Compared to the fall of 2013 — less than a year after Governor Brian Sandoval became the first Republican U.S. governor to announce that his state would expand Medicaid in line with the Affordable Care Act — a quarter-million more Nevadans are now covered by the federally subsidized health insurance plan for low-income people. But the number of clinics in greater Las Vegas, the state’s population center, hasn’t kept pace.
At the same time, the ACA prioritizes preventive care, requiring insurers to cover services such as immunizations and mammograms. The thinking (backed up by extensive research) is that heading off illness before it sets in will ultimately save everyone involved lots of money.
So, for the plan to work, more people have to be insured and go to the doctor for check-ups — but there aren’t enough places for them to go in Nevada. What to do?
“Obviously, there are long-term things that we're working on in our community, such as the (UNLV) medical school, to try and change the trajectory and try to improve access to care,” says Don Giancursio, CEO of United Health Care. “That's going to take time. But in the short term, this is designed to get out into the community and get to people who otherwise can't get into clinics.”
“This” is Medicine on the Move, a 45-foot-long semitrailer custom-outfitted as a mobile doctor’s office by Health Plan of Nevada, United Health Care’s low-cost coverage provider, and physicians’ group Southwest Medical Associates. The truck, which started making its rounds the first week of May, was parked outside City Hall on Tuesday, August 8, so officials could take a tour and employees with one of United Health Care’s insurance plans could see the doctor.
The trailer takes about an hour to set up, expanding from 12 to 16 feet wide with a bump-out that serves as the lobby. Somewhat rickety metal stairs lead up to a camper-style door, but once inside a patient would hardly know he’s not in a stationary, brick-and-mortar medical clinic. The trailer holds an intake office, waiting area, bathroom, two exam rooms and a radiology space with a digital mammography machine and portable X-ray. Patients can get pediatric and adult primary-care services, such as blood tests, immunizations and sports physicals, from the clinic’s physician, two nurses, two medical assistants and radiology technician.
“There are other mobile medical clinics in the country,” Giancursio says, “but there’s none that we’re aware of with the full suite of services that we built into this one. And there’s no other one in the state of Nevada.”
The mobile clinic recently returned from a trip north, where it received patients in Hawthorne and Yerrington, Nevada. Its focus, though, will be on Southern Nevada, where the bulk of patients with United Health Care plans are located. The August 8 visit to City Hall coincided with Las Vegas’ announcement that it had signed an agreement with the clinic’s owners to park it at four recreation centers in neighborhoods with large Medicaid populations. The agreement is supposed to make sure that the centers keep schedules and space clear for the clinic on a regular basis, and provide for necessary permitting. It’s meant to help people with practical barriers to health-care access, such lack of a babysitter or car, by taking the care to them.
The clinic also visits other community centers, churches and homeless shelters in so-called health-care deserts, as well as businesses whose employees are enrolled in UHC plans. People can make appointments on the clinic’s website or simply walk up when it’s in their area.
“This is feasible because our organization is focused on population health management,” Giancursio says of the expensive truck (“in excess of seven figures” is as precise a cost as he’ll give), many of whose services will be subject to the notoriously low reimbursement rates of Medicaid and Medicare. “Because we serve such a broad continuum of members — collectively more than a half-million in Southern Nevada — this was an investment in delivering medical infrastructure to the community.”
