HOW Van: Health On Wheels

Program Description

Geographically isolated – Wallowa County is surrounded by rivers, canyons, and mountain ranges on all of its borders. This frontier county nestled in the northeast corner of Oregon has a population density of only 2 people per square mile. The individuals and families that choose to live in such a remote location are required to be innovative. And in order for behavioral healthcare providers to meet needs, the delivery of services must be equally innovative. As Wallowa Valley Center for Wellness embarked on our CCBHC journey we took the charge to provide services “beyond the four walls” to heart. We developed a mobile health clinic, called HEALTH ON WHEELS, that brings medical, dental, mental health and substance use services to the most remote areas of our county. By using a collaborative approach to care involving several community partners, we’ve implemented a creative approach to whole body wellness that addresses all needs to all ages of people. We do not let barriers to care such as isolation, lack of transportation, childcare issues, or inability to pay get in the way of our vision to provide 100% access and 0% disparity to integrate wellness services and resources for all.

Creativity

WVCW delivers unique health and wellness programming with the HOW van to our most remote areas of Wallowa County. Medical, dental, mental health and substance use services are delivered to people in fun and creative ways using “themes” to attract new users to the van. From providing a Community Health Worker for open enrollment and paperwork help, to providing immunizations and dental screenings, or simply talking to folks about stress relief/blood pressure and giving away fruit infused water bottles, the HOW van seeks to address all domains of health. Understanding the deep connection between humans and their pets, we are also looking at providing a Veterinarian on the van in the future, to address those pet concerns folks may have but are not able to drive 2 hours to a clinic for. This mobile clinic is both feasible and successful, providing quality healthcare to folks in rural and hard-to-reach settings.

Leadership

It is the intent of community leadership to bring together key parts of the health care system in order to transform health care delivery in Wallowa County. Organization leadership meets monthly which enables us to not only determine which health care issues are critical, but to understand what factors might be contributing to the level of need. This network to develops plans for responding not only to health care system issues, but also to the social determinants of health present in Wallowa County. Our Executive Leadership team and community partner leaders, capitalized on the idea of a mobile clinic by combing this service with our CCBHC program. By engaging and coordinating care with community partners, we arrived at a model of collaborative care all providers readily buy in to.

Sustainability

The combination of our CCBHC status and our partnership with FQHC Winding Waters Clinic, there is committed to provide this service as part of our regular programming. To accomplish this, we facilitate the sharing of resources, tools, knowledge, experience and lessons learned from one trip to the next, constantly evaluating and adjusting the program as needed. The HOW van routes and partners have been identified, but the program now needs a data-driven deployment. We know that we are offering high-quality care at considerable cost savings because we are catching symptoms early through prevention, instead of transporting folks to the critical access hospital when a medical condition becomes a 911 call. Visiting Medical Residents vie for rotation on our van, our primary care providers love it and the people we serve appreciate our efforts to serve them near home. This program assists with recruitment, retention and job satisfaction.

Replicability

Mobilizing health care seems obvious but is an underutilized idea. The current program is about touching people face to face and does not rely on telehealth or internet connections, because there are none. Our joke is, “all you need is a bucket and some soap,” which makes this program completely replicable. It’s taking healthcare delivery back to it’s roots of the “country doctor.” Our program is about taking screenings, primary care, advice, med delivery and in some cases even hospital-grade triage out of the “4-walls” and as close as possible to people’s homes. By doing this, we also get as close as possible to the early stages of health issues. The proximity to care reduces barriers. The power dynamic is very different from how care is delivered in a traditional clinic. People are freer to share concerns about issues in their lives that go well beyond a blood pressure screenings.

Results/Outcomes

According to Harvard Medical School’s Impact Report, “mobile clinics are improving access to care with up to 6.5 million visits annually. Mobile clinics mainly serve the uninsured (60%) and the publicly insured (31%), and generally operate in low-income communities. Overall, mobile health clinics in the United States are getting more bang for their buck in providing quality care at a lower cost. The average return on Investment for mobile health is 12:1. That means for every $1 spent, $12 are saved. Mobile Clinics provide cost-effective prevention services that help people live long and healthy lives. On average each mobile health clinic saves 65 quality adjusted life years every year of operation. This means that each visit they save on average $1,600 due to this prevention.” With improved ability to collect data, we will have a better understanding of patient/provider satisfaction as well as per patient/population cost savings.