I spent a day with a health van providing care to low-income New Yorkers, and it reveals a hidden safety net for thousands in the world’s wealthiest city

Clarrie Feinstein/Business InsiderOfiong Okon gives Daniel Waits his physical exam inside one of the Community Healthcare Network’s vans.
  • About 700,000 people in New York City don’t have health insurance.
  • The Community Healthcare Network is working to ensure that people without insurance can receive basic healthcare services.
  • Founded in 1981, CHN has 14 federally qualified health centres in four boroughs and a fleet of vans that go to different neighbourhoods throughout the city almost every day of the week.
  • CHN says that it provides care for 85,000 New Yorkers annually and that 2,090 patients were seen in the vans over the past year.
  • Business Insider spent a day with one of the vans in Manhattan’s East Village to see how people without insurance get care in the wealthiest city in the world.
  • Visit Business Insider’s homepage for more stories.

New York City is the wealthiest city in the world. And yet more than half a million people in the city don’t have health insurance.

A healthcare network whose mission is to “turn no one away” is working to ensure that people without insurance or who are undocumented can get basic health services.

Founded in 1981, the Community Healthcare Network has 14 federally qualified health centres in four boroughs of New York City – Brooklyn, the Bronx, Queens, and Manhattan – that provide basic primary-care and sexual-health services.

It also has a fleet of four vans that go to different neighbourhoods throughout the city most days of the week. CHN says that it sees 85,000 New Yorkers annually and that 2,090 patients were seen in the vans over the past year.

Health vans can go to where the patients are

While the vans see only a fraction of the patients the health clinics see, a CHN representative told Business Insider that the vans “bring care to people where people are,” focusing on communities that have often gone without care.

The vans can bring care to areas that regular clinics don’t reach. CHN cited recent examples of vans being sent to provide vaccines during the recent measles outbreak, going to hard-hit communities after Superstorm Sandy, and providing after-hours care at clubs and bars.

CEO Robert Hayes told Business Insider that the vans usually go to areas with more acute needs based on New York City health data. He also said that CHN works with other community centres and organisations in the city to coordinate scheduling and notify residents when a van will be in their neighbourhood.

“The reality is we turn no one away. We accept any insurance,” Hayes told Business Insider. “Under federal law, we are required to have a sliding fee scale based on their income. But we don’t want that sliding fee to be a deterrent to people needing care. No matter what, they will receive treatment.”

The vans are a sharp reminder of the inequality that persists in New York City. There were about 8,980 ultra-rich people living in New York in 2018, the most of any city in the world, Wealth-X said in its 2019 World Ultra Wealth Report. The group defines the ultra-wealthy as having a net worth of at least $US30 million.

Business Insider spent the day with one of the vans at 14th Street and Second Avenue to take a closer look at how underserved populations get care in one of the world’s wealthiest cities.

Every Tuesday, a CHN van parks close to the intersection of 14th Street and Second Avenue. Vans are stationed at different intersections in the city most days of the week.

Clarrie Feinstein/Business InsiderA CHN van is at 14th Street and Second Avenue every Tuesday from 1 to 9 p.m.

In this location, there are high rates of HIV-related cases, representatives for CHN told Business Insider.

Since CHN has been around for over three decades, most people know when the vans will show up from the schedule or by word of mouth. If patients like the service, they might bring their family, friends, or partners as well.

Dr. Freddy Molano, the vice president of infectious diseases and LGBTQ programs and services at CHN, has been working at the organisation since it began. He witnessed the implementation of the mobile health clinics when the idea wasn’t “fashionable,” he told Business Insider.

Clarrie Feinstein/Business InsiderDr. Freddy Molano, CHN’s vice president of infectious diseases and LGBTQ services.

The first van was in the Lower East Side, where CHN provided basic medical care to the homeless population. Molano said that by having a van come to the communities on a weekly or twice-weekly basis, the organisation ensured that people who might not otherwise receive medical care could get access to these services.

“What might be obstacles at other clinics, here, are not. We see you regardless of income,” Molano said. “We see many people who have never even seen providers.”

Inside the van, Nehemias Grullon, a community educator, looks at patient records and talks to incoming patients about insurance options. He collects pay stubs and general income information to help patients figure out their insurance options.

Clarrie Feinstein/Business InsiderNehemias Grullon, a CHN community educator, in the van.

On average, the vans, which mainly offer primary-care and sexual-health services, see 15 to 20 patients a day, with some seeing as many as 25. People can come to the van with an appointment or walk in.

Clarrie Feinstein/Business Insider.A chair in one of the two exam rooms in the health van.

Ofiong Okon, a nurse practitioner and CHN’s medical director of mobile van health centres, began working at CHN five years ago, becoming a medical director one year after joining the organisation.

Clarrie Feinstein/Business Insider.Ofiong Okon is CHN’s medical director of mobile van health services.

“When I think of mobile care, it really is the essence of community health,” Okon told Business Insider. “It makes sense to go where the community needs you. It’s an evolving model of what primary care traditionally looks like.”

Daniel Waits, who’s uninsured, said he’s visited the health van four times since July. Waits told Business Insider he found the clinic from a simple Google search and made an appointment the same day.

Clarrie Feinstein/Business InsiderDaniel Waits gets his physical exam in a CHN van.

Waits said he likes that there isn’t usually a long wait time, unlike at other health clinics.

“It’s really quick, which is great. I’m usually not here for longer than an hour,” Waits said. “The services they provide are limited, but what they can provide for sexual health and basic care is very comprehensive.”

Waits said he doesn’t notice that he’s in a van when he goes for his appointments.”It just feels like a room, like any other clinic,” he said. “You don’t notice you’re in a van until you go outside.”

Clarrie Feinstein/Business InsiderOkon with Waits.

During this visit, Waits had to show paperwork with his income to see what insurance he qualified for. But Waits said he doesn’t see the point in getting insurance.

“I’m in a weird bracket where I don’t make a ton of money but I’m not super poor – I’m in this mid-range,” he said. “To pay a monthly premium and high deductibles doesn’t make sense to me. I’d rather just pay the fee when I use the emergency room, which is rare. It actually ends up costing less.”

Okon often also provides a sexual-health consultation to patients, discussing treatments like PrEP, a medication taken to prevent people from getting HIV.

Clarrie Feinstein/ Business InsiderOkon finishes Waits’ physical exam.

Okon said CHN provides a lot of sexual-health education and care with PrEP.

“This is an open environment, and we want people to feel comfortable and feel like this is their community,” she said.

Okon has some recurring patients and has become a personal care provider for some patients over the years. She is in the mobile van two to three days a week and works at a CHN clinic in the South Bronx.

After each visit, Okon washes her hands and prepares to see her next patient.

Clarrie Feinstein/Business InsiderOkon washes her hands before seeing a patient.

Healthcare providers in the van can also take blood for disease screenings and other tests. CHN says the 14th Street van location averages about 900 unique patient visits annually.

Clarrie Feinstein/ Business Insider.A work station in the CHN van.

The focus for CHN is preventive care, or keeping patients healthy.

Clarrie Feinstein/Business InsiderGrullon and Harvey Diaz, a program manager at CHN, in the hallway connecting the two exam rooms.

“I have been here for 30 years, and I’ve stayed because CHN is committed to serving those most in need,” Molano said. “Right now, in this political environment, more than ever, we need to be serving these communities.”

Moving forward, CHN is working to add more behavioural-health services to its health centres and vans, CEO Robert Hayes said.

Clarrie Feinstein/Business InsiderA CHN health van.

“It’s really important for us to start building on integrated care and to connect behavioural-health agencies to healthcare services and vice versa,” Hayes said.

Molano said CHN is also working on an emergency case fund to provide people with basic social services like housing, food, and substance-abuse treatment.

“We want to have that holistic approach and cover the social determinants of health,” he said.

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