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Wellmobiles Provide Basic Healthcare to Uninsured

By Laura Schwartzman
Capital News Service
Friday, Feb. 29, 2008


BLADENSBURG, Md. - The Governor's Wellmobile parks outside Bladensburg Elementary School on Thursdays administering vaccinations and providing physicals and basic health care, all for free.

No questions asked.

"I'm certain that we've saved people's lives," said Chris Simmons, 35, a nurse practitioner and team coordinator of the Central Maryland Wellmobile, a wheeled clinic with two exam rooms, a waiting area and a lab.

Operated by the University of Maryland School of Nursing in Baltimore, the Governor's Wellmobile Program has four mobile clinics that travel around the state serving uninsured or underinsured patients at different locations four days each week, often in school parking lots or shopping centers.

They're not intended to be primary care providers or emergency rooms. Gushing blood, broken bones and women in labor get sent to nearby hospitals. Instead, the Wellmobiles aim to save the state money by preventing future hospital visits.

Rebecca Wiseman, the program's director, estimates the clinics saved Maryland $2.7 million last year by treating roughly 7,300 patients who often had nowhere else to turn except costly emergency rooms, which are reimbursed by the state.

Patient Dora Hercules, 49, of Oxon Hill, said the clinic is always welcoming. A breast cancer survivor, Hercules was previously insured, but her current job offers no health benefits. She relies on the Wellmobile for preventive care.

Hercules recommended the clinic to family and friends.

Correction

The first-edition version of this story incorrectly stated how often patients are referred to hospitals and how staff members deal with serious issues such as cancer.
Patients needing urgent treatment are referred to hospitals about once or twice a month.

"They help all people," she said.

A majority of patients are employed, but the absence or inadequacy of health insurance can force people into emergency rooms for routine problems, Simmons said.

In a report issued last year, the Census Bureau estimated that Maryland had about 755,000 uninsured, or about 13.5 percent of the state population, in the period from 2004 to 2006. That is a slightly lower rate than the nation as a whole.

And there are those who slip through the cracks.

"Some patients make just too much to qualify for the state Medicaid program, but don't make enough to buy private insurance," he said.

The Central Maryland Wellmobile serves locations in Prince George's and Montgomery counties, primarily treating Spanish-speakers. They see about 15 to 20 people a day, Simmons said, although this can shoot up to 40 or 50 when they perform school and sports physicals for students.

About once or twice a month, they might send "acute" patients to nearby hospitals for appendicitis, blood clots, abscesses and other emergencies. Cancer patients are referred to specialists who are equipped to deal with the condition.

The bulk of cases are diabetes related, Simmons said. The disease can lead to catastrophic problems for sufferers who are undiagnosed or left untreated.

"If we can help people gain control of their diabetes, they're much less likely to fall victim to wounds, amputations, very costly hospital stays, kidney disease, heart disease, loss of vision," he said. "It has a huge impact down the road."

The Wellmobile program started in 1994 as an effort to boost Maryland's rates of childhood vaccination and evolved into a care provider in 1998. The clinics now handle primary care and more, including women's and men's health, cancer screenings, blood tests and annual exams.

The Wellmobiles mostly advertise through word-of-mouth and see patients by appointment, but walk-ins are also permitted.

Most units have a supervising family nurse practitioner, a case manager, an outreach worker and a professional driver.

Nursing students can also staff the Wellmobiles to get hands-on, supervised experience required for graduation and licensure.

Mette-Jaya Ramanathan, 29, a family nurse practitioner and nurse midwife student, was on hand in Bladensburg on a recent Thursday.

"As a student, it gives you an exceptional clinical site for learning because the clinical instructor is an educator, not just a clinician," she said. "It increases what you can get out of the site."

Trilingual clinical outreach worker Grace Flores, 30, is a Spanish translator but also speaks French with patients from Haiti, Cameroon, C"te d'Azur and other countries.

A former health hotline operator with CASA de Maryland, Flores helps patients connect with other government and nonprofit resources.

Wiseman said the program gets overwhelmed at times and will stop accepting new patients for a month or so, but such instances are rare.

"We really haven't had to turn anyone away, but they may have to wait [or come back next week]," she said. "We triage them and try to see how urgent their care is."

Each clinic costs about $1,000 a day to operate, she said.

The governor's budget provides about half the program's necessary funds, and private grants from MedStar Health, CareFirst BlueCross BlueShield and smaller sources make up the difference.

With looming health care staff shortages in the state, Simmons predicts a need for more safety-net providers.

"Demand is much greater than our resources," he said. "There's so much more that needs to be done in terms of addressing disparities in health insurance, individuals with no health insurance and lack of access to basic medical care."

Simmons wants to spread the word about the Wellmobile, especially for routine physicals, vaccinations and preventive care.

"A lot of people don't realize how sick they are until they start feeling better," he said.

 

Copyright 2008 University of Maryland Philip Merrill College of Journalism


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