Drive-through testing and vaccinations. Telehealth. Home visits. Covid-19 has changed the way providers around the country deliver health care, and the changes aren’t going away anytime soon.
But for community health centers and free and charitable clinics around the country, that may actually be a great thing.
Rosalie Danchanko, the executive director of Pennsylvania free clinic Highlands Health, described distributing Covid-19 vaccines at grocery stores, churches, and even a local farm show. “We stand on street corners, we go into bars,” she said.
Highlands Health has also implemented telehealth and curbside services for people picking up their medication. But for Danchanko, it’s the home visits that staff members are making to remote, rural households that’s the biggest change.
“We have learned from this whole pandemic that no longer can you be a physician or a medical provider if you’re not willing to go where the people are. That’s my new mantra: We have to go where the people are,” she said.
The vaccinations and other services her team has provided to disabled or hard-to-access patients have inspired Danchanko to adopt the practice permanently. She’s planning to set up a mobile van that can drive up to community buildings or travel the rough terrain to marginalized patients’ homes – sometimes following directions like “go four miles and look for the red barn,” she said.
“Where They Are”
Dr. Shantanu Nundy, a community health center physician and the author of Care After Covid: What the Pandemic Revealed Is Broken in Healthcare and How to Reinvent It, would likely be unsurprised to hear Danchanko’s story.
For Nundy, Covid-19 didn’t break the health system. It just showed the problems that were already there. “I really look at Covid as a magnifying glass rather than an anomaly,” he said.
What was wrong, he explained, was a system that didn’t really serve patients – and that left many unwilling or unable to seek care.
“In my mind, what’s broken [in health care] is this heavy reliance on fixed facilities,” he said. “We need to meet patients where they are – literally meet them where they are, whether that’s at home, at church, at the barbershop, or online,” he said.
Nundy said the current health care system is designed around acute care, rather than prevention or well-being: “We have to wait for people to raise their hand and say that they need help.”
But many nonprofit health care providers, like health centers and clinics, are rising to the task, Nundy said. He described texting with patients due to Covid-19 restrictions, and finding out something that might not have come up during a scheduled medical appointment: they couldn’t afford the medication he’d prescribed at the pharmacy. Nundy was able to prescribe more affordable options for this patients.
Where, when, and how
Dr. Wilhelmina Lewis, a physician and chief executive officer of Florida Community Health Centers, said technology has helped her staff treat patients more effectively. For example, remote monitoring devices, such as blood pressure monitors, glucose monitors, and pulse oximeters, can relay patients’ results directly to the health center’s staff, giving them more readings – and perhaps more accurate readings – than they may have gotten during a single doctor’s visit.
“It gives us more data points as we engage in medical decision-making,” she said.
Lewis’s health center, like Danchanko’s clinic, is developing a mobile team that will go to community centers, local agricultural buildings, and other places where hard-to-reach patients are likely to be found. Team members will provide health education, HIV testing, vaccines, and primary care, as well as enrolling patients in Medicare or Medicaid.
Lewis explained that reaching patients isn’t just a matter of being in the right place. It also matters when a provider is there. With that in mind, she’s looking to outfit the mobile clinic with people who are willing to work in the evenings and to expect the unexpected.
“One day they could be Covid testing, the next day they could be next to an orange field,” she said. “It would be hard enough to find people willing to do that work if there were not a workforce shortage [in health care]…You really have to find people who are very mission oriented.”
“The meeting of mind”
“We talk a lot in clinical medicine…about trying to meet the patients where they are. But I don’t think people understood what it actually meant,” said Dr. Monera Wong, a geriatrician and chief medical officer at the Massachusetts-based community center Harbor Health. “Meeting the patients where they’re at is truly meeting them where they’re at, not where we believe them to be or want them to be.”
For Wong, that’s not only a question of providing vaccination clinics or employing technology – although she said telehealth has played a vital role in helping families be involved in a loved one’s health care.
But in addition, she said, it’s about “understanding their health, poverty, job loss, bereavement.”
Wong gave the example of a health center patient who was on her way to pick up her daughter at 4:45 p.m., expecting a 5:30 p.m. telehealth visit. Instead, the doctor called her 45 minutes early because they were ahead of schedule.
“It struck the patient that [the doctor was] truly not sensitive to what their needs are,” Wong said. The patient had the choice of pulling over to take the appointment, or declining and rescheduling. Instead, providers need “to really understand, when we’re making decisions like that, what it might look like to a patient on the other side.”
Sometimes, for providers, that means understanding that a patient coping with a bereavement isn’t emotionally ready to talk about managing diabetes. As a geriatrician treating patients who’d lost loved ones during the Covid-19 pandemic, Wong has seen that firsthand.
“It’s as though my priorities for their health and their priorities were not aligned anymore. They couldn’t afford themselves what they needed to get back on track,” she said. “It’s not only the physical meeting, it’s the meeting of mind.”
Beyond the pandemic
Treating people more holistically and empathically doesn’t begin and end with patients. Lewis described setting up town halls for overwhelmed staff members that included the presence of a psychologist, so they could share what they were going through.
She plans to continue the practice. “Even though the pandemic will go away, health care will always be a stressful profession,” she said.
Providers have been especially receptive to new ways of interacting with patients during the pandemic because they have experienced the loss of their own patients, Wong said. For that reason, she’s encouraged staff members to express their own grief and to highlight the loss of individual patients in group sessions.
“When they went in to approach the next patient, that approach was less transactional,” she said. “I think the pandemic has allowed us, and we have embraced it, to really make empathy a norm for our interactions with patients.”
And Wong described extending vaccination and testing outreach to people – such as ambulance drivers and home health aides – traditionally described in the business as “vendors.” Wong felt a responsibility to those people who were involved in patients’ care, even if they weren’t affiliated with Harbor Health.
For Nundy, all of this is reason for optimism. These changes mean it’s likely that more patients will receive the care they need, and that care will be more effective.
“If you’re in someone’s home…you don’t need to do a survey to find out they have five steps going up to their house, or if they have carpet, or food. You can see it,” he said.
Since the pandemic began, Direct Relief has provided more than $489 million in medical aid to more than 3,000 nonprofit health care providers and organizations in the United States. During the same period, the organization granted more than $96 million to U.S. nonprofit groups, including health centers and free and charitable clinics.
