SPEAKER_00: 0:01

Welcome to the Healthy Matters Podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, health care, and what matters to you. And now here's our host, Dr. David Hilden.

SPEAKER_02: 0:19

Hey everyone, and welcome to episode 9 of our show. I am your host, David Hilden. You know, with healthcare, we often picture clinic rooms, waiting areas, maybe a hospital hallway or two. But for a lot of people in our community, even getting to a clinic isn't simple or even possible. So today, we're talking about a healthcare model that flips the current model in your head. On its head. We're going to be exploring the concept of mobile health, care that goes directly into neighborhoods, shelters, and community spaces to reach people where they are. Joining us today is clinical nurse practitioner Shay Anga Beecher, who is out there doing this work every day. Shay, welcome back to the show.

SPEAKER_03: 0:58

Hi, thanks for having me again.

SPEAKER_02: 1:00

You're a repeat guest on the show. You're an expert. You in fact you might be the person most knowledgeable about mobile health of anybody I know. So for people who are less familiar with the concept of mobile health, can you give us a general sense of what it actually looks like?

SPEAKER_03: 1:13

So mobile health we may think is something new, but it's actually not. And I'll have you think back to some famous normal rockwell paintings where doctors make house calls. And there's been different situations throughout history, which I'm a fan of, about getting medical care to patients where they are. I know during the 1970s, we would take our Jeeps across the world and work on smallpox eradication. There's actually a woman, a black midwife, Eugenia Broughton, who in the early 50s created a mobile clinic in South Carolina providing uh prenatal and postpartum care to moms. And even NASA partnered with the Navajo Nation to provide mobile clinic in the Southwest. So it's not a new concept. For us here in Minnesota, it means providing health care where patients are at, where they live, where they go to school, where they worship, and where they play.

SPEAKER_02: 2:03

I've been here about 25 years. I think we're pretty good, not always, not perfect, but pretty good at caring for patients when they get to us. But that we've done actually a pretty poor job over the decades of doing this. We're here in downtown Minneapolis. It's in the middle of the urban center, and it's sometimes hard to get to our big campus downtown for a variety of reasons. And our forays into the community in mobile health have been less robust when I started here. I'm well aware of what you're doing. Could you tell our listeners, however, what do you do in mobile health here in downtown Minneapolis? What's your role?

SPEAKER_03: 2:39

So I am the medical director for the mobile health program, which began on May 7th of 2020. And since then, we've gone through several evolutions of our program based entirely on communication feedback from our patients and our community partners. It started as the vaccine mobile, and we were trying to make sure that kids didn't get exposed to measles while also experiencing a global COVID pandemic.

SPEAKER_02: 3:03

Yeah, that was May of 2020. That was about three months into a global pandemic.

SPEAKER_03: 3:07

Yep. Just got our white van and our toolbox from Home Depot and went knocking out. Thinking back on that, I don't know if we should have done that, but we did it and it worked. And patients actually said we wanted more. So we then expanded to provide pop-up clinics in school and gymnasiums and parking lots and libraries. And then we pivoted again to providing postpartum care so that mom and baby could be seen together in the mobile unit. And we're about to launch prenatal care this weekend, providing care for women that are expecting.

SPEAKER_02: 3:39

You said patients were telling you things back then in the pandemic. What were they telling you? Were they telling you about their experiences trying to get in, or what were you hearing?

SPEAKER_03: 3:46

We'd be providing care in the mobile unit at House A. And then the neighbors from House B would lean over their porch and say, How do I get my niece signed up for this? She doesn't go to this hospital, but she goes to this hospital. Can we contact you? Or word would spread and I get a phone call from a Head Start social worker saying, I heard this happens. Can you guys come to our school and do this next? And so it really is a movement and a model that's been led and promoted by the community themselves. Aaron Powell Do you have a sense are these programs common? In the United States, yes. There's a program in Ohio called Wellness on Wheels that provides and has been providing care to moms and kids for a couple of decades. University of Miami PEEDS has a program that works specifically with newcomer or immigrant patients. And then our neighbor next to us in Michigan, Wayne State, has a program that's very unique and gets unattributed patients screened and then pulled into their healthcare system. Within Minnesota, I'm proud to say that, especially in the Twin Cities Metro, we are the most stable and consistent program serving pediatrics and maternal health. And we also bill for uh care when we can.

SPEAKER_02: 4:53

So you are in our department of pediatrics? Correct.

SPEAKER_03: 4:56

Do you see mostly kids? On the mobile unit, I personally only see kids. But we partner with our uh colleagues in midwifery and OB and Family Medicine to provide care to mothers as well.

SPEAKER_02: 5:06

Could you talk a little bit more about what drew you to this type of a practice?

SPEAKER_03: 5:11

I uh out of school was a public health nurse in East Baltimore and door knocking. I spent most of my time going row home to row home and connecting with patients of various ages, providing care that they otherwise normally wouldn't get, couldn't get, because of barriers in accessing care. After that, I moved overseas and worked in Tanzania and practiced what we call bush medicine. And then those situations, individuals or families would take one to two days to walk to our rural clinic. And so again, I practiced a version of mobile care where we would go on our Jeep, pull on our boots. You literally were a Jeep, weren't you? We would pull on our rubber boots because when we were hiking through the tall grass, literally there were pythons, and we had to make sure that we wouldn't get bit and have my vaccine cooler and have my stethoscope around my neck, and we would go and we would visit families. And so I grew up in or I came to be who I am based on some early experiences that really strengthened my belief that healthcare should be somewhat decentralized and dictated by people.

SPEAKER_02: 6:20

From East Baltimore to the Bush visits of Tanzania to Minneapolis, what does a day look like for you now?

SPEAKER_03: 6:29

So I staff the mobile unit once a week now, uh, and that's pediatrics. We spend the first uh part of the morning, first half an hour or so, packing everything up and anticipating what potentially a family could need. A lot of our work is done before the actual in-clinic in mobile visit. Our community health worker, our nurse will telephone the family and get to know not only what vaccines they need and therefore what vaccines I need to pack, but what size diaper the kids need if they are food insecure and how many bags of food to bring. In addition to do you need a school absence note? Do you need any type of paperwork or physicals, photocopies of physicals that we need to bring with us so that you can share with your school? There's a lot of planning that goes into it so that our visits can be smooth.

SPEAKER_02: 7:20

So when you go out to communities, do you go to a location and just wave your banner and say, here we are? Or do you is it like the book mobiles of the past? Is it like mobile blood mobiles? Is it like the ice cream truck? I'm not trying to be flippant, but well, how is it when you go out there? Do people have an appointment? Or and and what is the what does the mobile unit look like?

SPEAKER_03: 7:42

It's a cute mobile unit. I'm really proud of our media team here. They did a nice job of making it kid-friendly, bright colors, superhero graphics that represent the diversity of our patients. And while kids are really drawn to it initially, once they get their vaccine, they may not want to come back as on the post. I was in that thing once. But it's a it's a sweet, very fun-looking mobile unit. We have different modalities of care. So in some situations, we do go from house to house. Care occurs in the unit. Those are scheduled appointments and they're based on geography, so that we're not moving from North Minneapolis to Richville back to Maplegrove and then over to West St. Paul. So it's really dictated based on a route that keeps our team efficient in how they provide the care. We also provide pop-up clinics, and those are pediatric primary care again at Minneapolis Public Schools, Columbia Heights School District, Head Start centers in various counties. And that allows us to see 20 some kids in an afternoon or a day, which allows us to see more patients at once.

SPEAKER_02: 8:47

So you talked about vaccines, but you do more than that.

SPEAKER_03: 8:50

We did the full well trial check. Yep. So imagine it's a clinic visit. Imagine that you go to your doctor for your kids' checkup. You're gonna get your height, your weight, your physical exam. You might get a fingerprint to test for anemia or lead exposure. You get to talk about mental health concerns, behavioral concerns, get your referral to whatever specialist you need, get your vaccines for our postpartum families. These are moms that have delivered in the last six to eight weeks, sometimes 12 weeks. In those situations, we review the birth process, how did it go for mom? We know that family planning is important, and then we need an extended period of time between the current pregnancy and the next, so that the next pregnancy is healthy for mom and that baby. So we do provide birth control. And sometimes that means that it's a prescription for pills, sometimes it means it's a depot shot or an explanant implant.

SPEAKER_02: 9:43

Aaron Powell Let's talk a little bit about that trust issue that you raised. A lot of folks have had bad experiences due to no fault of their own with the healthcare system. The healthcare system has not been great for many of our communities. So they're coming, maybe, I'm I'm imagining, from a baseline position of some tenuous trust or lack of trust. How do you build that with people that you don't know? You just drove up in a cool looking van, but you drove up. How do you develop trust?

SPEAKER_03: 10:12

There is no mobile health program without trust. Because we are entering into the space of a community member or a patient, there is some level of respect given to that space. We are guests in that space. The power dynamic that typically exists with your white coat in a clinic with four walls is out the door once you are outside a patient's apartment complex, a row home or a house. And so on some level, it's humbling for us as staff. We come in with our egos checked a little bit. And then it's really getting to know the patient. Like I said, during those pre-clinic telephone calls, making sure that there's some cultural congruence between our staff and the patients. At our pop-up clinics, uh, we have a Spanish-speaking bilingual community health worker, and we make a point to have patients connect with her first before they see the provider. And that's really important for us, not only to build trust, but to give voice to patients and how they want their health care visit to go. Our community health worker addresses the various social determinants of health. Sometimes that's food and security, sometimes that's understanding of how to navigate the healthcare system and sign up for health care insurance. But after speaking with the community health worker, then the patient is able to better focus on some medical needs that may have not been a priority to begin with.

SPEAKER_02: 11:39

So you've touched on this already, but a a big reason that mobile health exists in the first place is because not everybody can easily access care. And you've touched on a few of those reasons here why they can't. But what are some of the biggest barriers people face when it comes to getting medical care in general?

SPEAKER_03: 11:55

Aaron Powell I would say first and foremost is transportation or lack of reliable transportation. I know that we think it's easy to get on a city bus or schedule a medical taxi cab. But now imagine that you have an infant in their car seat, a toddler or multiple kids with strollers and their snacks and their bottles, and trying to navigate all that is very stressful. In addition to transportation challenges, there's potential conflicts with child care or elder care. Finance is a big thing. Having to figure out whether you still have the same health insurance or being unaware that you're there's a gap in your health insurance coverage prevents you from signing up or committing to appointments.

SPEAKER_02: 12:39

I've encountered that so many times.

SPEAKER_03: 12:47

And who's really reading all the mail that they get into?

SPEAKER_02: 12:51

Trevor Burrus, Jr. So what happens to someone's health when those barriers start to stack up and they don't get addressed?

SPEAKER_03: 12:56

Aaron Powell You put it off until you're in the emergency room or hospitalized. And that's the truth of it.

SPEAKER_02: 13:01

So some listeners might be thinking, okay, come on, just make an appointment. Why is that so hard?

SPEAKER_03: 13:06

Aaron Powell I don't know if anyone's trying to make an appointment and you speak English and you have degrees. Life gets busy, and even if you know how to work the system, it's a lot to set aside time to make your medical appointments, especially when you're also worried about rent or food or a family member that is chronically or acutely ill. Preventative care gets pushed to the back burner for sure. I would say every mobile health visit that I staff, there's an example of a patient or a family whose barrier is stacked up and care keeps getting delayed. And I've seen the effects firsthand. For example, there's a family who is very socially isolated. They have a toddler and is not connected to any type of Head Start Center or public school system, not connected to any system for that matter. And as we were doing the well child checked, and I was getting a feel for the child's nutrition and diet intake, the mother relayed that this almost two-year-old was taking six to seven bottles of formula a day. Which, if you know anything about toddlers, they shouldn't be taking bottles, let alone six to seven a day. And so after I started exploring a bit further, I learned that the mother had a hard time engaging with social resources and was quite food insecure and actually hadn't had fresh milk for her child for the past five to six weeks. And so while our job is not to provide food to every family in a sustainable manner, our job is to connect families to resources like food shelves, not only food shelves, but food shelves that deliver. And in this particular case, we were able to go through some of the minimum dietary requirements for growing almost two-year-old, connect the family with our community health worker, and get them connected to a food shelf that delivers.

SPEAKER_02: 14:58

What a great example. So we're taking the clinic to the community. We're talking about mobile health programs with clinical nurse practitioner Shayanga Beecher from the Department of Pediatrics here at Hennepin Healthcare in Minneapolis. We are going to take a quick break and then dive a bit deeper into the subject and talk specifically about how it's helping ease the burden on emergency departments and why that should matter to everybody. Stick with us, we'll be right back.

SPEAKER_01: 15:23

When Hennepin Healthcare says, we're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at Hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

SPEAKER_02: 16:00

And we're back talking with Shay Beecher about mobile health and specifically the program at Hennepin Healthcare. I want to dig more into a phrase I've heard you use before, Shay. You've said that mobile health program is sort of the safety net of the safety net. That's kind of a powerful phrase. And what do you mean by that?

SPEAKER_03: 16:16

Henup and Healthcare is a safety net. I think one of the largest ones in Minnesota.

SPEAKER_02: 16:20

I think we're probably the largest one.

SPEAKER_03: 16:21

We're the best one in Minnesota.

SPEAKER_02: 16:23

Yeah, you got it.

SPEAKER_03: 16:24

We see everybody and we care for everybody. And I love it. And that's what makes us so special and why a lot of us are drawn to work here. With that said, they are probably a subset of our patients. They may have come here once or twice, whether in the newborn nursery for the first time with their first breath, or whether they are coming to the emergency room and they just fall off our radar. They're not only no showing to a clinic visit, they haven't even made an appointment to be seen. And so we now have a subset of our safety net patient population that is managing their health care at home or not managing their health care at home. And so our goal for the mobile clinic is to reach out to these patients that are on the fringe, that are disenfranchised, that are highly vulnerable, and make sure that we see them, establish trust, and then pull them back into the healthcare system.

SPEAKER_02: 17:17

I really like that. So, listeners, you may not be familiar with the term safety net in healthcare, but around here it's like what we do every day and it's why we come to work. And I think our communities, all of us need a safety net in our life for when things didn't go well, or we we need some backup, something to help us when things aren't going well in our life. But even our safety net has holes in it. And so I really like that. There's yet another safety net for the safety net. How does your mobile health team work, Shay, with shelters, outreach workers, community organizations, you know, support services in the community? How do you work with those folks to help support patients beyond just your single visit?

SPEAKER_03: 17:55

So when our team comes in with our mobile unit, as cute as it is, we are still considered a part of the healthcare system. And we depend on community members to vouch for us because patients may more likely go to their school nurse, their shelter caseworker, their imam, or their faith leader than they would go to us. Now, if that faith leader says, I vouch for this mobile unit, I know they do good work, we've now been invited into a sacred space. And that gives us the invitation that we need to not only share our message about what it means to be healthy and accessing care, but then we can even provide that care as well.

SPEAKER_02: 18:35

So we've talked a lot, Jay, on the show about how busy our emergency departments can be and how oftentimes they can be overwhelming for patients and frankly for the staff as well. And it's maybe not the best place for all medical care to happen, but sometimes it has to. It sounds like you can actually help us out here with mobile health. How might that happen? What is the relationship between what you do and people needing to seek emergency care? And how can you help that out?

SPEAKER_03: 19:00

We started noticing this early on when the program first started. We would see kids that had symptoms that would probably go unchecked until they presented to the emergency department. This just actually happened a couple of weeks ago. Uh, I was scheduled to see a 12-year-old for a well child check. Looking in the chart, the patient hadn't been seen since probably kindergarten, because that was when the last set of vaccines were given. And when I did the exam, I noticed that his lungs were very tight. He wasn't getting good air in. And I said, Are you having a hard time breathing? And both the patient and the mother is like, Yeah, he just has had this cough and it's just not going away. And sure enough, as as we were going through the discussion, he had had asthma as a child. He never got the medication refilled. Typically, he just sits and minimizes his activity until it quote goes away. And so in this situation, we I was thankful enough to connect him with medication through our pharmacy's home delivery process. And had when I called back a few days later, he had started his inhaler and seemed to be doing a little better.

SPEAKER_02: 20:06

Because this kiddo was having an asthma as well, 100%. And listeners, that's not good. Kids can't breathe, they need to get treatment.

unknown: 20:14

Yeah.

SPEAKER_03: 20:14

And it wasn't on their radar to pay attention to it because he's a 12-year-old boy, didn't verbalize anything, didn't want to bother his parents with one more issue as they were dealing with quite a few.

SPEAKER_02: 20:24

And he hadn't been seen in the healthcare system for five, six, seven years, maybe.

SPEAKER_03: 20:28

Right. So at the beginning of our program, we decided to pay attention to the ways in which our mobile unit was potentially preventing ED visits. And so we did a retrospective analysis of the patients seen between May of 2020 and February 2024, and we compared ED visits six months before and six months after a pediatric mobile clinic visit. So there were about 1,200 unique patients, and we found that there was a statistically significant reduction by 25.2% in the mean number of ED visits across all patients. What was even more remarkable is when we broke it down by race, for patients who identified as black, this was more significant with a 41.2% reduction in ED utilization following a mobile visit encounter.

SPEAKER_02: 21:16

So after your mobile visit encounter, patients are less likely to visit. Right. And you have actual data to back that up. Correct. Why why do you think it is that they don't go to the emergency department? Was it just your initial visit? Or do they somehow get plugged into care?

SPEAKER_03: 21:32

Aaron Powell I think there's a couple of things going on at the same time. The first is navigating healthcare is a challenging concept for many, especially for individuals that aren't familiar with the healthcare system in America compared to maybe where their parents grew up or where they grew up. And so when we do our town halls where we connect with our community partners and community spaces to talk about things in open ended sessions, we learn that. There's confusion about what a primary care provider is, what a medical home is, office visits that aren't the urgent care or the emergency room. And so for a lot of folks, it's really I get sick, I go here, and I get my medication and I go home. And if it's really bad, I'm gonna stay in the hospital for a few nights. I don't think there's a common knowledge of preventative primary care. When we are with the patient in the mobile unit, we for sure hand them a pamphlet or say, hey, do you want us to come back to you? And if so, we can put in a referral for a future appointment. And then by the second or third appointment, we say, Hey, what's the plan here for us to get you back into this system? Comfortable with us. We have some great friends and colleagues who are similar to us. Can we connect you to a clinic that's close to your home? And sometimes we do see that graduation, and those are the cases that I think, all right, this is really working.

SPEAKER_02: 22:50

Yeah, they I bet that's really working. If you can get those resources for people. So some listeners are probably thinking, Shay, that this is cool, this is really interesting, but it doesn't affect me directly. So how does meeting people where they are in their community, in their private spaces, how does that ultimately make the healthcare system stronger and more sustainable for everybody?

SPEAKER_03: 23:13

I think the health of our neighbor is just as important as the health of us as an individual. I don't want to be sitting in a workplace where someone's coughing up measles and then I'm infected and I bring it home to my kids and family. We're all in public spaces, whether it's public transport, uh, schools, concerts, Vikings games. And I think it's really important to all of us to make sure that we are getting the same access to the basic rights: food, water, healthcare. And that looks differently for some people, and that requires a little bit extra work for some people. At the very least, we can support it, even if we don't engage in it.

SPEAKER_02: 23:51

I could not have said that any better, so I'm not even going to try. So this whole episode has been a good reminder that healthcare doesn't just happen inside buildings. It happens in relationships, it happens in trust, it happens in showing up where people actually are. So, Shay, before I let you go, if there's one thing you wish people better understood about mobile health or about the patients you serve, what would that be?

SPEAKER_03: 24:14

So I was thinking about how to answer this, and I thought that too. Um one of my favorite things growing up as a kid on Saturday mornings, I would watch first Sesame Street and then Mr. Rogers. And this has carried with me even to present time as I lead our mobile health team through yet another challenge that we faced over the past five years. Mr. Rogers was my favorite. We loved watching Daniel the Tiger and Lady Everlane and the song of Won't You Be My Neighbor sticks with me and has helped shape some of my lessons for my own kids. The quote, however, is one that centers our team in current times and in other times of transition and challenge and unpredictability. And that's when you look on the news and you see all this bad stuff happening, Mr. Rogers' mother would say to him, look for the helpers. Focus on that. And I think mobile health as a program, as a team of individuals, we are able to be the helpers in times of uncertainty, of challenge, of unpredictability. Because we are a small unit, we are nimble, we can provide care wherever it is, not just a brick and mortar clinic, but in a church basement, in a mosque, in a school. And we can make sure that we look out for our neighbors regardless of their race, their creed, their gender, their age, and maintain that mission that I find has drawn many of us to work at Hennep and Healthcare.

SPEAKER_02: 25:45

Mobile Health is one of the ways Hennep and Healthcare lives out its mission, especially for people who might otherwise slip through the cracks. And Shay, thank you so much for leading this program. She is the leader of the program. She is the heart and soul behind it, in my opinion. And so, Shay, thank you for being one of those helpers and being on the show today. Thank you. And listeners, thank you for tuning in today. We will be back in two weeks' time with another great topic. And in the meantime, be healthy. Be well.

SPEAKER_00: 26:13

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org. Or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.