In our Strategic Plan we stated that we’d increase patient capacity by 40%. Knowing the importance of this comes with understanding the lack of specialty care in some of the most at-risk neighborhoods throughout the greater Chicago area. By increasing our patient capacity, we are creating systems, programs and avenues to assist with closing the gap as it pertains to access to quality care, with the goal being to reduce health disparities, increase health equity and level the playing field in availability of care. In an effort to reach this goal, Mobile Care will continue with the tried and true method of adding new school sites as well as resurveying current school populations for new patients and further removing the barrier of location and transportation by permanently offering virtual visits as an option. We have also added additional services like physicals and immunizations, partnered with Howard Brown Health to meet the demands of COVID-19 testing and vaccinations in addition to performing HIV testing in partnership with Howard Brown Health. We’ve worked with PerfectVision to deliver no cost eye exams and glasses to kids and most recently we’ve partnered with UIC to address the opioid crisis. All of these efforts have greatly expanded our reach. Using some of the tactics above we are diligently working to bring our unique patient (for asthma) volume up to 1,200 by the close of the current fiscal year. When this is accomplished, more families across the Chicagoland area will have received high quality care to address various needs. Thousands of kids will have reduced their trips to the ER, hospital stays and school absences related to asthma/allergies and, hopefully, have a better quality of life.
-Kamari Thompson, Director of Patient Services
Children with untreated chronic conditions experience increased school absenteeism and poorer performance in school compared to their peers. Children with untreated chronic conditions use expensive ERs and hospitals for medical care at triple the rate of other children. The vast majority of preventable emergency department visits among children, as well as negative health outcomes and cost, are being shouldered by economically disadvantaged parents who have children with chronic health conditions. This cannot be a reality we allow ourselves to accept.
Mobile Care Chicago’s Board and staff are committed to maintaining healthcare access for the thousands of people who came to us for the first time during the pandemic, but doing so will mean substantially increasing our clinic capacity. I feel very fortunate to report that, thanks to our many individual and grantmaking supporters, this expansion is already well underway. We’ve dramatically expanded our clinic staff (from 13 staff in the first year of our Strategic Plan to 20 staff currently), and we’re going to be hiring more positions in 2022. Our ultimate goal is to serve over 10,000 children annually across all of our programs by the end of 2023. Just as important, however, is to use this opportunity to streamline our protocols and make it easier to scale beyond 10,000 children in the years beyond. There are tens of thousands of children in and around Chicago lacking necessary medical and dental care. As an organization nationally recognized for its ability to reach and effectively treat people in need, we must do everything possible to drive the health clinics people need to their neighborhoods quickly and consistently. I’m excited to implement our plan through 2023—I know many lives will be changed for the better because of this effort.
Patients currently make appointments on Mobile Care Chicago’s clinics in one of three ways: First, they can add their name to a school list when our clinic date is announced; second, they can call our Patient Services department and have the scheduling team manually add an appointment into the schedule; or third, they will get a call from Patient Services reminding them that they’re due back. Fielding calls, tracking due-backs in excel, and keeping separate lists for each school is, to understate the issue, cumbersome and opaque to our patients (and our partners). Yet each clinic we operate has its own unique rotation of community locations and its own rotation schedule, so most traditional online scheduling systems are overmatched by our 150+ clinic locations.
Through our Strategic Plan interviews, our patients asked us to think about the bigger picture: the role automation can play in patient outreach and empowerment. Parents may sign their child up to visit the Dental Van weeks before their child’s dental appointment, but they don’t receive an automated reminder the day before the Dental Van will be at their school. Asthma patients, by contrast, do receive regular reminders of their appointments, but if someone can no longer make their asthma appointment, their only option to modify their appointment is via phone call, something that can be hard for parents while they’re at work. A lack of automated reminders and web-based scheduling assistance may have been ok when MCC was managing 3,000 patient appointments annually over two clinics, but now involves head-spinning challenges for a Patient Services department that is coordinating five different clinics and facilitating almost 8,000 patient appointments annually.
Under the Strategic Plan, we will expand Mobile Care’s patient-facing communications and marketing ability, and add communication technology upgrades. Though we’ve done quite a lot of work in this area, the reason we score this a 2 out of 5 is because of the complexity of the challenge. We’ve determined that when it comes to open booking, we need to start with vetting new electronic health record databases (EHR’s), and through that process we hope that one of two things will happen: either we find an EHR that has an open booking function built into it, or the EHR is compatible with a scheduling system that functions almost like a customer relationship manager (or is a CRM).
We’ve narrowed down our top EHR’s, and we’re talking with sales reps (everyone’s favorite job). From there, we will choose a few of the best EHR’s, demo them with our Patient Services team, and build out a universal scheduling framework so patients can be updated on their appointment times and make changes to their appointments. When open booking is implemented, patients will have many more tools to track and modify their appointments. Patient Services will have a less complex workflow and can scale to assist a higher volume of patients more easily, and MCC can confidently achieve its goal of expanding to 10,000 patients served by the end of 2023.
-Rachel Lessing, Communications and Development Manager
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.
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.
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.
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.
“We need to get the word out there,” Maybell Hoskins says. “If parents don’t know, they can’t help their child.”
Maybell has been an Asthma Educator with the Mobile C.A.R.E. Foundation Asthma Van for 14 years. She coordinates patient visits, teaches children how to prevent asthma attacks, and explains triggers to parents and local teachers. She is a local fixture in a community where 25% of children have asthma.
“People come up and tell me, ‘I had to take this child to the hospital every month. Since coming to see you, I don’t have to do that now.’ That’s rewarding.”
Maybell is well acquainted with the positive results of the Asthma Van’s work. Over her years, she’s managed the cases of over 1,700 low-income children, and has rallied the teachers and administrators of Metcalfe Elementary behind asthma control. “Every teacher in this school knows who to send kids to if they have asthma,” one of the teachers tells me. “It didn’t used to be like that.”
The work of Asthma Educators like Maybell has been proven to decrease asthma-related hospitalizations by up to 81%, and ER visits by 64%. Considering that some of the children Maybell has helped were being hospitalized every two months before joining the Asthma Van and its comprehensive education, treatment, and on-going asthma care, this translates into an overwhelming improvement in a child’s quality of life.
And Asthma Educators are cost-efficient. As an example, the national no-show rate for a community clinic is 30%. Mobile C.A.R.E. Asthma Vans currently have an average 16% no-show rate. Metcalfe, with Maybell’s help, had a no-show rate of 11% last year, with an 8% no-show rate for the last half of the year. Though that percentage may sound small, Mobile C.A.R.E. estimates that putting four more Asthma Educators into the most distressed areas it serves would save the organization $122,000 per year, as well as increase organizational impact by maximizing doctor-patient face-time.
But Maybell’s success as an Asthma Educator is far more than just numbers. It’s a cultural change in areas known for a lack of reliable information about chronic diseases. “Before I met Maybell,” one teacher says, “I didn’t realize how serious asthma could be. It’s something we monitor now, and each year we screen every new child for asthma so we can catch problems before they’re problems.” Asthma Educators save money, and transform lives.