The Codman Square Health Center is planning to use a mobile van to serve new and existing patients who find it difficult to get to Codman or other health facilities. If things go well, appointments could be in play by next spring.
“I have to say I’m just really excited about Codman getting outside these four walls,” said Dr. Guy Fish, Codman Health’s CEO, who noted that barriers to service for patients seeking care, like transportation, child care, and increased anxieties about immigration enforcement fears, have prompted an increase in missed appointments.
“We want to focus our efforts on no-shows, why they’re not coming,” he said. “For example, with the executive orders in January that have targeted TPS (Temporary Protective Status) and ongoing enforcement activities, we’ve seen a jump in no-shows at some clinics of about 16 to 20 percent.
“It’s not that they don’t need care, but they’re trading off the risk of seeking care versus their health if they come out of the house. That helped us understand that Codman Square needs to come out of its four walls and deliver care outside these walls.”
A mobile medical van— something already in use by other facilities in Boston— is one tool. A new vehicle could cost upwards of $500,000, according to Fish. A Request for Proposals (RFP) is going out this month, with delivery of the van expected in December and appointment scheduling by next year’s second quarter.
The van would be about 17 feet long and have two exam rooms, an ADA compliant wheelchair lift, a bathroom, computer space, and wi-fi capabilities.
Fish and his team hope to serve older adults in particular. A curious trend being seen at Codman is that once a patient turn 65 and transitions from Medicaid/MassHealth to Medicare, they drop off the logs.
“For us to lose that cohort when they have a higher likelihood of multiple clinical disorders, we’re seeing an opportunity, and we’re going to go to them,” said Fish.
A second focus will be maternal health. Transportation is a huge barrier for new or expectant mothers, he said, with 40 percent citing it as a reason for not seeking care or being a no-show.
“Many of these patients who are pregnant are plugging in here, but only for one or two visits while you need a lot more than one or two visits for maternity,” said Fish. “We have to see you frequently and on schedule to detect things that could cause complications like pre-eclampsia…For a post-natal appointment, it is super hard getting an infant or toddler to a clinic. It is even harder when you have another toddler to bring in, too.”
A final need is Substance Abuse Disorders (SUDs) treatment, and the clinic is waiting to hear more about a grant offered from Boston Public Health Commission (BPHC) that would add SUDs treatment to the van’s services.
The Codman team expects that the van would be on the road three days a week, two of them in Dorchester and the third given over to patients in Randolph – an area where the center has a growing number of patients who have moved out of Dorchester.
Fish noted that of the 25,000 patients under the Codman umbrella, some 6,000 are based in Randolph or surrounding communities. With a school-based health center set to open in September at Randolph High School – a facility that will be open to the community after school hours – the van would add to that new service. He said the Health Center has surveyed patients and found that they would like to see the van it at churches and senior housing complexes rather than at parks or housing developments.
“We would want to be very scheduled so people can know and count on us showing up at a defined time,” said Fish, noting that Codman will be mindful of staying in their catchment area and not intruding into other health center territories.
“All of these things would happen better in community and at church groups and other places, meeting patients where they are rather than them coming to us,” he continued. “We can park the van and do care in neighborhoods where patients are at.”
Codman Health doesn’t plan on paying for the van acquisition through its operations budget; instead, it has targeted foundations and organizations that fund mobile health. They already have received a purse of $100,000 in this year’s state budget, courtesy of state Rep. Brandy Fluker-Reid.
“I’m super excited the focus is on the work in the community and the services we can deliver – the core,” said Fish. “The focus here is on the community.”
