The Future of Community Health is Mobile: A Q&A With Dr. Arturo Brito, President & CEO of Children’s Health Fund

Across the country, children and families face barriers to basic preventive and primary care, compounded by severe provider shortages and a youth mental health crisis that has been escalating for over a decade. For families in need in both rural and urban communities, the widening gap in healthcare disparities means countless children struggle to access the care they need. To help ensure healthcare access for every child, bringing comprehensive, integrated care directly into their neighborhoods via mobile healthcare is no longer just a temporary measure—it is the future of community health.

To learn what this means for communities and healthcare systems, we spoke with pediatrician and president and CEO of Children’s Health Fund, Dr. Arturo Brito.

Dr. Brito has extensive experience in community health for children, starting with the Indian Health Service in rural Alaska and later running a mobile clinic program in South Florida that started after Hurricane Andrew. He also brings a deep understanding of population health and systems reform, having driven major systemic change as a state public health deputy commissioner and foundation director. Today, he leads Children’s Health Fund, a group that has been using mobile clinics as true "medical homes" for kids since 1987.

In this Q&A, Dr. Brito explains how mobile clinics build strong trust by being open with patients and hiring local community health workers. He also breaks down the actual costs of this care, showing how mobile clinics can be more affordable and effective than traditional offices. And, he shares how technology like Electronic Health Records (EHRs) and telehealth help these programs be sustainable, and exactly what lawmakers need to do to bring mobile care to places that need it most. Here is what he had to say.

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Dr. Arturo Brito vaccinates a child at a mobile clinic

What brought you to the field of mobile healthcare?

I was moving back to Miami after having worked in rural Alaska with the Indian Health Service. In Alaska, everybody technically had insurance, but because of the extreme remoteness, actual access to healthcare was incredibly challenging. In 1994, I noticed a job listing for a medical director of the South Florida Children's Health Project. This intrigued me because of their focus on access to healthcare post Hurricane Andrew. Beyond the recovery work they were doing with the mobile clinic, they noticed a widening gap in healthcare disparities. The further removed people were from downtown or the medical center in Miami, the less likely they were to have access to quality healthcare. We also saw working families who had been in the country for generations suddenly lose their Medicaid for six months or a year with nowhere to go. I interviewed for the position and fell in love with the idea of bringing healthcare directly into communities. After my experience in very rural parts of Alaska, I couldn't look at healthcare the same anymore, and I thought mobile clinics fit the bill.

As a pediatrician and national leader of a major children’s health advocacy organization, why do you think mobile healthcare is important to the future of community health and for ensuring access to primary and preventive care for children?

Mobile healthcare is the future and it's now.

Since 1987, Children's Health Fund has been pioneering mobile clinics in the way we use them as true medical homes and provide comprehensive care that's integrated. We offer medical and mental healthcare, for instance, with social service, connecting individuals, children and families to subspecialty care. We focus on displaced or marginalized populations, hard to reach populations, from urban to rural.

However, when you think about it, bringing healthcare directly into communities is really something we could all benefit from, because it really is making it easier for individuals to access that care. And there's something about it that is kind of like the home versus visiting team in sports, right? The home team, in this case, is the patient, and puts them in a position that makes them feel more comfortable.

Going into the community [as a pediatrician], you really get a better grasp of some of their specific challenges. Every community has their challenges, but particularly the under-resourced ones, and you better understand why patients might get sick, or how to prevent the problems from occurring in the first place.

Looking into the future, there's a resurgence in requests to our organization for helping develop mobile clinic programs because of what's going on around the country. Rural hospital closures are one issue. There are also increasing issues around youth mental health that have been escalating for more than a decade. There aren’t enough providers to help people with their daily challenges. Being forced to travel 45 minutes for a 15-minute appointment is a burden, particularly for people that are struggling with making ends meet. Mobile healthcare will continue to alleviate that.

How can mobile healthcare engender trust and loyalty within the community?

There's a certain level of intimacy that mobile clinics offer. When you're in a mobile clinic, patients can see everything. There's something about that transparency that makes it more likely to develop a healthy relationship with the patient and family and the community at large.

I would also say that we learn more from challenges than easy wins. We have to work to develop a trusting relationship with the community first. We struggled initially with the Haitian American community, for instance. I spoke a little bit of Creole, but we didn't have anybody with that cultural background. And then we hired a [Haitian-American] individual as a community health worker to really build that trust.

Whether in a fixed or mobile clinic, we have to work to overcome trust barriers. I think there may be more mistrust of healthcare in a community that has been marginalized. Our mobile clinic helped us overcome those barriers because we were actually going to them, as opposed to the patients coming to a healthcare center downtown.

I think it's the transparency combined with the fact that we’re bringing healthcare directly into the community that makes a difference.

You’ve noted the importance of data to inform decision-making and drive change. What sort of data do you think could move the needle for the mobile healthcare sector?

There are often a lot of questions about costs. We did an analysis when I was in South Florida on the economics of mobile care, and what we found is that the care we provided was, dollar for dollar, superior and less expensive than a fixed-site clinic because it was naturally integrated. I'd be working side by side with a psychologist, a social worker, sometimes a nutritionist, for instance. This helped tear down the myth that physical and mental healthcare and social services are all different things. I think the challenge we have with fixed site clinics is that you have all these divided rooms and care is provided in so many ways. I know a lot of fixed site clinics try to integrate it, and there's been some success with that. However, in a mobile clinic, you don't have to force it. It just becomes integrated almost organically. But beyond just operational costs, it's about the ROI of prevention. For example, studies show every dollar spent on a vaccine saves $7 to $14 down the road. Or think about our adolescent mobile programs that work with homeless or foster youth—how do you put a price tag on spending the time needed to prevent a teen suicide or an unintended pregnancy? That is the real value we bring directly into these communities.

We also look at the numbers of kids that are seen. Last year, there were more than 133,000 children seen through our national network, through nearly 500,000 visits, meaning approximately 3-5 child visits per year, per child. They're coming back. And that, to me, is really important. That ratio of 3-5 visits is comparable to what you would expect in a typical pediatrician's office.

In my experience, patients are far more likely to keep their appointments in a mobile environment. When fixed-site medical centers are hard to reach, people frequently miss specialist appointments. To help with this in our South Florida program, we had a dermatologist ride along once a quarter because most patients struggled to make the 45-minute drive to the main facility. We regularly scheduled 30 to 40 patients per day for the dermatologist. Over six quarters—a year and a half—we had only one missed appointment.

How has the implementation of Electronic Health Records (EHRs) transitioned mobile health from a temporary 'charity' model to a financially sustainable one, particularly in securing consistent Medicaid and insurance reimbursements?

Number one, EHRs really helped amass data in a way that you wouldn't have if you had to do it by hand given time constraints. That data makes it possible to get reimbursed for those visits. It becomes near real-time billing. Also, use of EHRs means we can take up less space on the mobile clinics [because of reduced paper charts].

Children’s Health Fund was at the forefront of developing EHRs because of the need to free up space. We developed our first version in 1989!

It's really helped mobile clinic programs in our national network assemble data in a way that makes a convincing argument for billing that is aligned with what the requirements are in that state for getting reimbursed.

Looking at tech more broadly, how else can technology integration enhance quality of care?

The Innovation Lab at Children’s Health Fund is developing data-driven, user-friendly apps. We started with an asthma app last year that puts the control of a child's condition directly in parents’ hands. The app was developed from educational materials that are rigorously science-based, specifically the National Heart, Lung, and Blood Institute (NHLBI) guidelines. Those guidelines are life-saving, but they can be so cumbersome that less than 40% of pediatricians actually follow them in traditional practice. By turning them into a user-friendly app, we are using tech to ensure patients receive gold-standard care, and we’re continually evaluating how the tool is being used.

We also use telehealth on mobile clinics, and we're going to end up using it more. We're looking for funding for this because we're finding that because of the ICE raids that have occurred over the last year and a half, a lot of families, not just immigrant families, are now even fearful of taking their children to any healthcare facility, even a mobile clinic. Black and brown families are particularly fearful. That creates more of a demand for telehealth.

Technology can also help with access issues. Maybe the parent needs to stay home because of other children at home, or a child that's bedridden, on a ventilator, or intubated at home, for example. So, technology like telehealth makes things easier for them.

What action do you want to see from policymakers to scale mobile healthcare, and why does it help the big picture for mobile healthcare?

I think policymakers should be encouraging the use of mobile healthcare in rural and urban areas – any healthcare desert.

They should demand integrated programs like integrative mental health and should also fund evaluation, focusing on cost analysis, and help determine what issues mobile clinics are resolving, like transportation barriers, and maybe provide additional support for services our clinics can’t do as readily.

On the provider side, it's our responsibility to make sure that the quality is there, that we're collecting the right information, that we are not only skilled, but also approach patients in a non-judgmental manner. I focus on that because of the type of patient populations that we have, and part of that integrated system includes the use of community health workers. I don't think there's been a better time to incorporate community health workers than now as we see a resurgence of the need for and expansion of mobile clinics. They're the best to really understand those communities and make the connection with the providers.

What role could mobile healthcare play over the next five years as individual states implement their Rural Health Transformation Program initiatives?

Mobile healthcare should be filling the gap where healthcare centers are shutting down or overburdened. Dental care is especially important. One Idaho mobile clinic program uses their clinic in a very unique way. They provide comprehensive dental care, but they also visit different communities in a vast rural area to determine if, when, and where they should build the next brick-and-mortar clinic. It’s a great model because it ensures states aren't building a permanent facility only to have an empty building sitting there with money wasted.

Federal and state governments should be looking for solutions to lower healthcare costs by focusing on prevention on the medical and dental side. This includes the resurgence of vaccine-preventable diseases, particularly in an area like South Carolina, which is struggling with an outbreak of measles.

You’ve been an active participant in Driving Health Forward. How do you think participants can continue to work together to grow their businesses and the sector?

There are so many smart people in our workgroups; I’ve learned so much from them. I think we should continue to get diverse groups to understand different aspects of mobile healthcare, including not just the actual practice of medicine but also the administrative, funding and reimbursement sides, and advocacy. We need to continue to understand the challenges and work together on this cause.

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