Mobile medicine looks to cover health care gaps
Two separate services gear up in Spokane areaOctober 24th, 2019
Two separate health care partnerships here — one involving MultiCare Health System and the other involving Washington State University — have created relationships with mobile health care services to provide treatment for different patient populations.
Tacoma, Washington-based MultiCare Health System, which operates Deaconess and Valley hospitals here, has partnered with Denver-based DispatchHealth to provide acute care, such as sutures and IVs, in patients’ homes. MultiCare began offering DispatchHealth to its Tacoma patients in late 2018, before bringing the service to Spokane in mid-August, says Christi McCarren, senior vice president of retail health and community-based care. Since then, DispatchHealth has served nearly 200 Spokane-area patients.
“What we’re trying to do with DispatchHealth is create a partnership that allows people to stay in the comfort of their own home and recover in a place that they’re more comfortable in,” McCarren says.
McCarren says 80% of DispatchHealth patients are over age 60. The service is valuable to that population, something she learned from personal experience. She says she used DispatchHealth a few times to get medical attention for her mother and stepfather, who are both in their 90s and who have limited mobility.
“Having somebody come to their assisted-living (facility) is perfect, because then I don’t have to take these fragile individuals either in an ambulance or pack them into my car with their walkers and wheelchairs,” McCarren says. “It’s so much easier than subjecting them to a long emergency room stay, which is really difficult for seniors.”
Many patient referrals to DispatchHealth come from senior-living facilities, McCarren says. MultiCare’s physicians also refer some patients for the service; some doctors like to have DispatchHealth perform a follow-up visit a few days after a patient comes in for an office visit.
DispatchHealth can provide care for a wide variety of illnesses, injuries, and conditions, including applying intravenous fluids and medications, offering breathing treatments, replacing urinary catheters, and sewing lacerations, McCarren says.
DispatchHealth nurse practitioner Christina Duncan says one of the important benefits of treating patients in their homes is that the providers get a more comprehensive view of how a patient lives, which can inform treatment plans. For example, some patients who regularly call DispatchHealth or visit their primary care provider for complications related to congestive heart failure may be subsisting on high-sodium foods that can exacerbate their condition.
“In a hospital, you would never get to see that,” Duncan says.
The Nissan Rogue vehicles that DispatchHealth providers drive are outfitted with seven boxes filled with supplies, one for each body system, as well as a small lab that can be used to run tests for illnesses such as strep throat. MultiCare also contracts with a mobile imaging company to perform X-rays on patients at home, McCarren says.
However, McCarren notes that DispatchHealth’s services can’t treat everything.
“If it’s a true emergency, this isn’t an appropriate service,” she says. “There are certain things that we will not treat in the home. Patients who have chest pain or symptoms of a stroke are not the kinds of patients that we see at home.”
MultiCare had wanted to start a mobile health care services arm, but developing the logistics and technology posed a significant challenge, she says.
When she discovered DispatchHealth, it seemed like a perfect fit for MultiCare’s vision of mobile health, she says.
“It meant that we could start the service sooner than if we tried to develop it on our own,” McCarren says. “They’re innovative, and they have more of a startup mentality. They move very quickly to get things accomplished, whereas sometimes bureaucracy holds us back in health care systems.”
McCarren says MultiCare launched its partnership with DispatchHealth in Tacoma so that she could keep a close eye on the service and resolve any problems before introducing DispatchHealth into MultiCare’s other markets.
DispatchHealth can lower the overall cost of care, McCarren claims, for both Medicare and privately insured patients. The cost of a DispatchHealth visit is roughly equivalent to an urgent care visit, and three to five times less expensive than going to the emergency room.
The service does treat uninsured patients, McCarren says, at a cost of about $250 per visit, depending on which services and treatments the patient needs.
DispatchHealth has 14 employees in Spokane. Each DispatchHealth vehicle carries two providers: an emergency medical technician and either a nurse practitioner or a physician assistant.
“They serve different functions,” McCarren says. “The nurse practitioner or physician assistant are the ones rendering care, and the EMT is in a supportive role, running lab tests, helping get things set up.”
She adds, “It’s also for safety. Some home situations are not what you might expect.”
While DispatchHealth has an office in Spokane Valley, at 920 N. Argonne, care teams remain on the road throughout their shift. The service is available 8 a.m. to 10 p.m. daily, including holidays.
Patients can request a DispatchHealth visit through the company’s app, online at dispatchhealth.com, or by calling 720.647.5329. The patient will be asked a series of questions, and their answers determine whether they should be referred to an emergency room or if a DispatchHealth team can treat them.
WSU and Range Health
Earlier this month, Washington State University’s Elson S. Floyd College of Medicine announced a new health care nonprofit, called Range Health, that is separate from the university and will partner with WSU and its medical school.
The nonprofit aims to bring health care to the state’s rural and underserved areas. As part of that mission, it unveiled the William A. Crosetto Mobile Health Care Unit, a coach bus converted into a medical office that will travel to outlying communities to provide medical care to patients in those areas.
Dr. John Tomkowiak, founding dean of the college of medicine and director of Range Health, says he was familiar with the concept from his experiences with a similar service provided by Chicago-based Rosalind Franklin University, where he was president of the university’s health system.
“It did amazing things in terms of outreach to the community and being able to provide care, services, wellness, all sorts of things,” Tomkowiak says.
After arriving in Spokane, Tomkowiak quickly realized the gap in health care into which those in rural and underserved areas can easily fall. The college of medicine asked its partners to identify gaps in care that a mobile health unit could fill. A group of WSU students helped the medical school conduct an assessment of health care needs in seven eastern Washington counties.
The university’s fundraising team found two donors to provide funding for the mobile health unit. One donor is the estate of William A. Crosetto, a cattle rancher from Othello who died in January 2018.
“He wanted to bring better health care access (to rural communities),” Tomkowiak says.
The $250,000 mobile health unit will begin offering services in early 2020, he says. Two exam rooms and a lab on the coach will enable Range Health to provide mobile primary care services.
“All the things you see a normal family medicine or internal medicine doctor for, we’ll be able to do on the coach,” Tomkowiak says.
The Crosetto Mobile Health Care Unit will initially serve nine counties — Spokane, Okanogan, Douglas, Lincoln, Adams, Ferry, Stevens, Pend Oreille, and Whitman. The mobile unit also will serve the Colville Indian and the Spokane Indian reservations.
Like DispatchHealth’s units, the Crosetto Mobile Health Care Unit will be limited in what services it can provide. The unit’s providers will handle treating some injuries or conditions for short-term relief, but they will recommend that a patient dealing with a serious issue go to a full-service hospital.
“For example, if there’s a complicated fracture, we would be able to set it and splint it, but not cast it,” Tomkowiak says.
Until the mobile health unit officially launches medical services, it will travel to the medical school’s clinical campuses in Vancouver, Tri-Cities, and Everett to provide education and training through simulations.
“Eventually, we’re going to build a coach that is dedicated to simulation, because not only can we use it to help train our students, but we’ll also be able to help train providers in rural and underserved areas,” Tomkowiak says.
Providers who serve rural and underserved areas are sometimes the only ones available to provide health care to those areas, and leaving their practice to go elsewhere for training is often difficult for them to do, he says.
“Bringing them tools where they can get recertified or maybe certified in something new and not have to leave their clinic parking lot will be an awesome thing,” Tomkowiak says.
The nonprofit envisions rolling out a fleet of coaches, many of which would be used as mobile primary care facilities, while others will be dedicated to education and simulation training. He hopes at least one coach will be converted into a mobile dental care center. He also hopes to see wellness services and providers counsel patients on nutrition and exercise.
“Part of the cool aspect of the coach, as we get fully implemented, is that we’ll be able to have different providers on the coach,” Tomkowiak says. “You won’t have to go three different places; you just go to our coach. Then you could potentially see the psychologist and maybe a family medicine doctor, then a nutrition and exercise physiology specialist.”
The mobile unit will accept privately insured patients and Medicare and Medicaid patients. The nonprofit is formulating a plan for offering services to uninsured people. That plan could see the nonprofit asking uninsured patients for an optional donation.