BOSTON — Chongcan Zhu, an 83-year-old longtime resident of Boston, lives alone — but she doesn’t feel a sense of isolation when it comes to receiving health care. That’s thanks to the van that comes straight to the senior residential community where she lives, providing services to people dealing with conditions like high blood pressure and cholesterol, diabetes, and substance use disorders.
“It’s very convenient to have the doctor check up on me,” said Zhu, who has been a patient at the Mass General Brigham Community Care Van about five times so far, speaking through a translator.
As an immigrant from Wuhan, China, who doesn’t speak English, she’s long struggled with navigating the U.S. health care system and finding people who understood her. But here, just steps from her apartment, she is greeted by Mandarin interpreter Jay Liang, who sometimes rides along in the van. He stands directly next to the nurse practitioner, who checks Zhu’s blood pressure and prescribes her a refill of her medication. By the end of the visit, Zhu’s face has lit up.
The van, one of three operated by Mass General Brigham since 2021, is meant to help people like Zhu and her fellow seniors at Symphony Community Park who might otherwise face barriers to accessing health care. Older people may face issues with transportation and mobility, or lack nearby friends and relatives who could take them to clinics. This on-demand health care service is also an easy way for seniors to get vaccines: “Thanks to the van, I was able to get my Covid booster this time,” said Zhu.
The vans are part of a larger movement of mobile clinics in Boston that grew during the peak of Covid-19 as the pandemic shed light on health disparities. They provide an example of how hospitals are trying to make care more accessible beyond their premises — a model that may grow even more popular in the wake of recent policy changes.
Meeting patients where they are
The Community Care Van program aims to address social determinants of health along with more traditional medical concerns, partnering with food pantries, nonprofits, and even law enforcement to bring services directly to patients. The vans operate on a walk-in basis, and anyone can qualify.
“Even if a patient doesn’t have insurance, we will help enroll them,” said Priya Sarin Gupta, the medical director of community-based clinical programs at Mass General Brigham and Harvard Medical School who leads this initiative. Under Massachusetts state law, most residents over age 18 are required to have health insurance coverage or else pay a penalty through their tax returns.
Each van is equipped to provide culturally competent care in multiple languages so that providers can speak directly to patients, either in person or via telemedicine, and operates on expanded hours to reach people beyond traditional appointment times.
At Symphony Community Park, all patients are screened for issues like housing instability and food insecurity. Hypertension patients such as Zhu, for example, took home a bag of fresh produce supplied by the van’s community partner, Fenway Cares, a food access program that works with providers to supply meals tailored to help people with high blood pressure.
The vans also provide medical services to recipients of already established community organizations who operate in low-income areas, like food banks and nonprofits. Some of their regular locations in Roxbury, the part of Boston with lowest life expectancy, include Roxbury Tenants of Harvard, a tenant organization advocating for affordable housing, and STEPRox Recovery Support Center, a safe space for those interested in recovery.
“Our health care delivery model truly allows us to engage with communities and instill a sense of trust among the patients we serve,” said Sarin Gupta. Patients who are essential workers, lack access to child care, or are houseless often feel lost in the health care system, but these “clinics on wheels” aim to provide a beacon of hope.
For instance, this past July, about 300 migrants entered Boston, including many from Haiti and Venezuela fleeing political instability. While many were sent to shelters or local hotels, some were sent to emergency rooms over concerns about tuberculosis infections and exposure.
“Hospitals providing traditional brick-and-mortar care were overburdened and unable to fulfill the demands of this vulnerable population,” Sarin Gupta said. To help address the issue, vans parked right by the shelters and performed tuberculosis testing as well as screenings for other infectious diseases.
The promise of postpartum care on wheels
Other mobile health programs across Boston are also trying to address gaps in traditional care models. At Boston Medical Center, pediatrician Melissa Nass and her team created the Curbside Care Van in 2021 for mothers and their babies during the six-week postpartum period, commonly known as the “fourth trimester.” Given the racial disparities in maternal mortality — with Black women two to three times more likely to die from pregnancy-related complications compared to white women — as well as discrepancies associated with postpartum depression and lactation, they wanted to create a care model that would pave the way for better health outcomes.
“While women bring in their babies for care, they themselves don’t often return for care in this postpartum period,” said Nass, a pediatrician who wrote the proposal for and now leads the Curbside Care Van initiative. “So 40% of women don’t return for a postpartum visit at Boston Medical Center, and that’s consistent with the literature and a national scale for publicly insured women.” The program is fully funded by the Boston Celtics Shamrock Foundation.
Porshai Peters, a 29-year-old Boston public school teacher and mother of two, was initially worried about accessing care for herself and her baby in a van instead of the hospital. Now, as a two-time user of the van — once with her first child in 2021, and recently with her second child five months ago — she describes this as a “special experience.”
“I had a second-degree laceration after giving birth to my first son, Jasper,” she said. “After a nurse referred me to the van for the next six weeks after, I was able to see a pelvic floor therapist right away, which was instrumental to my healing.”
Patients like Peters are referred to the van based on a needs assessment. Providers let patients know ahead of time when they will be in their area to provide care, with multiple visits scheduled based on the mothers’ and babies’ needs. “The staff on the van would call me a few days in advance about their schedule and then also call me on the day of the visit,” Peters said.
During the first visit, the medical team delivers food, diapers, clothing, and a variety of other things to support the family. Peters particularly appreciated the weather-appropriate clothes for her newborn baby who was born during the summer months. “My first son was born in the fall, so he did not have any newborn summer clothes I could pass down to my younger one. I am grateful for the clothes that the van provided as I did not have to worry about shopping for clothes while I was recovering after birth,” she recalled.
Patients are also referred to enroll in direct benefit programs like the Supplemental Nutrition Assistance Program, as well as its subsidiary, Women, Infants, and Children. In the van, there is also a lactation consultant that supports mothers in learning about breastfeeding.
The initiative was made possible by the unique partnership between Boston Medical Center’s pediatrics and OB-GYN departments. “Interdepartmental collaboration is not something that typically happens in academic hospitals, but we felt that if we collaborated together, we could really streamline care for patients and reduce fragmentation across systems,” said Nass. “So in our care, we put a nurse practitioner on the van with pediatric expertise to see the newborns and we put a midwife on the van to see the mothers, and these two providers see the dyad together.”
Getting mobile care covered
In Longwood, the Dana-Farber Cancer Center has a mammography van that is on the road three to four days a week, providing screening mammograms and breast health education. Patients are referred to follow-up with a specialized provider if their mammogram warrants concern.
For years, the van provided free mammograms to houseless and uninsured communities, but the program lost funding in 2011.
“All of the patients we serve through the van have to have medical insurance so we can bill their plan for the mammogram, which is usually fully covered since it’s a preventative service,” said Tia Goodman, the program manager of Dana-Farber’s mammography van. If a patient is uninsured, they get referred to Dana Farber’s financial assistance office for further support, just as they would at the hospital if they were unable to afford a care service.
As the only digital mammography van in the entire state of Massachusetts, this initiative has partnered with a number of different community sites, including Boston’s Health Care for the Homeless Program. Most of the unhoused patients served were signed up for health insurance and had their initial mammogram covered, Goodman said, but it was challenging to get ahold of them for follow-ups because they often don’t have the privilege to stay in one place.
“We have worked with the unhoused, but it’s been difficult when it comes to patients who have an abnormal finding and additional imaging needs to be done,” she said. The program last served houseless patients in 2021, and is working to do so again.
Mobile clinics that provide preventative care — performing health screenings, administering vaccines, and providing care for chronic conditions such as diabetes and hypertension — can pave the way for healthier communities, according to Sarin Gupta. An economic study conducted in Boston found that mobile clinics reduce costly ambulance rides, hospitalizations, and repeated trips to the emergency room. It can provide annual savings up to $36 for every $1 invested.
A few recent government policies may help further bolster the popularity of mobile clinics and other alternative health care delivery models. As of this October, the Centers for Medicare and Medicaid Services allows public and private insurers to reimburse providers of mobile medicine to homeless and unsheltered populations.
Meanwhile, in March 2023, Congress passed the MOBILE Health Care legislation to expand care in rural and underserved communities. The number of health centers using mobile health units has already increased by 40% since 2019, according to the National Association of Community Health Centers. That increase is expected to continue in 2024 when new MOBILE Health Care legislation will take effect and allow federally qualified health centers to use new grant dollars on mobile units, which they were previously not allowed to do.
Providers are often more likely to get involved with mobile health initiatives when they’re eligible to get reimbursed, said Taylor Boyd, a first-year internal medicine resident at Massachusetts General Hospital. Boyd is one of the 56 internal medicine residents at Massachusetts General Hospital who are required to partake in a community health rotation on the Curbside Care Vans so that they’re exposed to community-embedded care.
“For some folks, this may be a motivating factor to be able to provide care in areas where it’s really needed. They would get compensated in sort of a similar way as if they’re in a larger sort of medical setting,” said Boyd.
Peters often sees the Curbside Care Van driving around throughout her own neighborhood, which “warms her heart” as she remembers the special care she received as a new mother. “I wish to see this program expand outside of Boston and serve communities affected by housing displacement such as shelters.”
Now, Peters often tells pregnant friends who may have trouble accessing postpartum care about the van. She said that the service helped her recover quickly so she could be present and well for her baby and her entire family and community.
That’s the kind of impact that Sarin Gupta says mobile health programs are all about: “When you lift up one person, you lift up everybody.”
Support for this story was provided by The Neal Peirce Foundation, a nonprofit organization dedicated to supporting local journalism about solutions to cities’ problems.