Appalachian Regional Healthcare (ARH) Mobile Clinic: Q&A With ARH Chief of Staff, Rocky Massey

Healthcare access can be challenging for rural Americans as many brick and mortar hospitals and clinics are closing. To highlight the experience of mobile healthcare efforts tackling these challenges, we spoke with Appalachian Regional Healthcare (ARH) Chief of Staff, Rocky Massey about ARH’s mobile clinic and mobile healthcare outlook. 

The ARH mobile clinic was established in 2022 and provides health screenings, primary care, and chronic disease management to underserved areas, and also emergency response. Rocky Massey serves as ARH’s Chief of Staff for the ARH system covering West Virginia and Kentucky. With more than 40 years at ARH, Massey previously served as Interim CEO for the Paintsville ARH Hospital and for 19 years was the CEO at the Beckley ARH Hospital in Beckley, W.Va. He has also led ARH’s West Virginia external and governmental affairs and physician recruitment efforts.

We asked Rocky a few questions about ARH’s mobile clinic, and mobile healthcare more broadly. Here’s what he shared with us.

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1. Why was launching the ARH mobile clinic such an important priority?

Massey: Back in July of 2022, we were really faced with some devastating and catastrophic flooding in eastern Kentucky. At that time, we were very fortunate to be able to partner with Marshall University to get some support from their mobile health clinic. When we learned about it, we thought it was a great way to take care of people where they needed it most–right at home.

Since then, that unit has been traversing around the region, assisting through other natural disasters. And these disasters seem to be happening annually. You couple that with the challenges to delivering rural healthcare and it just made sense to us that a mobile care strategy would really be a great approach going forward and consistent with ARH’s mission for healthcare delivery in rural Appalachia. It’s about bringing the ability to care for people outside hospital or clinic walls and into the communities–offering new access to those who might have difficulties. It’s about addressing access barriers to rural healthcare and primary care services and prevention and wellness.

2. What are the gaps in care that the mobile clinic helps to fill in central Appalachia (Eastern Kentucky and Southern West Virginia)?

Massey: A big one is transportation barriers for rural people–rural health access, and we’ve been using our mobile clinic to attempt to fill that gap.

But we also have people in Appalachia who are committed to their careers, their trades and their families–they can’t miss work time. So, we’ve seen, in central Appalachia, people will seek healthcare when they're having a baby, or when they have a terminal condition or life-threatening event. But, not so much on the primary care prevention, wellness screening side.

So, our goal is to gain their trust and to give them the opportunity to access primary care. And that's a big deal in Appalachia, bringing care into the community. Hopefully, we will help normalize this kind of care. Annual screenings and prevention are really powerful over the long term for costs and health outcomes. People can get this care from a mobile unit whether it's at a community event or a workforce development initiative or because it's simply convenient and it’s there. It meets their lifestyles.

We find these needs through our partnerships, which have so many different forms, whether it's state agencies, or local community colleges, or the local chambers of commerce. It can even be a grocery store. It’s wherever we can reach out and establish our presence. We make the ARH brand well known and hear from our partners what they need. Do you need A1C testing for diabetes? Have you just experienced some type of disaster where you need a tetanus clinic? We want to be part of their 911 call when they have a need for screening and prevention during immediate disaster relief. We’re even working in one county in Kentucky where there's a healthcare desert and we're now going to be offering women's services through the mobile clinic.

3. What are the biggest barriers to scaling mobile healthcare at this time?

Massey: There's really a number of these for us. First is staffing. That's not unique to ARH–I don't think it's any secret that staffing healthcare services is a problem nationwide. The staff who work on this mobile clinic really have to be the right people to provide the best patient experience. But, it's a new patient experience, and for new hires it’s a very different work experience for them.

Another barrier is capacity to meet demand. We rolled out this mobile clinic at a ribbon cutting with the governor in the summer, and as soon as we looked up the clinic was booked out to October. Demand from our local partners really outweighs our capacity–we could probably have two or three of these units rolling around Appalachia right now.

Funding is another issue. We have to be creative. We have to present our case–that this works and that we need to expand on it. We’re serving communities where there are low incomes, food insecurity, comorbidities, low life expectancy, and a percentage of children in poverty. But all these barriers are things we can overcome with our persistence and our consistency and our availability.

4. How does an initiative like Driving Health Forward help address these barriers?

Massey: The way I see it, Driving Health Forward as a campaign really is providing learning opportunities for us. To hear from efforts like ours, and from leaders, providers, and others helps  accelerate learning. It increases exposure to implementation methodologies and creates a sense of community around mobile healthcare. Driving Health Forward for us really shines a light on ways to use and track and scale mobile healthcare that we can use to align outcomes to rural environments. And it gathers partners who can collectively advocate for and support strategies to build on successes. So, it's truly a strategic approach to key partnerships.

5. What does success look like for your mobile clinic in the short and long term?

Massey: One example is from when we had the tornadoes in May this year that rolled through London, Kentucky. We were one of the first organizations, on the ground there providing important preventive services like hundreds of doses of tetanus shots to folks who had been injured.

Another time in Beckley, West Virginia, we rolled up to one of their fire departments and did a healthcare screening event to complement that city's benefits program. We made it easy for their workforce to meet screening requirements for benefits–like blood work, and some ultrasound screenings. We contributed to keeping that very important workforce–police, fire, city employees–healthy.

Also, a month ago we were at the Kentucky State Fair and did A1C testing lots of the fairgoers. In one case, we detected juvenile diabetes in a family that had only a very distant family history of type 1 diabetes. We truly can make a difference.

In the short term, success for ARH will be continuing to operationalize the unit and building and managing a schedule that meets needs both on the prevention side and the primary care side. It’s about scheduled appointments, but it’s also about being available for health and wellness and screenings. And then, if there's a disaster somewhere, we need to be on the road for that.

Over the longer term it's working with partners, such as the ones we have in the Arise Grant, or with other regional employers. That can really be a huge opportunity and allow us to have further reach and improve outcomes. We also will have some exciting news coming out as we're working on a new strategy that will allow us to expand mobile services, on the diagnostic side of things and bringing a whole different scope of health and prevention, into the mobile health arena.

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