Reference no: EM135163

"Supporting Mobile Health Clinics: The Children's Health Fund of New York City". See case study below.

• Examine the case study, and prepare the conclusions, recommendations, and implications.
• Suppose the implementation challenges in the case and the technologies used to meet them, along with the final questions posed at the end of the case.
• Summarize your findings in a two page paper using proper APA formatting.

Supporting Mobile Health Clinics: The
Children's Health Fund of New York City

The Children's Health Fund

The Children's Health Fund (CHF) develops and supports a national network of 22 programs and two affiliates in 15 to 17 states in the United States and the District of Columbia. The mission of the CHF is to provide comprehensive health care to the nation's most medically underserved children, from birth up to age 24. In-person primary health care, mental health, and oral health services are delivered by teams of doctors, nurses, dentists, psychologists, social workers, and nutritionists at more than 200 service sites across the United States in partnership with pediatric departments and specialists in affiliated academic medical centers or Federally Qualified Health Centers (FQHC).

The CHF's integrated approach to health care is consistent with the concept of an "enhanced medical home" in which continuity of care is ensured via coordination across multiple healthcare providers and specialties.

In the United States, the Medical Home concept is being adopted as one aspect of health care reform to ensure a high quality standard of care that also seeks to increase efficiencies and reduce costs for acute care. This type of integrated health care delivery is enabled by health information technology (HIT)-not only computer software but also communications networks.

The cofounder and president of the CHF, Dr. Irwin Redlener, received his M.D. from the University of Miami in 1969. But his life mission for bringing medical care to underserved children reportedly began when he was a medical resident in pediatrics at the Children's Hospital of Denver and saw a poster for VISTA (Volunteers in Service to America) with the words: "If you're not part of the solution, you're part of the problem." Dr. Redlener's quest to become part of the solution began with delivering medical care in Lee County, Arkansas, then working on earthquake relief in Guatemala, followed by serving as medical director for USA for Africa, and this poster is hanging in his office today.

An important motivation in my life has been working with kids whose situation makes them vulnerable for reasons out of their control. They are desperately ill, or living in extreme poverty, or disconnected from medical care. I feel most energized by trying to help children who have the fewest resources.

In 1987, Redlener cofounded the Children's Health Fund(CHF) in New York City. Its initial focus was on pediatric care for homeless kids, and his cofounder was singer/songwriter Paul Simon. While working for USA for Africa, he helped solicit the help of other recognized entertainers, including Joan Baez, Harry Belafonte, Lionel Richie, and Michael Jackson. When he learned that Paul Simon was interested in doing something for the homeless, he reached out to him:

I was working for USA for Africa, setting up the grant office in New York City. Paul Simon, who was on the We Are the World record, wanted to do something for the homeless. We visited a number of welfare hotels. In the Hotel Martinique [in Times Square] a thousand children and their families were warehoused. Somebody suggested that we should get a van and bring doctors there.

That was the beginning of what would become CHF's national network of Children's Health Projects (CHP), in which health care is delivered via doctors, nurses, and other professionals in an RV-size mobile medical clinic (MMC) that is driven to locations where the people are who need it-such as city shelters for homeless families.

The flagship program with the first MMC was launched in NYC in 1987, and by 2009 the program had been expanded to cities and some deep rural areas within CHF's growing national network of clinics. The clinics are supported by 41 state-of-the-art MMCs (32 medical, 3 mental health, 5 dental, 1 public health field office, and 1 health education) operating in different programs across the country (see the map in Exhibit 1). By 2009, some had been in service for many years and while not obsolete, lacked some of the newest features, such as modular network cabling and upgraded electrical generators; 7 new MMCs were in some stage of procurement in June 2010.

The payments for the medical care provided by CHF primarily come from four sources: private individual and corporate donation, congressional aid, and two government health insurance programs that support children living in poverty. These programs are Medicaid and the State Children's Health Insurance Program (SCHIP). Medicaid insures kids whose parents earn little or no money; the federal government pays part of the costs, but programs are administered and partially funded by state governments.

SCHIP, a newer federal program initiated in 1997, insures children in families that earn too much to qualify for Medicaid, but too little to afford private health insurance. In February 2009, President Obama signed a bill that continues funding for SCHIP ($32 billion over the next 4.5 years).

Mobile Medical Clinics at the Children's - Health Fund

CHF's Mobile Medical Clinics (MMCs) are housed in 36- to 44-foot long blue vans, designed to provide a full range of pediatric primary health care including preventive care (e.g., childhood vaccinations), diagnosis and management of acute and chronic diseases, mental health, dental, and health education services. In addition to care provided in the mobile clinics, care is provided at stationary clinical sites located in shelters, schools, and community centers, and traditional health clinics (e.g., the South Bronx Health Center for Children & Families in NYC). The mobile clinics routinely visit low-income neighborhoods and homeless and domestic violence shelters to provide medical services, but MMCs have also been deployed to provide medical services in response to public health crises or emergencies, including the 9/11 attacks on the World Trade Center, hurricanes Rita and Katrina in 2005, and the 2010 Gulf of Mexico oil spill.
Two primary CHF principles are at the heart of the design of the MMCs:

• To provide high-quality pediatric primary care as well as mental health services, dental services, and social services to medically underserved populations with children.

• To operate in partnership with a high-quality local medical institution, such as an academic medical center or FQHC, to ensure access to other medical experts as needed as well as coordinated health care for the local population.

Access to reliable, affordable transportation is a major constraint for those living in poverty at government-sponsored locations, as well as areas where there are few health care providers, known as HPSAs (Health Professional Shortage Areas). To help remove this constraint for low-income and homeless residents in New York and four other major areas, GlaxoSmithKlein provided a $2.3 million grant to support transportation funding in 2004: $35,000 on taxi rides and $20,000 on bus tickets for adults were spent by the Dallas Children's Health Project (CHP) the prior year. In New York, this Referral Management Initiative had dramatic results: specialist appointment compliance rose from 5 to about 70 percent.

The medical home concept is based on the premise that a returning patient will be supported by a trusted healthcare team who knows the patient and has access to documentation of his or her health history. shows a model of the MMC and its layout, with a separate registration area and waiting room, a nurse's station, and examination rooms.

The sides of the blue vans are painted (like "billboards") to clearly signal that they are CHF units with qualified medical personnel onboard. On a given day during a given time period each week, the MMCs are scheduled to be at the same location with the same medical personnel onboard.

We don't just show up like in an ice-cream man mode, give a shot and disappear. The protocol is that every Tuesday from X-time to Y-time the doctor is there.

-Jeb Weisman, CIO

Providing high-quality primary care from a mobile clinic does present some unique challenges for supporting those who are delivering the health care, such as:

• Designing an environment which is consistent with and will support standard physician office and clinic processes. This includes providing the required space and medical equipment to support high quality delivery of primary care, including sufficient, highquality electrical power.
• Complying with regulatory standards such as those set forth by JCAHO (e.g., PC locations) and government legislation (e.g., HIPAA laws for privacy and security of personal health information).6
• Supporting a mobile unit that operates at multiple, primarily urban, sites-each with its own unique environmental factors.

• Providing computer and communications technologies within the MMC that are reliable and dependable, as well as off-site access to technical support.

Another important consideration is the overall cost for each mobile clinic-including the initial costs for a stateof- the-art MMC as well as continuing operating costs. The majority of the approximately $500,000 capital budget for each MMC is allocated to the required medical equipment and associated vehicle requirements (i.e., space, power, and transportation needs). Preventive care via a medical home should of course result in long-term cost savings for state and federal payers as children receive immunizations and regular health checkups that can avoid costly visits to hospital emergency rooms, but these are difficult to measure. Given the national shortage in primary care physicians, CHF's association with a major medical center also means that MMC may be part of medical residents' formal training rotation, often in pediatrics or community medicine, as part of the medical team.