up-end our present social structure to comprehensively address. Yet, at the heart of SDOH is a simple and urgent syllogism: 

  • In our society, a lot of people don’t have enough money to meet their basic needs
  • As a result, they are forced to make concessions on many or all of their basic needs
  • Keeping people, and families in particular, in an economic position where their basic needs cannot be met is not free or economically responsible because, ultimately, there is a massive social cost that must be paid, through our healthcare spending and in other areas; far higher than if people had been given the funds to meet their needs in the first place
  • Because the social cost is so high, we as a society need to document all of the areas where low-income people have had to concede their basic needs partially or fully so that we can understand and try to remediate the price we, collectively, are paying
  • In doing this accounting, we are documenting a road: once people are set upon this road it leads to poor health, dramatically increased risk of chronic health conditions, huge unpaid hospital bills, and untimely death. We may not see where this road leads in each individual step, when the end is not yet on the horizon, but we know where it goes because people have walked this road before and are now in the process of walking it, everyday.

Mobile Care Chicago is a very small charitable organization that specializes in delivering medical care to people with chronic conditions, and the question might naturally arise what meaningful role an organization like ours can play in creating systemic change, the likes of which would move the needle on mortality rates, healthcare spending, and the prevalence of chronic health issues.

The answer, which may surprise you, is that a small organization can do an awful lot, and we are committed to doing even more. Our approach to social determinants starts with people and their specific needs. Not every family experiences all social determinants of health in the same way or to the same degree. One issue, like housing, might be at a crisis level, while something else, like access to nutritious foods, might not be an issue at that time. Addressing needs, then, starts by listening to specific people, and developing unique plans. The reason we emphasize an expansion of the community health workers in our Patient Services Department when discussing SDOH, is because building capacity allows us to ask more questions and resolve a greater set of issues.

Based on the answers our families gave us last year, we know that these are the social determinants that we mitigate currently:

Transportation – over 70% of MCC patients report that a significant barrier to receiving consistent medical care is an inability to take time off work to travel to distant clinics that accept public insurance or will grant appointments without charge for uninsured patients. By driving high-quality medical care within blocks of patients’ homes, and offering all services free of charge, MCC removes a substantial barrier. The organization also offers telehealth appointments so that parents do not have to take off work and travel in order to be present at medical appointments.

Health Behaviors – Effective preventative care is not necessarily about how often one sees a doctor, it’s about strong, intentional health habits that promote wellness. All of MCC’s medical appointments have a substantial focus on education and empowerment, teaching and reinforcing for families the specific actions, like regular tooth brushing, use asthma control medications, allergy trigger avoidance/reduction, that will aid them in their goal of overall wellness. MCC’s Patient Services department continues to provide education with regular case management calls between regularly scheduled patient appointments. 

Safe Housing – Mobile Care Chicago offers Home Environmental Assessments, in partnership with the EPA Region 5 and the American Lung Association’s Illinois Chapter. These assessments proactively identify and remove allergy triggers that make a home potentially dangerous for a person with severe allergic reactions. These assessments also feed back into reinforcement of positive health habits, giving Patient Services staff a better idea of what they can emphasize through education.

Equal Access to Education – Asthma and tooth pain are the two most common causes of school absenteeism, according to the CPS Office of Student Health and Wellness. Over 50% of new MCC patients had missed days of school for a chronic medical condition in the year before enrollment in their mobile clinic. One year later, 96% of those same patients had not missed any days of school.

Access to nutritious foods and physical activity opportunities – MCC tries to partner directly with local food distribution points to ensure that families who need both resources do not have to make multiple trips to receive the assistance that they need. Physical activity is a major indicator of asthma control, and through providing sport physicals so that students can participate in athletics, and by offering comprehensive asthma management, MCC allows children who would have significant barriers to athletics and healthy play to participate in those activities.

Polluted air and water – MCC frequently collaborates on research that can measure and address potential causes of harm in air and water. Most recently, MCC and UIC partnered on a study of particulate matter and airborne heavy metals in Chicago’s Southeast side. The findings are being presented to community groups presently, and are published in the International Journal of Environmental Research and Public Health under the title “Assessment of Metal Concentrations and Associations with Pulmonary Function among Children with Asthma in Chicago, Illinois.” Other publications on other aspects of metal exposure are planned in 2022.

Language barriers – All of MCC’s clinics are bi-lingual (Eng/Spn) so that the portion of MCC’s patient population that feels more comfortable speaking Spanish, which is over 60% of current patients, can receive education and support in their native language.

Is this a comprehensive methodology to address all Social Determinants of Health? No. It’s not even close. We’re frequently in discussions with our patients and community partners to understand how we can do more. 

Through addressing these substantial health barriers, however, there’s no doubt that Mobile Care Chicago has helped change the trajectory of patient families. We’ve shared stories publicly in the past about patients who were able to focus more in school, participate in athletics, go on to college, or were inspired to pursue jobs in healthcare because of their experience on the mobile units. We’ve also shared stories of families who had close brushes with death and found their health completely transformed through regular access to a specialist aboard our Asthma Vans. Indeed, if every child had the same access to medical providers as our patients, it would save the City of Chicago over $11.7 million dollars annually in decreased hospitalizations, and another $24.9 million in decreased ER utilization. Sometimes resolving health barriers for families doesn’t require a place that can do a little of everything, but rather a place that can do some things really, really well. Expanding our Patient Services Department translates into expanded capacity to listen to what our patient families need and, ultimately, to adapt our organization to resolve their most urgent issues.

–Matt Siemer, Executive Director

Create an Engaging Educational Experience for Children: 3

The most important component of Mobile Care is our patients. And knowing that we are equipping them the forever tool of knowledge, is priceless. I believe the old Saying “knowledge is Power.” I also believe that prevention through education is a major key. When we teach our families, our patients in particular, how to identify and reduce triggers, recognize symptoms, properly administer medications and create safe home environment we give them tools to improve their quality of life wherever they are and in whatever stage of life they may be in. The staff at Mobile Care never misses an opportunity to educate. As a matter of fact, most of the time we spend speaking with patients is education-based.  We’ve done in-school (pre pandemic) interactive asthma education, we currently do medication education on controller vs quick relief vs allergy medications and when, how and how much to administer. There is also the teaching of proper spacer technique. All of this sounds routine and pretty boring, but then I like to do a thing I call teach-backs. During teach backs the patient (when age appropriate) teaches me or the staff on that van which medications to take, when and how much, when presented with different scenarios. They’re also given the opportunity to demonstrate proper spacer technique. This helps build confidence and encourage the patient to take an active role in controlling their asthma and allergies. I believe that we’ve laid a great foundation and as things progress and we are given greater permissions and less restrictions there will be more opportunities to offer more engaging educational experiences. It is my hope that by educating those enrolled in our program directly that we will indirectly elevate the level of knowledge of those folks that they come in contact with in their daily lives and both kids and adults with asthma and allergies will be adequately educated and able to live a more controlled and asymptomatic life.

-Kamari Thompson, Patient Services Manager

Oral Health Education is an essential component of the dental program. The dental team provides a prevention service, and we strive to educate our patients on the importance of dental care. Many sites/schools are in underserved communities that struggle to receive primary medical/dental care. Patient families, as a result, do not have the privilege of receiving dental care or education very often. Or many parents who fear the dentist and do not have the proper education/experience to share the positive side of dental care with their children. 

The dental team educates the K through 2nd-grade students on the importance of healthy eating and brushing/flossing habits. We believe educating the younger children will make a more significant impact and hopefully enlist healthy habits. The team does not leave anyone behind; they also give every student chairside oral health education.   

Dr. Navarro and our team of Dental Assistants have presentations with Flossy, the puppet, and a giant toothbrush to show the students the proper way to brush their teeth. Dr. Navarro engages the students by asking questions and having students involved with brushing the puppet’s teeth. She also educates the students with other props on the importance of healthy eating habits. We created an Oral Health Education video over the summer. Due to covid, it was hard to get groups of children together for a presentation. This video helped us reach many students at smaller sites. 

If we could involve parents in this educational portion, it may make a more considerable difference to their children’s dental habits. Preventive education for the whole family would be a dream come true. 

 -Vicky Alcantar, Dental Program Manager

Talk to the leaders of our core programs and they’ll all tell you that 50% or more of managing childhood conditions is education. Each patient visit, regardless of program, incorporates tons of teach-backs and educational materials to help kids and parents stay healthy. The issue we hope to address in our Strategic Plan is building on our success: there’s been a lot of research in education sciences regarding incorporation of interactive and gamification elements to help children learn. We didn’t have those elements when our Strategic Plan started, but we’d like to make education fun and substantial, with lessons children will take with them for the rest of their lives.

Again, we’re not starting from scratch. A major component of every health service available at MCC is patient education. If a patient doesn’t understand the health issue they are dealing with, how their treatment works, and how they can continue that treatment at home, their chances at recovery will be negatively impacted. We wouldn’t want to fill a cavity for a child, and then not educate them on the importance of brushing and flossing- or they’ll show up again in a few months with more cavities. On the asthma and allergy side of things, there are many things the patient needs to do at home to stay on top of managing their condition between visits. This education keeps them safe, and out of the emergency room. Making education engaging and fun is important for many reasons: we want to empower patients to effectively manage their condition and to feel optimistic about their treatment. But by making it fun, our patients are more likely to remember what they’ve learned.

On the communications side, our role is to create materials that support the things our doctors and nurses teach every clinic day. So far, we’ve created an educational welcome packet for Dental Van patients. The packet is visual and colorful, filled with oral health management tips. Our team also filmed an oral health education video for the Dental Team, starring kids ages 3-12, and scripted by the team themselves! We’ve also extended patient education onto our social media pages. Our next step is to work with the Asthma Team and Patient Services to update their educational materials and incorporate videos for asthma and allergies as well. Both programs could benefit from more video content, which is a priority for our team this year. There is a lot of work to do on this topic for communications, but luckily we get to work with the experts in our clinics to bring patient education projects to life. 

– Rachel Lessing, Development and Communications Manager

Integrate Data from State, City, and MCO Partners into MCC’s Geographic Analysis: 1

One of the questions I’m asked most frequently about our mobile clinics is, “how do you choose where to go?” This is a hard question to answer. Our clinics can’t be everywhere at once (though one can hope!). Each mobile clinic can only go to an average of 17 sites each month, which makes the available dates on our calendar our most scarce resource.

The way we choose where to go is, right now, community-based. We ask our patients what they’re hearing from friends, we ask nurses at schools, we ask health partners, and public health officials, and Medicaid Managed Care Organizations. We take it very seriously. If we don’t choose our locations wisely, we risk overlooking the areas of greatest need.

For all nine years that I’ve been at Mobile Care Chicago, in addition to the above, we’ve desperately sought out every scrap of data to help inform our understanding of where mobile clinics can be most helpful: what areas have the highest rate of dental carries? Which neighborhoods lead the County in ED visits for asthma? Which zip codes have the lowest ratios of health infrastructure to population size, which have the fewest providers accepting Medicaid, and which have the highest childhood morbidity/mortality rates due to chronic conditions? Of crucial importance to us: where are low-income people being pushed out of, and which areas are they moving to? Ideally, we would want to see each of these data points (and many others) in three or five year trends, and we would want to bring them into conversation with each other to get a picture of where we are going to be most needed not just in the present, but also in the near future.

Much of Illinois’ potential public health data exists in Medicaid claims because that’s what everyone is required to submit in exchange for money. Claims data is fragmented among many Managed Care Organizations, while public health data is separately kept by the City, County, and/or State. Access to data could inform our decision-making process, and for that reason we unceasingly pursue partnerships that would get us access to aggregate claims data, public health data, or both. 

You would think that all of this information would be widely available, and frequently updated. Don’t public health officials have a vested interest in assisting charitable clinics, since each patient MCC takes on saves the State over $15,000 each year? It brings me no pleasure to defy your expectations and report that that data is not only rarely made available, in many cases it partially exists or doesn’t exist at all. There are not centralized “data sharing” repositories in our health departments that are staffed to field aggregate-level data questions from health partners and, with budget cuts in prior years at the City and State levels, in some cases there isn’t a person who even knows who data questions should be directed to. In many cases, if an organization like ours requests data, it has to be pulled together on a one-time basis by public servants who have other responsibilities and, as such, it can take months to receive, and it can’t be replicated or validated with frequency.

Given this long summary, many people (myself included) would be tempted to see this as a textbook case of a Quixotic task and toss it aside in favor of more immediate action. But I appreciate our partners and staff pushing me and all of us at Mobile Care to not only defy that temptation, but to do the opposite and make it a focal point of our Strategic Plan. We cannot lose focus on how crucial this item is, and what it represents: a government-induced access barrier that separates people from the resources that could help them. 

We often talk about “access barriers” as something individual people have to overcome: travel, no time off work, inability to afford co-pays and out of pocket costs, etc. To be sure, those are all important. But when we can’t share data, it’s like a football coach telling a quarterback, “here’s the play call, but don’t tell the wide receivers where to run.” 

If health providers ask our public health system, “where do you need us most?” and the answer back is we don’t know and we can’t invest to find out, then it’s our fellow residents who suffer. There has to be a better and more compassionate way for us to all consistently align our focus toward the best interest of our neighbors, and until there is one, this item cannot be removed from our priority list.

-Matt Siemer, Executive Director

Expand the Scope of Home-based Services for Parents: 5

Expanding the scope of home-based services for parents is important because it allows us to reach people who would otherwise struggle to access needed medical services.  

This item was emphasized in our Strategic Plan because for years we noticed a frustrating peculiarity: when we went walking through our partner schools to talk to teachers or use the restroom, we’d stumble upon children who had no-showed for their patient appointments earlier in the same day! Historically, when we were not able to complete a patient appointment, it wasn’t because the children weren’t available, it’s because the parents were not available. They couldn’t make it to the school due to another obligation: work, couldn’t get a babysitter for younger siblings, or a competing, emergency appointment. 

In the first year of our Strategic Plan implementation, before the pandemic, we began allowing parents to access their child’s appointment virtually. We expanded our implementation of virtual visits during the pandemic, and we continue to offer parents the opportunity to connect to their child’s appointment remotely. Mobile Care also launched virtual home assessments during the pandemic, which have allowed us to provide a greater level of convenience and care to patient families. Our COVID vaccination team, as of last month, has completed 1,000 home-based COVID-19 vaccinations, and recently began offering flu shots for home-bound seniors as well. I believe that we are in a good place with our home-based services, though we will continue to pursue home-based expansion opportunities to the benefit of the families we serve. 

-Kamari Thompson, Director of Patient Services

Assist Communities in Health Promotion by Expanding MCC’s Communications and Marketing Ability: 3

Communication barriers are often the root of why so many people have trouble accessing health services (and many other resources). The premise of MCC- connecting and communicating with families through their schools- largely solves that problem, but as Mobile Care evolves, and as the pandemic continues on, it’s not enough. If disinvested Chicago-area communities aren’t aware that MCC exists, or how our model of care works, we can’t effectively assist them in improving their health, even though we have the resources to do so. 

Many people who need our services don’t have cell phones, smartphones, or access to the internet – where we promote our services on social media platforms and our website. The majority of our communities don’t have media sources engaged in sharing free resources, or active neighborhood facebook groups. To solve this problem, we do a little bit of everything. We’ve created materials for health fairs and back-to-school fairs, we’ve printed out flyers to pass out at food distribution sites, we’ve posted on facebook pages of local businesses and asked for help from those with reach in their communities. We make sure to use geotags and hashtags so if someone searches for free asthma care or free dental care in Chicago – MCC pops up. As a result, many patients were able to schedule appointments with us even when schools were closed.

We’ve also worked to create consistent branding and messaging that is true to our mission, messaging that helps people understand who we truly are. We don’t want anyone to assume that “free” means quick, low-quality care, or that they’ll eventually receive a surprise bill for our services. 

There are web-based components in our communications plan as well: we plan to update the Mobile Care website, create video content, add tools like open booking, and maybe even a live map of our clinics. These tools have been requested by many of our patients and will be prioritized alongside the more traditional grassroots efforts described above. 

There is always going to be more work to do on this item, however, and the work will always be varied. To effectively assist communities in health promotion, we need to continue to listen to the schools and communities we serve, analyze the response from each strategy we implement, and build communications and marketing strategies around what works best for our patients. 

–Rachel Lessing, Communications & Development Manager

Add Emissionless Technology to All Mobile Units : 3

Adding emissionless technology to our mobile units means installing battery banks to provide electrical power to our clinics (as opposed to gas/diesel generators). This reduces our dependence on fossil fuels, which are the primary power source for all mobile medical units. The installation of battery banks reduces carbon emissions from MCC’s mobile clinics, which is not only important on a global scale, but will improve the air quality in and around the clinic for patients and staff. The addition of emissionless technology will also decrease daily operating costs over time by decreasing fuel consumption. 

At present, three of MCC’s clinics have been outfitted with compartments for battery banks, have the necessary hardware in place, and about 80% of the necessary wiring changes completed. One mobile unit, our Dental Van, had a battery bank operational, which was very helpful to our understanding of how we can best organize these systems. Now that we understand the technology much better, we’re using what we learned to make all of the battery banks more efficient.  

The completion of the battery banks is scheduled for Feb. 2022. The last steps include the completion of wiring peripheral components, programming of equipment, safety tests, and final adjustments based on actual power consumed during a clinic day.  

Once the emissionless power systems are in place, Mobile Care Chicago’s clinics will be cleaner, quieter, and more dependable.  

-Ian Stark, Director of Programs

Strategic Plan Update: Add Communications Technology Upgrades (EHR, website, online booking): 2

Add Communications Technology Upgrades (EHR, website, online booking): 2

Right now, the vast majority of patient appointments at Mobile Care happen via phone call. We don’t have an option to book an appointment online, and if a patient wants to make an appointment on, for instance, the Asthma Van and the Dental Van, they have to call two separate phone numbers. In patient interviews, streamlining scheduling was a frequent topic.

Furthermore, if we want to increase the number of patients we see, we need to have a system that can handle increases across all clinics. So this item is important because it supports the success of other strategic plan items, including increasing patient capacity by 40%, expanding the Patient Services Department, and integrating referrals across all programs. I also wish to make the jobs of Patient Services, and clinic staff easier because the systems they have now take up a lot of their time. 

The specific actions that we are taking are: 

Part 1: Electronic Health Record Database (EHR) -(which we hope will include online booking) 

  • interviewing patient services about how scheduling works and asking them for pain points that they see in their current system and working with clinic teams to make sure that whatever system we choose can be customized to their needs
  • researching EHR systems 
  • demo’ing EHR systems with salespeople from each system 
  • presenting our findings to Matt, both clinic teams and patient services so they can help decide which system is best
  • deciding how to integrate EHR into our website 
  • training staff on using new EHR  

Part 2: Website 

  • Ask staff about what kind of website we want to build/what it should accomplish 
  • Based on how we choose to integrate EHR into our website, we will choose between building a website in-house (squarespace, wix etc) or outsourcing the website with custom code 
  • Decide what content will live on website (outline format)
    • Present and get feedback from Matt/Ian and patient services
  • Create a wireframe to organize above content 
    • Present and get feedback from Matt/Ian 
  • Create design elements / photo and drop into wireframe 
    • Present and get feedback from more/all staff ? 
  • Code/create live website 

We’ve interviewed clinic staff over the last few months about EHR pain points, and completed industry research to make sure we know what our ideal interface is. We’ve done the same process for a new website, a project we’re eager to launch after we identify our ideal EHR solution. When this is all accomplished, staff will have more time to focus on serving our current patients and acquiring new patients, and will spend less time organizing everything in a way that, while effective, is redundant and not super efficient. I also see this EHR upgrade creating harmony between the work each clinic does and increasing referrals between clinics (and outside of them). In regards to the website: MCC will be easier to find/access by both patients and donors, and from a communications standpoint, upgrading the website both aesthetically and content-wise will increase both patient and donor engagement. I see it driving more patients to us, which is the ultimate goal, and helping us receive more community awareness to support those patients. 

-Rachel Lessing, Communications + Development Manager

Strategic Plan Update: Modernize and Expand Current Fleet: 4

When we started our Strategic Plan in 2019, we had three mobile units: a 13-year-old Asthma Van, a 7-year-old Asthma Van, and a 4-year-old Dental Van. At about the eight-year mark, the everyday wear and tear starts to get the better of a mobile clinic, so we had one vehicle that desperately needed to be replaced, and another one that was looking a little rough. Modernization and expansion of Mobile Care’s fleet of mobile clinics, then, was imperative to our organizations ongoing success. Modernizing our fleet allows us to:  

  • Increase patient and provider safety through the use of negative pressure ventilation systems
  • Improve patient care by replacing medical equipment and electronics with the current technology 
  • Decrease our carbon footprint by powering our clinics with battery banks, greatly reducing our dependence on power though the combustion engine of a gas generator. In addition, the reduction of carbon emissions provides a cleaner environment for patients while on or near the clinic.

Expanding Mobile Care’s fleet allows for an increase in simultaneous medical and dental clinics, which positively impacts our overall patient capacity and continuity of care for new and current patients.  

Thankfully, we’ve not only made progress here, we’ve added a new level of innovation. We are still hoping to retire our (now 14-year-old) Asthma Van, but we are renovating the interior of our 8-year-old Asthma Van, we added a new Dental Van (avid readers will remember that, tragically, our previous Dental Van was lost to an electrical fire in October 2019), and added two new “Class C” mobile units.

These two new clinics, launched in the summer of 2021, are called “Flex Vans.” Unlike our other vehicles that are designed for one specific purpose, Flex Vans can support any one of MCC’s services on a given day.

Negative pressure ventilation has been added to two of our clinics, whose services have the highest risk of airborne pathogens. Converting all clinics to have all antimicrobial/non-porous surfaces is 75% complete. Three clinics have been outfitted with compartments for battery banks.  

Asthma Van remodeling and battery bank completion are currently underway. Modernization of the Asthma Van, including the addition of running water and layout changes, are scheduled to be completed by the end of 2021. The completion of battery banks on all mobile units is scheduled for Feb. 2022.

Once the above items are completed, patient and provider experience will significantly improve via increased safety, improved clinic flow, and an improved air quality on and around the clinics. Furthermore, the move away from gas generators will reduce the costs of daily clinic operations in the long-term.  

-Ian Stark, Director of Programs

Strategic Plan Update: Solidify Expertise in Home-Based Services: 4

When people are able to access medical care from their homes, it reduces or eliminates a barrier to carefor one of the most vulnerable populations. When people don’t have to leave their homes to interface with health experts, we are able to reach and assist kids and families that would otherwise face challenges traveling to distant clinics.

As part of our Strategic Plan, we are looking to not only expand home-based services, but also build a body of best-practices for the delivery of services in a home-based or virtual setting. Although MCC had begun offering virtual asthma and allergy clinic visits to a small group of patients prior to the onset of the pandemic, the reality of healthcare in the time of COVID-19 pushed us to offer 100% of our asthma/allergy visits virtually. Since people with asthma were spending more time than ever at home, we began providing virtual home environment assessments to identify and remove allergy triggers that were counteracting asthma medications.

Not only have virtual asthma and allergy clinic visits had far better outcomes than we could have anticipated, but virtual home environment assessments have been a great success as well. In the future we will work to reduce the time that it takes for families to receive allergy remediation products by having a supply of products readily available for delivery to families. Once this is done, it will help us collect baseline (and other) data sooner as well as identify and address asthma/allergy issues more quickly. 

-Kamari Thompson, Patient Services Manager

Transportation is the top barrier to clinic access on every patient survey Mobile Care distributes. It’s easy to say, “well, such-and-such clinic is only a 25 minute drive from so-and-so’s house,” but that ignores so many complicated factors including: 1) where the child’s school is in relation to the clinic (since most parents need to factor in time to pick up the child from school); 2) whether the parent has a reliable car; 3) whether they live in an area with linear bus routes from home to school to clinic (and back again); not to mention, 4) the most important factor: work schedule. With these complications, it’s easy to see why parents consistently flag transportation as the top barrier, and why it’s nationally considered one of the core “Social Determinant of Health.”

Allowing parents to join a child’s appointment remotely, and assuming the burden ourselves of ferrying children to and from their classrooms to the mobile clinic, means parents don’t have to leave work or (these days) home-based work environments in order for their child to receive on-going, excellent quality follow-up care. The strides we’ve made solving this barrier for parents (such as the telehealth appointments and virtual home environment assessments that Kamari mentions, but also working with parents via our dental clinic to provide oral health education remotely) are among the most important innovations we’ve taken on. As a result of telehealth implementation alone, our no-show rate dropped from 27% to 12%. That’s a game-changing impact for children with chronic diseases.

Also of note, in March 2021 we began working with the Cook County Sheriff’s Office, Meals on Wheels, and the Cook County Department of Public Health to launch delivery of COVID-19 vaccinations to home-bound people. We are the only group providing this urgently needed service in the southern suburbs of Cook County, where our medical providers have delivered over 800 doses of COVID-19 vaccine in the past six months. This program is bringing a potentially life-saving vaccine to seniors and people with severe medical conditions, and is helping us deepen our understanding of the protocols and procedures needed to deliver other medical services directly to people’s homes.

-Matt Siemer, Executive Director

Strategic Plan Update: Expand Partnerships with Primary Care Providers and Health Stakeholders: 2

Specialists can’t address every medical, behavioral, or social issue of a child, just as primary care and social services can’t solve the issues that a specialist can. Mobile Care Chicago is able to excel in our specialty clinics because we can focus on children who have Big Problems that require the tools and expertise that our clinics provide, but we never forget that there’s a whole child to think about. For that reason, we push ourselves to build relationships with Primary Care Providers (PCPs) and other health stakeholders so we can all communicate and bring a variety of strengths to the table for each individual child and their specific health/emotional/social needs.

Our Strategic Plan calls for us to integrate our EHR more fully with PCPs so we can send electronic referrals and, most importantly, know whether or not the referral was successful. We are also pulling lists of PCPs who have a lot of overlap with our patients so we can meet with them more frequently. We are vetting new EHRs currently, as is discussed elsewhere (spoiler!). We also need to increase our staff capacity so we can more regularly interface with the hundreds of Primary Care offices in Chicago (as well as mental health professionals and other important stakeholders). We have a lot of work to do yet on this item, but accomplishing this will bring resources to our patients much more efficiently, and that’s very motivating!

-Matt Siemer, Executive Director

Mobile Care Chicago