Community Care Vans: Improving Health Care Access and Equity

For many, going to the doctor is a minor hassle. You might have to take time off work, or battle rush hour traffic. But what if your job doesn’t offer you any paid time off or health insurance? What if you only have limited transportation options or access to childcare? It can be difficult for patients facing those obstacles to access medical care, especially in minority or lower-income communities. 

Mass General Brigham Community Care Vans are designed to make health care more accessible. The vans are part of the larger United Against Racism initiative at Mass General Brigham, which addresses structural racism affecting patients, staff, and the community. 

Priya Sarin Gupta, MD, MPH, medical director for community-based clinical programs at Mass General Brigham, explains: “The Community Care Vans move the front door of the hospital out into the communities. We provide increased access and care for preventable conditions that disproportionately affect historically marginalized individuals and communities.” 

Dr. Sarin Gupta leads the van program with Elsie Taveras, MD, MPH, Mass General Brigham chief community health and health equity officer, and executive director of the Kraft Center for Community Health at Mass General, and Sarah Wakeman, MD, the Mass General Brigham senior medical director for substance use disorder (SUD).

Originally launched as a response to the COVID-19 pandemic, the Community Care Vans now offer screening and treatment for conditions like hypertension, diabetes, and SUD. In this article, Drs. Sarin Gupta, Taveras, and Wakeman discuss how this community-driven care has evolved. 

COVID-19 disparities and mobile health care

In Boston and across the country, minority communities were hit the hardest by the COVID-19 pandemic. In an effort to make clinical care more equitable, Mass General Brigham started the Community Care Van program in January 2021, during the second surge.

The vans initially focused on COVID-19 offerings, including:

• Testing
• Vaccines
• Reliable health information
• Resources like masks and hand sanitizers

The Community Care Van program was based  on an earlier mobile services model, Community Care in Reach. The Kraft Center developed this program in 2018. It offers mobile treatment and harm reduction services for SUD.

The Community Care in Reach program has increased access to care. They bring on-demand addiction services directly to people at the highest risk of near-term death. The program has made over 20,000 contacts with people living with addiction, and has been recognized as a best practice in Massachusetts.

“Our goal during the COVID-19 surge was to reduce the burden of COVID-19 disease in the communities we serve,” says Dr. Taveras. “Based on our experience with Community Care in Reach, we knew we had a solution that worked. We were ready to launch our mobile COVID-19 program based on those experiences,” she adds.

The Mass General Brigham Community Care Vans were a great success, providing more than 10,000 COVID-19 tests and 20,000 COVID-19 vaccines.

The importance of community engagement

Involving local organizations was key to the program’s impact.

“From the very beginning, it was important to us to engage with community-based partners that would co-create the program with us. We worked with public officials and community-based organizations in the neighborhoods that we serve. Together, we designed the mobile program locations, and planned to attract patients to the various services,” says Dr. Taveras. To date, the Mass General Brigham team has partnered with more than 100 local organizations.

In addition to co-creating the programs with local stakeholders, the program leaders hired bilingual, community-based staff. Dr. Sarin Gupta says, “We’re mindful of providing culturally humble care. Part of that is having staff who understand and live in these communities.”

Building trust with community members was a priority. “There’s robust research looking at mobile care as a way of engaging with communities that may not have felt welcomed in more traditional health care system, because of barriers like racism or experiencing trauma,” says Dr. Wakeman. “The mobile piece becomes that first front door of connecting people with people, welcoming them in, and building trust.”

An early example of the program’s success was the community of Chelsea, MA. “Chelsea went from being one of the communities with the greatest COVID-19 burden, to having one of the highest COVID-19 vaccination rates in the area,” Dr. Taveras notes.

The same communities most affected by COVID-19 are also impacted by SUD and other preventable diseases at higher rates. “We’re in the midst of the worst overdose crisis our country has ever seen,” says Dr. Wakeman. Last year, Massachusetts had the higher number of overdose deaths on record for the state. As COVID-19 pandemic showed signs of easing, program leaders saw an opportunity to expand their services.

Evolving the Community Care Vans program

“We are using a data-driven, community input-based approach into other conditions, like hypertension, diabetes, and SUD,” says Dr. Sarin Gupta. “The trajectory that a patient has with those conditions can be changed if we’re able to intervene earlier.” Another example of these efforts is an initiative to improve kidney transplant care for underserved communities.

The vans are each staffed with:

• A physician lead
• A nurse practitioner
• A medical assistant
• A full-time community health worker
• An operations/community engagement manager

“We're able to be familiar faces that go into these communities on a regular basis,” Dr. Sarin Gupta says.

The van staff now provide:

• Screenings for blood pressure, cholesterol, diabetes, and SUDs
• Assessments of body mass index (BMI), physical activity levels, and mental health conditions like anxiety and depression
• Education on exercise, nutrition, better sleep habits, and quitting smoking
• Vaccinations for COVID-19, the flu, and more
• Support for social risk factors like housing instability or food insecurity

Through this combination of clinical and social care, the Community Care Vans provide a foundation for improving long-term health outcomes. “When we’re addressing things like food insecurity with our patients that have hypertension, we’re providing them with medically tailored meal boxes that will actually help their blood pressure,” Dr. Sarin Gupta says.

“Hypertension is a silent killer. It’s challenging to treat and screen for hypertension if you don’t also help mitigate the social risk factors that can assist with managing heart disease,” Dr. Taveras says. Her research on sleep and heart health in children and teens shows that lifestyle can have a huge impact on health later in life. Treating these conditions at an earlier stage can reduce the risk of more severe disease.

Improving access to health care

The Community Care Vans program has 3 vehicles that visit 7 local communities: Chelsea, Revere, Everett, Salem, Lynn, Peabody, and several neighborhoods in Boston. The van schedules and locations are available online and updated weekly.

“The idea is to capture essential workers and people that otherwise have trouble accessing the health system. Maybe they have multiple jobs or childcare to worry about. It’s important to offer expanded hours outside of the regular appointment times,” Dr. Sarin Gupta says.

The vans operate on a walk-in basis, and you don’t have to be a Mass General Brigham patient. “When we’re not on the ground, our team is working closely to communicate back with patients. If patients have a primary care provider, we’re reaching out to them to let them know the patient visited us,” says Dr. Sarin Gupta.

For patients with SUD, a team of addiction specialists and recovery coaches from Mass General Brigham Bridge Clinics deliver addiction services on the Community Care Vans, beginning with two locations in Roxbury. “Our mobile Bridge Clinic team is creating friendly, person-centered spaces on the van and engaging with community members through outreach. The goal is to provide welcoming care that people can access without any barriers, so they can engage around their substance use and their health,” says Dr. Wakeman.

Another priority for the Community Care Vans is bridging the digital divide. “We have all these health resources available on a digital platform. We’re making them more accessible to folks that wouldn’t otherwise have access, and providing them in different languages,” Dr. Sarin Gupta says.

SUD treatment as a priority to address the overdose crisis

SUD treatment is a key part of the services the vans offer. The vans provide treatment for opioid use disorder, as well as other types of SUD including stimulant use disorder and alcohol use disorder.

“Inequities in who’s dying from overdose have only worsened in Massachusetts. Black, Latino, and American Indian men have the highest rates of death, and they’re rising,” says Dr. Wakeman. “One of the things that makes it so devastating is that opioid overdose is an entirely preventable cause of death. We know how to prevent and reverse overdoses. When the underlying condition is opioid use disorder, we know how to treat that.”

“We need to step outside of the brick-and-mortar, clinical approach to think about why we are seeing such high rates of overdoses, and to disrupt the way we offer those services for SUD,” Dr. Taveras says. “That’s critically important because the current approach is not reaching the populations that are dying.”

The vans incorporate care provided by Mass General Brigham Bridge clinics. “We have four regional Bridge clinics across the system, open to any person from the community,” says Dr. Wakeman. “We offer Bridge Clinic care, both on the vans and through outreach on the street and in the community.” The goal is to engage with patients and offer immediate access to treatment and support, connect them with the Bridge Clinics, and ultimately link to long-term care in the community. 

Bridge Clinic treatments include:

• Medication
• Individual counseling and psychotherapy
• Group therapy
• Recovery coaching
• Connecting to primary care if needed

“Addiction has touched most people in Massachusetts, whether through personal experience or that of a friend or family member. Many of our team members have been affected by this crisis, and are from Boston themselves or grew up in neighborhoods where we are now providing mobile care. They are already trusted ambassadors in their communities, and feel drawn to and are passionate about this work from their own relationships and life experiences,” Dr. Wakeman says. 

The future of the Community Care Vans 

More than 2 years after the program’s launch, mobile health offerings at Mass General Brigham continue to grow.

“We want to be data-driven and research-backed in everything that we launch. We are holding ourselves accountable to clinical outcomes and have very specific goals and metrics, and a clear focus that allows us to have a program that will result in measurable impact and improvement,” Dr. Taveras says.

Because of the high burden of heart disease and SUD, Dr. Taveras confirms that improving the services for those conditions remains the highest priority. But program leadership is eyeing other avenues for the future. “We’re thinking about other use cases for our mobile program. Maternal health being an example,” she says. “How can we improve maternal mortality and health equity?” The team is also considering adding cancer screening and prevention.

At its core, the program will continue to be collaborative and community-oriented. “I think of this early journey as one of learning, listening, and constantly iterating the design of our model. I hope it continues to grow, and that it becomes easier for people to access care in the moment that they are ready,” says Dr. Wakeman.