By Will Atwater
Rural residents often face significant barriers to accessing health care. Power outages, challenging travel and extreme weather events — such as hurricanes, heat waves and floods — only worsen the challenges posed by limited access to clinics and medical specialists.
This scenario recently played out in western North Carolina, where Hurricane Helene left many rural health care facilities inoperable. In response, the state deployed some mobile medical units to deliver care directly to affected communities.
But ahead of future disasters, more help may be on the way.
Mission Mobile Medical Group, based in Greensboro, announced in February that it was awarded up to $26 million in federal dollars “to develop the next-generation mobile clinic under the Platform Accelerating Rural Access to Distributed and Integrated Medical Care (PARADIGM) program,” according to a news release.
The mobile health care company will use the funding to design and build mobile “medical suites” — self-contained clinical units tailored for rural health systems. The goal: deliver hospital-level care and advanced diagnostics to communities across the country, according to the release.
“Only 12 percent of physicians practice in rural communities,” said Travis LeFever, chief executive officer of Mission Mobile Group. “With such limited access to medical care and emergency services, rural families — especially children — face barriers to care that should make us all question our priorities, political policies, and our public and personal principles.”
Mobile clinics could help eliminate the need for long-distance travel, particularly for residents of remote areas where building a permanent facility isn’t feasible. They also offer vital access for hard-to-reach populations, such as migrant workers or fishing communities.
The $26 million initiative is funded through the Biden-era Advanced Research Projects Agency for Health (ARPA-H). Although the Trump administration has canceled or frozen billions of dollars in other federal programs, the funding awarded to Mission Mobile has not, so far, been affected, according to LeFever.
Delivering assistance
While mobile clinics aren’t new, they’re becoming an increasingly vital part of the health care system — especially in rural “health care deserts” and in the wake of natural disasters, when traditional brick-and-mortar facilities may be inaccessible.
But even in calmer times, staffing rural clinics can pose a major challenge.
“In rural settings, typically, you don’t have as many providers [and] specialist positions,” said Lyn Jenkins, the executive director of the Community Care Clinic of Dare in Nags Head on North Carolina’s Outer Banks. “Three of the counties in eastern North Carolina don’t even have a practicing dentist.”
This shortage often forces patients to travel outside their communities to find treatment — an obstacle that can be costly and time-consuming.
“We see a lot of transportation barriers within the Outer Banks area,” Jenkins said. “But also [barriers] to get to other hubs like Virginia or Greenville or Elizabeth City, for specialists that we don’t have down here … We just can’t support all the specialists in this small rural area.”
North Carolina has 96 rural health clinics, according to James Werner, a spokesperson for the state Department of Health and Human Services. As of 2020, more than 3 million residents — about 33 percent of the state’s population — live in rural communities, according to the Office of State Budget and Management, and North Carolina is second only to Texas for the size of the rural population.
Nationally, more than 60 million Americans live in rural areas where access to rural hospitals is shrinking. Between 2013 and 2020, 4 percent of rural hospitals closed, according to the U.S. Government Accountability Office. Those closures have forced patients to travel, on average, 20 more miles for regular care and 40 more miles for specialty care.
Advanced technology
The new mobile clinics will be powered by MARCUS — short for Mobile Access to Revolutionary Care Connecting US — Mission Mobile’s customizable system that allows clinics to be outfitted with medical equipment tailored to the specific needs of each community.
“[PARADIGM’s mission] is to develop the next generation of mobile clinics across several teams,” said Emily D’Agostino, a Duke University School of Medicine associate professor and project research team lead. “Several teams were awarded funding to work together to try to revolutionize how care and access to care work, particularly in rural settings.”
D’Agostino noted that rural residents are more likely to be underinsured or uninsured and often face multiple chronic conditions — increasing their risk of adverse health outcomes.
“You have higher heart disease, higher cancer, higher lung disease, higher stroke and trauma,” D’Agostino said. “It’s not just that there aren’t providers, transportation is a major barrier in access to care.”
Bridging gaps in coverage
Jenkins, from the Outer Banks, sees opportunities for rural clinics to share the mobile resource.
“On specific days we could use the van [to go] to areas that are hard to reach or [where] there are a lot of people working as day laborers who can’t leave to come into the free clinics,” she said.
Werner agrees that mobile medical units can increase access to health care for rural residents.
“We believe this is an excellent way to meet patients where they are and to address transportation barriers faced by residents who do not live close to a provider,” NC DHHS spokesperson Werner said. “While our support of mobile medical units has primarily focused on primary medical and dental care, we certainly see the potential in Mission Mobile’s approach to create more specialized services — should they be needed — through adaptable spaces.”
Still, some rural health advocates are taking a more cautious, wait-and-see approach to Mission Mobile’s plans.
“The bottom line is, if they are successful at expanding access to care in rural areas — overall, I think that that’s a good thing,” said Nathan Baugh, executive director of the National Association of Rural Health Clinics. “But, I’ve seen initiatives like this come and go [during] my time.”
While it’s not clear how much the mobile medical units will cost, Mission Mobile provides information on its website about applying for grant funding.
The ARPA-H program will support a shared-service model, allowing rural hospitals and other entities to access mobile medical equipment without having to purchase it outright, LeFever said in a text message.
According to the company’s website, the first modular units are expected by mid-2025, with a full national rollout anticipated by 2027.
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