Health care goes mobile: COVID-19 experience speeds doctors’ transition to increased patient outreach from Crain’s Detroit Business
September 27, 2021
The more than 18-month battle against COVID-19 has changed how doctors practice medicine, care for patients, manage their practices and interact with other providers.
With more than 664,000 deaths nationally, rising at more than 1,800 per day, and 21,841-plus in Michigan over at least four surges of the disease, families of the stricken are heartbroken and health care providers are exhausted — both physically and mentally.
During the crisis, physicians also have learned many lessons that will forever change the way they practice, evaluate patients in office settings and in hospital emergency departments, doctors say.
For Drs. Charles Shanley and Phillip Levy, two leaders at Wayne Health, a 400-provider multi-specialty group affiliated with Wayne State University in Detroit, COVID-19 sped up the group’s change to preventive medicine they felt necessary to serve their inner-city patients, many of those with multiple chronic diseases.
The COVID-19 pandemic forced providers to put more resources into patient outreach, Shanley, a vascular surgeon now CEO of Wayne Health, said: “There’s an old quote from Wayne Gretzky: ‘Why were you so great?’ (He said) because ‘I skate to where the puck is going.'”
By the 2030s, Shanley predicts, “hospitals are going to be intensive care units and operating rooms.” To meet patient needs, he said, Wayne Health and the health care industry must evolve into an integrated ambulatory platform that links directly to specialty care, community health workers, pharmacists, dentists, social workers and behavioral health providers.
“Phil and I sat down and discussed the fact that he being in emergency medicine and me in vascular surgery, we’ve always been frustrated that we’re dealing with the end consequences (of chronic diseases),” said Shanley.
“Unfortunately, over 25 years I’ve taken care of a lot of people with end-stage disease that I know was preventable if we got to them sooner,” Shanley said.
“It might be severe vascular disease; it might even result in an amputation, or kidney disease or heart attacks or stroke,” he said. “But it’s the result of not doing the things that we needed to be doing when the person was 25 to 30 years old, the unrecognized hypertension that after 20 years, presents as a stroke.”
Levy, an ER doctor and Wayne State professor who practices at Detroit Medical Center, said the lethal mix of chronic diseases and COVID-19 caused him to rethink the reason he got into medicine.
“Like a lot of other ER physicians I was driven by the adrenaline of acuity, seeing and helping people in extreme (situations) with whatever they were presenting with,” said Levy, who is Wayne Health’s chief innovation officer.
But day after day in the DMC ER, Levy said, he saw many people in their 50s and younger, predominantly Black, come in with severe heart disease, kidney disease, diabetes, uncontrolled hypertension and those with strokes and heart attacks.
“I researched it and found many with strokes and heart attacks, and other diseases, start with uncontrolled blood pressure, mixed with uncontrolled diabetes,” said Levy
Shanley and Levy said COVID-19 — either by contracting it or delaying care because of it — will make patients with chronic diseases worse for years to come.
COVID-19 presented Wayne Health with a unique opportunity to accelerate the group’s move toward preventive health services and refine its outreach strategy.
“Using mobile health units, we can reach these vulnerable communities. It’s never going to occur in the traditional doctor office or hospital setting,” Shanley said. “We felt we could reach people with an integrated network where you have a mobile component that goes out to where they’re at and links them in a very directed way.”
Using five mobile health units designed and partially funded by Ford Motor Co., Levy said Wayne Health staff are bringing free health screenings, COVID-19 testing and vaccines and other services directly to the community.
Last month, the Wayne Health Mobile Unit brought services to Detroit Chassis LLC, a Detroit-based automotive supplier.
About 137 of Detroit Chassis’s 500 Michigan employees have so far received either a COVID-19 test, vaccine or primary and preventive health screening at the company’s plant, said CEO Dennis Edwards.
“Detroit Chassis has been around for 21 years partnering with Ford and during the pandemic Ford has supported us tremendously with masks and best practices,” Edwards said. “They came to us and asked if we were interested in connecting (with Wayne Health). This is exactly what we wanted to do with employees to help them with wellness and keeping them safe.”
Edwards said employees, mostly union workers with UAW Local 155, were happy to have the convenience of on-site health screening and COVID-19 testing.
“It’s voluntary, but we have incentivized it by paying for their time right after their shifts,” Edwards said. “If you didn’t get the service, you weren’t paid for the time. It’s a win-win with a focus on health.”
During the two visits, Edwards said, the Wayne Health team was very professional and answered many questions.
“There was a line and one worker wanted to get a second COVID shot. She didn’t have enough time with a busy home and schedule,” he said. “I brought her to the front of the line to ask and Wayne Health gave her a second booster.”
Edwards said Detroit Chassis has a second plant in Avon, Ohio, with about 75 workers. He said the company is looking for a provider for on-site health screenings.
“I know there are a lot of people who need regular blood pressure testing, and diabetes is something you need to monitor,” Edwards said. “A lot of employees thanked me for being able to get these services. This is a pilot, but we hope this will grow and become a regular thing.”
On Sept 1 and Oct. 1, Wayne Health will offer mobile health screening to a second company, Detroit Manufacturing Systems, for their 1,200 employees, Levy said.
“We are working on innovative economic models for value-based reimbursement to further expand mobile and preventive health care services at work sites,” he said. “Our vision is for the mobile health units to bring care directly to where people are — at work, at home, where they learn or where they play.”
Mobile unit services include blood testing for diabetes, cholesterol and kidney function; blood pressure screening; COVID-19 testing and vaccines; school immunizations and sports physicals; child wellness exams; HIV screening; behavioral health and patient education resources; and primary care physician referrals.
All the services are free for participants and insurance is not required. Insurers will be billed for screening tests. To date, more than 35,000 nasal swab COVID tests and 9,500 COVID vaccines have been provided through the Wayne Health Mobile Units at community locations across southeast Michigan.
“We’ve always had a very robust network of subspecialty care. What we are doing is linking these populations with chronic diseases, including women’s health and primary obstetrics, to specialty care,” Shanley said.
“Now we can use our mobile outreach to create connections to get them the other things, whether it’s financial assistance, linkages to other social and behavioral health services.”
Levy said Wayne’s mobile health unit initiative is focused on identifying people with problems before they develop chronic diseases.
“There are a number of people out there who are insured but don’t use health care, maybe they stopped using health care because of COVID,” Levy said. “Maybe they never really trusted health care or wanted health care or admitted, you know, that that strange discomfort in their chest was something that we’re concerned about.
“Nonetheless, there’s a lot of people out there, and if we can use this mobile outreach and rethink health care delivery, bringing care to people and meeting their needs in their community, and letting them take the circumstances of how they receive care, and well, that’s a lot better than waiting in the ER for someone to come in with problems.”
The Michigan Department of Health and Human Services, and Wayne State University donors such as the Cielo Foundation, have helped to underwrite the mobile vehicles and the cost of uninsured care under the program.
Levy said external funding provided 100 percent of the mobile unit and costs for testing, vaccines and other services to schools, churches and other community locations by state funding and philanthropy.
“When participants have medical insurance, their insurer is billed for testing,” Levy said. “There is a fund created through philanthropy that covers the cost of testing that is not covered by insurance.”
Levy said Wayne Health plans to expand its mobile health program for community-based, preventive health screenings and for work-site screenings. External funding also enabled the group to add “mini-mobile health vehicles” for door-to-door services.
Wayne Health recently received a $2.6 million grant from the American Heart Association to deploy mobile health units to provide direct, personalized health care and coaching to Black people with high blood pressure living in select under-resourced neighborhoods in Detroit.Health care goes mobile: COVID-10 experience speeds doctors’ transition to increased patient outreach.
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