Under Pressure Episode #6: From pandemic response to portable population health: how the Detroit mobile health unit program pivoted to address hypertension in a community

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Instructions

Monday, July 11, 2022, 12:00 PM - Friday, July 11, 2025, 12:00 PM

We welcome a special invited guest, Dr. Phillip Levy of Wayne State University, to describe how he and his team turned mobile health units into a valuable tool to address hypertension in vulnerable communities in Detroit, Michigan during the COVID pandemic. 

How did the mobile van program start? How have you morphed it to address hypertension?

Dr. Levy’s work in Detroit focuses on leveraging the emergency department as a population health center, not just as an acute care intervention point. He did work in Romania around hypertension, which he later applied in Detroit around hypertensive heart failure. This work led him to recognize the importance of addressing chronic hypertension to prevent the long-term complications of hypertension. He then began to develop programs to screen for hypertension in the emergency department (ED) and provide linkages to care both in the ED and in the community.

Nationally, the average admission rate nationally from the emergency department is about 15%; this means 85% go home. However, almost 100% of patients who visit the ED get a blood pressure measurement. His team aggregated blood pressures taken in the ED at the geospatial level. They used this data to target interventions (medications, food access, etc.) at the most affected populations in the Detroit area.

Using this infrastructure, they were able to target COVID testing to the most vulnerable communities. However, even drive-thru testing, which they rolled out early in the pandemic, did not allow them to reach certain neighborhoods. Thus, they acquired vans that allowed them to get into the neighborhoods for mobile health outreach for COVID testing. They now use these vans for preventative health services like blood pressure management. People can have their blood pressure measured and certain labs drawn at these mobile sites.

Tell us more about the logistics of mobile van program.

They have 10 vehicles, one of which is ADA compliant. Each vehicle has a team of 4-5 people including a medical assistant, a patient services representative, 1-2 nurses, and a community health worker. They write on the window the different services being offered that day (i.e., blood pressure measurement, labs, COVID vaccination) and the patient goes through and get the services they want, similar to a car wash.  There is no doctor on site. The central ethos of what they are trying to do is to make screening easy and barrier free.

How is the mobile van program promoted to the community?

The program is promoted through community partners, word-of-mouth, radio commercials, and television commercials. They use technology like cell phone and Google Maps data to target to high traffic, high need areas.

How did you move from targeting COVID testing to chronic care?

They targeted vans for COVID vaccination to areas with low vaccination rates. They have data that shows they increased COVID vaccination rates 10-15% in a population. They are using this background to scale to their efforts around hypertension. Community health workers are available at the vans to link patients to care by making necessary doctor’s appointments and arranging transportation to appointments. In the future, they would like patients to be able to receive all care in the field without ever having to come into the office. To do this, Dr. Levy proposes it would be better to move from RVUs to a capitated payment model that rewards outcomes.

How much skepticism have you received from the communities you are working in?

The environment created by COVID testing and vaccination habituated people to the idea that care can be provided differently, and so they were able to gain communities’ trust.

To what degree is the success of this model dependent on how many referrals you make to a brick-and mortar-office?

The program receives public and private funding that allows it to bill a philanthropic fund rather than the patient or their insurance. They do ultimately want to drive business into the clinics but if we move from an RVU to capitated payment model, the pressure to do this would be less.

Any final messages for our audience?

Don’t ever be stymied by the magnitude of the problem. Also, let’s use COVID as an inflection point to challenge the status quo and make things better going forward.

1. Discuss the mobile van program led by Dr. Philip Levy in Detroit, MI.
2. Describe how the mobile van program morphed from addressing COVID to providing preventative health services like blood pressure screening.
3. Restate how the mobile van program reduces barriers to care.

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