Bon Secours Health System's Care-A-Van, a 38-foot long mobile clinic, provides no-cost treatment to thousands of patients a year in Virginia who might not otherwise receive basic medical care.

Bon Secours sees the Care-A-Van as an embodiment of its mission. System spokesperson Emma Swann told the Chesterfield Observer, "As a faith-based, non-profit health system, we believe health care is a basic human right. Bon Secours is proud to operate the Care-A-Van and bring free care to those who would not otherwise have access to health care services."

By providing primary care services to under- and uninsured populations, the van also helps to treat medical problems before they lead to avoidable ED use.

How the Care-A-Van works

The Care-A-Van operates six days a week at 21 different locations in the Richmond, Virginia area. The van is staffed by a multidisciplinary team of physicians, advanced practitioners, nurses, nutritionists, pharmacists and medical assistants, along with a practice administrator, registrar, interpreter, licensed clinical social worker, and community outreach specialist.

Patients are treated for a number of conditions, including:

• Chronic conditions such as diabetes and hypertension;
• Gastritis;
• Headaches;
• Minor musculoskeletal pains;
• Minor skin rashes; and
• Urinary tract infections.

The mobile clinic also provides sports physicals, health education services, and enrollment in children's health insurance and Medicaid. "Anything you would go to a regular physician for, we can take care of in the van," said Melissa Gornitzka, the Care-A-Van's operations manager. Staff refer patients to other providers for more specialized care.

The Care-A-Van also has a pharmacy assistance program that provides qualified patients with no-cost medications. Bon Secours is applying for pharmacy distribution license for the van so staff can write prescriptions and provide medications rather than waiting to receive drugs from pharmacies.

Download our 2-page overview of Bon Secours' Care-A-Van

Challenges and successes

The Care-A-Van team has a low turnover rate, which staff in an interview with Advisory Board's Health Disparities Initiative attributed in part to seeking out job candidates who are committed to the clinic's mission of serving those in low-resource settings. The team is also well-prepared to deliver culturally competent care: Staff receive regular training on topics such as unconscious bias, and at least one-third of each van team is fluent in Spanish and English.

Staff pointed to high demand for the mobile clinic as both an indication of success and a major challenge. According to the Care-A-Van team, the mobile clinic is constantly at full capacity. In fact, it's common for patients to show up and stand in line for hours before the mobile clinic actually arrives, all despite the fact that the Care-A-Van does very little advertising. "This is one of our busiest clinics," said Julie Bondy, the practice administrator for both the Care-A-Van and St. Joseph's Outreach Clinic. "We have more demands than we can usually accommodate."

Gornitzka said that the clinic is receiving a new $400,000 van that will be 40-feet long and will be able to have more refrigerator space to store patient immunizations for flu season.

Other challenges cited by the team include the mobile clinic's lack of private space for patient interactions and the costs of Care-A-Van's vehicle maintenance, Wi-Fi, and medical supplies.

However, mobile clinics tend to deliver return-on-investment to health systems: Nationally, while the average operation cost of a mobile clinic is $429,000 a year, the average return is $12 for every $1 spent as the result of reducing unnecessary utilization of high-cost care in settings such as the ED.

For Bon Secours, it also goes back to the system's mission. Lynne Zultanky, the Hampton Roads administrative director for Bon Secours, said the health system is "committed to the health of our community." She added, "We believe that primary care is the base of that pyramid. We want to make sure patients are getting the care that’s necessary to improve their health and keep their health" (Bon Secours website, accessed 12/28; Perry, Suffolk News Herald, 5/5; Gray, WAVY, 8/22/16; Griset, Chesterfield Observer, 8/31/16).

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