Taking Healthcare by Storm: Industry Insights with Brooke Parker

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Brooke Parker, the Community Linkage to Care Program Coordinator of the CAMC Ryan White Program.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website: https://www.qualityinsights.org/qin/taking-healthcare-by-storm

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-PCH-102523-GK-B

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion and care.
 
 In each episode, Quality Insights Medical Director, Dr.
 
 Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists and brave patients navigating their own healthcare journeys.
 
 Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.
 
 Subscribe now, and together we can take healthcare by storm.
 
 Okay, welcome everyone to Taking Healthcare by Storm.
 
 I am Dr.
 
 Jean Storm, Medical Director of Quality Insights.
 
 And today I am so excited to be speaking with Brooke Parker from CAMC Ryan White.
 
 And I'm going to give her a chance to tell all of you about what she does, because in our initial discussion, I just could feel the passion just coming through the computer.
 
 So I am so excited to have her tell all of you what she does.
 
 So welcome Brooke, and tell us about yourself.
 
 So I'm native West Virginia, and I grew up in the Eastern Panhandle.
 
 Some people would argue that's not West Virginia, but I argue that it is.
 
 I went to Shepherd for my undergrad, and I'm a social worker.
 
 I'm a person in long-term recovery.
 
 I'm a harm reductionist.
 
 I live with my partner.
 
 We have 1,000 cats.
 
 I love being in the woods and exploring all the nooks and crannies of West Virginia.
 
 So how did you become involved in Ryan White Program?
 
 So I worked with Ryan White in the community during the pandemic.
 
 I was a social worker at a soup kitchen here in town, and Ryan White Program was coming and providing rapid HIV testing and hep C testing for folks coming in for meals.
 
 And so then I convinced them to come out with us another group that I volunteer with, and they started providing again rapid testing for HIV and hepatitis C alongside us doing some street outreach work for people who use drugs.
 
 We were doing some harm reduction outreach work, and so I got to know all the staff that way.
 
 And then I ended up getting hired around white towards the end of 2020 to help build out our response to the HIV outbreak that we were starting to see here in Canal County and support clinic expansion into the community.
 
 It's coming from a harm reduction background, and that's really what we needed, so it was a really good fit.
 
 I have to say, I hear you're volunteering a lot in West Virginia, and I just have to say, I really feel that the volunteers in West Virginia really make things run like you are all the backbone of this state.
 
 You are absolutely right about that.
 
 I had worked in Virginia for a number of years when I lived back home, and I thought that it was the same there.
 
 It would just be like the same kind of community and the same sense of collaboration there, and it was definitely not.
 
 And when it drove me, I never thought I would want to come back to West Virginia when I left.
 
 And as soon as I left, just to, I've always lived in the state, but when I started working in Virginia, I was like, oh my goodness, I've got to find a way to get back.
 
 Because we're a pretty unique state, and we've got some pretty incredible people.
 
 So tell us about the Ryan White Program for people who are unfamiliar.
 
 So Ryan White is federally funded in all 50 states of the country, provides funding for comprehensive, it's a comprehensive system of care, including HIV primary care, essential support services, medications for people living with HIV who are uninsured or underinsured.
 
 So as a payer of last resort, federally Ryan White works with cities and states and community based organizations to provide HIV care and treatment services to more than a half a million people each year across the country.
 
 The main goals of the program are to provide care and treatment services and improve health outcomes and reduce HIV transmission.
 
 So probably what a lot of people don't think about is who is, who was Ryan White?
 
 So that's a great question.
 
 We get asked that a lot.
 
 It's not, it's not the most relevant story anymore, but it's super important.
 
 So I'm glad you asked it.
 
 Ryan White was this incredible teenager from Indiana who was one of the first children diagnosed with AIDS.
 
 He was a hemophiliac and he contracted HIV from a blood transfusion in 1984.
 
 And so HIV and AIDS was really poorly understood at the time.
 
 And with the lack of education available in the community, he and his family endured a great deal of discrimination and criticism and threats and opposition, really stemming from stigma and fear and just ignorance about it.
 
 So he and his parents fought numerous times in court while he was sick for him to be allowed to just attend public school and engage in like very normal teenage things.
 
 But the belief at the time is that HIV and AIDS was spread through very casual contact.
 
 Like back then, 1983, the AMA believed this.
 
 That's what they have a whole paper published on how HIV is spread through casual contact.
 
 So it's come a long way, but he's a lot of the reason for why it's come this far.
 
 He and his family fought fearlessly for AIDS education and access to treatment, and his visibility really helped change the public perception of the disease.
 
 So we really honor Ryan White just for it.
 
 It's incredible work that he did while he was sick and then what his family carried on after he died.
 
 Yeah, huge impact.
 
 So when was the program started?
 
 It started, he died in 1990, and I think it was four months after he died, Congress enacted the Ryan White Care Act, in his honor, and the CARE stands for Comprehensive AIDS Resource Emergency.
 
 It's the largest federally funded program for people living with HIV and AIDS, and it's the pair of last resort program that we know today as Ryan White Program.
 
 Wonderful.
 
 I mean, that is a big change in a short period of time, really.
 
 Yeah.
 
 Huge change.
 
 So where are the locations of the program in West Virginia?
 
 So in West Virginia, Ryan White serves over 1300 people throughout the state, annually in three locations.
 
 So here in Charleston, we've got our clinic at Memorial Hospital, and then we do run a second location, same clinic, but just different location in Bethlehem one day a week.
 
 Then we have a program in Morgantown and Huntington.
 
 So we've only got the three, technically only the three programs in the state and Charleston runs two sites.
 
 It's still for just three sites, 1,300 people.
 
 It's a lot.
 
 Yeah, you guys do a lot with just a couple of several sites.
 
 I know our clinic, we cover 19 counties with just out of our clinic.
 
 So it's a lot.
 
 Yeah, so I feel like we're just coming out of the pandemic, the public health emergency.
 
 It ended in June.
 
 So how did the pandemic affect the services in the program?
 
 Oh my goodness.
 
 So I started November of 2020.
 
 I'd been working with Ryan White in more of a volunteer capacity or just in a collaborative capacity working for other organizations since the beginning of, it was the end of 2019, beginning of 2020.
 
 And so what I saw happen was, it was what we all saw.
 
 Care became just overall so much harder to access.
 
 We moved to so many more telehealth options just to offer protection and safety for our patients accessing that initial care.
 
 Like if someone is newly diagnosed or they've moved to the area, need to access care, became so much more difficult just because hospitals were all but shut down for a while for outpatient care or elective procedures and so the system of care that we knew was just kind of gone and we had to reinvent really everything.
 
 So when I came on, they were in the process of figuring out how are we going to take care of this clinic-based population and our providers, we've got incredible providers, they had to learn all of this new information about COVID and how it affects immunocompromised individuals, how it's going to affect just our population and I really, really love our clinic because the very first thing I learned was how much they pride themselves in the quality of care that they provide and I'm really proud to be part of that.
 
 For such a small clinic, it's 19 counties, we've got two full-time and one part-time nurse practitioner, so a total of three doctors, two RNs, our program director, who's a pharmacist and a couple of social workers working in different capacities and that's our team.
 
 The biggest impact that we saw here was just that shift in the population demographics, right at the start of the population through testing at that street outreach, then Ryan White at CAMC was able to sound the alarm bell about the increase in HIV numbers here in Kanawha and that outbreak was declared in 2021 by the CDC just a few months after I had started, so the clinic went from serving a very typical population, you know, for the most part, everyone is housed, they have friends or families or a partner to support them.
 
 Many of our, so many of our patients at the clinic have jobs in the work or they receive disability benefits, but they have income, they have a support system in place.
 
 They can access medical care with no issue, they can access behavioral health care support if they need it, and then it shifted to this population of people who primarily use drugs, it's people experiencing homelessness, they've got no supports, basically, no family, a lot of them have pretty severe mental health problems, really just like a population with social problems and unmet needs that our clinic had never seen, it's just never been part of their experience.
 
 So, we first thought about needing to adapt our clinic model and work to understand the shift in the population's needs.
 
 We recognized really, really quickly that the two or three hour long appointments that people are used to and that we were used to providing with that quality of care just weren't reasonable for people who are unsheltered or using drugs.
 
 It's getting to the middle of the very middle of Memorial Hospital, that maze of Memorial, to get to the outpatient clinic independently, like asking people in this population to navigate that independently, when most of them have never made it past the ER, asking people to make an appointment who don't have a phone, asking them to make an appointment and get to it, and they don't have transportation, who haven't access medical care on average of five years or more, just asking them to see a doctor in a hospital set, a hospital based clinic, even just getting labs done by less experienced phlebotomy staff.
 
 If that's a getting labs is never fun.
 
 The problems presented when people have a drug use history and trouble accessing veins and just trauma incurred from that.
 
 This was all, I think in whole, it was just barriers that we could not have predicted.
 
 No one could have predicted that many barriers.
 
 So we realized really quickly, we just didn't have the infrastructure or the understanding of the population's needs at the very beginning.
 
 And that really impacted the care that we wanted to provide.
 
 So we knew that we needed to start using different strategies.
 
 And so I started working from a harm reduction philosophy in our care model.
 
 And we really just started dreaming up how we could bring treatment and medicine and care to the streets to reach people and really start from the ground up to establish the trust and the rapport that we needed to even engage this population in care.
 
 Because at that point, engaging people in care was the first barrier.
 
 It wasn't even getting people to take their medication.
 
 It was just how do we even reach them?
 
 Yeah.
 
 Meeting people where they're at is how we need to do health care.
 
 Yeah.
 
 So I know you talked a little bit about telemedicine services.
 
 So are those virtual services still available now to individuals who are more comfortable with that mode?
 
 Yep.
 
 So we have virtual telehealth appointments available for all of our established patients who have access to phone and Internet.
 
 And I've worked with health departments and community providers through the southern part of the state.
 
 This is kind of a work in progress.
 
 I think it will always be a work in progress to be able to reach folks who have barriers to telehealth from their homes or they don't have access to the Internet.
 
 So, working with other doctors, other providers, health departments, for people to be able to come in and use the phone, use the Internet, use a telehealth station to be able to reach our providers.
 
 So, what should an individual, what should they expect when they initiate for their first appointment?
 
 I'm sure this will help a lot of individuals kind of start services if they know what to expect with their first appointment.
 
 You're absolutely right.
 
 So, we try to make it as accessible as possible.
 
 The standard was really, truly two, three, sometimes four-hour appointments.
 
 You speak with a provider.
 
 You go through, well, you start with, you go through the whole hospital registration.
 
 That's kind of like, this is our very standard model of cares.
 
 Hospital registration, you get the armband, you go check in, the way you talk to someone in registration, wait for the doctor, you see the doctor, you see the nurse, you see two social workers, you go for labs, you go for whatever other medical care you might need.
 
 But all in all, that was taking two, three, four hours.
 
 We still have that available and most of our clinic population has come back for that.
 
 Once you're established in care for that with that first appointment, where you learn about medication options and treatment options, you have any other medical problems addressed at the time, then it goes to a month out and then maybe two months out.
 
 Then the goal is six months out.
 
 The goal is really just twice a year.
 
 HIV is so simple to treat nowadays, it's twice a year, it's easier to manage than diabetes for most people.
 
 That's amazing to hear.
 
 So we still have that.
 
 Most of the time, we have same day options for appointments available.
 
 We have telehealth to speak with a provider and outpatient lab orders.
 
 If someone only wants to talk to a doctor on the phone or that's all they can do, if they're isolated, they don't have access to transportation, doesn't work with their schedule.
 
 Telehealth and lab orders sent into whatever lab core, wherever they need to go.
 
 Going to another community-based provider and us providing resources and mentoring support, if that's their choice.
 
 Then probably our biggest success is changing all of this to be offered through mobile street medicine.
 
 That's where we've really been able to engage this harder to reach population.
 
 And our Big Tar V Anywhere pilot program that we've started, that's just a seven-day start pack basically for individuals who can't make appointments.
 
 Along with mobile phlebotomy, we have one of our awesome HIV specialty providers on a mobile clinic, and people come once a week to pick up their medication, talk to a doctor, talk to a social worker, get help with housing, really whatever else they might need, language to behavioral health support.
 
 And they get their medication, they get to see us, and we get to really build that relationship with people.
 
 Now, so I would love to hear what you feel are the successes.
 
 You know, if you can tell me what you feel are the successes, some of the successes with the program.
 
 So I was thinking about this before we brought on, and I was like, I was kind of making some notes.
 
 I just like sat here and cried.
 
 I'm not going to lie.
 
 I was like, oh, my gosh, it's come so far.
 
 So when we first started, like no one even knew what was going on.
 
 You know, the people with the most risk or with the riskiest behaviors, they had no access to education or intervention.
 
 People who are newly diagnosed and knew they were living with HIV had nowhere to go for care or they were scared to seek help.
 
 We didn't really have testing available in the community the way we needed it.
 
 So people were just at a huge disadvantage.
 
 And I started working from a harm reduction framework.
 
 That's kind of how I've shaped my my social work practices from a harm reduction framework.
 
 And so it's thinking of the people experiencing the problem as the experts on the problem, not us.
 
 And like you said, starting from meeting people where they're at and it's listening to them to learn what to do.
 
 I don't know what to do.
 
 None of us know what to do.
 
 That's why we struggle.
 
 So by listening to people and building and earning trust and relationships with them, that's something I don't think we talk often enough about because it's pretty contrary to what the medical model of care is based on.
 
 If the folks affected by this truly don't owe us their trust, they really don't.
 
 We really do have to work to earn it.
 
 We were able to do that with our clinic by putting in that work and leaning on the relational model in social work.
 
 There's this close partnership and reciprocity between expert systems and the people that use those systems.
 
 So for the wins, even just learning how to deliver positive test results, that's of course where you'd start.
 
 And this is a pretty unique job for a social worker, I have to say that.
 
 Getting to work in public health like this and getting to work in infectious disease is not super common for a social worker.
 
 This is not like any other job I've ever had.
 
 So, but learning to deliver positive test results to people from people who had terrible experiences learning of their diagnosis, learning what not to do from people that had the most knowledge at the time.
 
 That was easily one of the biggest ones I saw at first where I saw like, this is going to work.
 
 If I can approach it from this aspect and this like this belief, then I think this is going to work.
 
 The biggest successes I can think of today go from the hollers that I've come to know and love and the folks that are, you know, really slowly and reluctantly engaging in care and starting on their meds, moving from a place of mistrust and usually a lot of anger in our first encounters to them texting and calling me and running up to me in random gas station parking lots with this huge hug when they got their first undetectable labs back.
 
 Like when they first, the people, when they would first go get their meds by themselves, like that very first time they went to get their meds from the pharmacy by themselves, like not with me, they text me and tell me that.
 
 Getting a picture of the first lease that they had ever signed for an apartment, like this are people my age, I'm almost, I'll be 40 next year.
 
 People my age, never having a lease in their name ever, never having an ID, sitting in the DMV with someone who's 35 years old, who's never been able to get an ID.
 
 Getting an ID, going through the HUD process and getting their first lease and them texting me a picture of it.
 
 I heard that's like, because housing means that they can continue to engage in care.
 
 Housing means that we've got somewhere to land that can keep their meds, they're not going to get stolen.
 
 I think of the established patients now that have asked me to meet them at the Burger King, you know, on a Friday night with their friend to get a rapid HIV test in the front seat of their pickup truck because their friend finally convinced them that they were worth getting tested, they were worth knowing.
 
 They were worth knowing their status.
 
 So many people don't believe that they are.
 
 All of the alleys and the bandeau porches and the tent encampments I've been called to after a patient of mine convinces a group of friends that they need tested.
 
 All the patients that have brought friends into care, not because of us, but because they finally knew that they were worth being cared for.
 
 That is just seeing so many people living with HIV, getting to do that public health work that we really can't do.
 
 We're just not good at it.
 
 They are so much more powerful than we are.
 
 And seeing even just peer recovery coaches, people with lived experience getting to test people that never ever ever would have agreed to get tested.
 
 Those are the ones I think of.
 
 Probably recently, this one, we celebrated this one.
 
 This one goes down in the books for sure.
 
 So, Cabinuva is the injectable HIV treatment.
 
 It's not the easiest to get approved by Medicaid.
 
 Our first Cabinuva patient on the west side of Charleston is a sex worker who's been living with HIV for years.
 
 And she had, we had such a hard time engaging her in care, and she's had such a hard time adhering to her treatment.
 
 And I'll tell you about it.
 
 The fight that our clinic brought to Medicaid just to get it approved, like they fought and fought and fought, and we got it.
 
 And it's been months now that she's been on Cabinuva, and it's moving towards undetectable status.
 
 And I don't think this woman ever thought that that would be true for her.
 
 When I first met her, she just said, I hope it kills me.
 
 And so just think of that three years ago to now is just, that's incredible.
 
 Amazing stories, amazing.
 
 So we're talking about meeting people where they're at.
 
 Do you work with community health workers or do you, how do you see community health workers in this population?
 
 So I had never really heard of community health workers until really just this last year or two.
 
 And I was looking at other states for their models and trying to think how we could translate this into something here.
 
 And then I realized all the work that's already going on around community healthcare workers here in the state.
 
 And where I've seen the most progress, the most success, the most sustainable work happening is with right now, a lot of it is peer recovery coaches that are working more as community healthcare workers.
 
 They might not realize it, but they're the most powerful community healthcare workers I've ever seen.
 
 It's people with lived experience working in their own communities.
 
 They know their communities better than I ever will, ever, ever, ever, ever.
 
 They know the haulers, they know all the back roads, they know the encampments where people stay under bridges, they know the shelter that's kind to people, and they know the soup kitchen that really is hateful to people when people don't go there.
 
 They know where to find people, and they have the relationship with people that is really, really needed in this population to be able to make, to move forward and have success in increasing health literacy, just increasing education, access to education, linkage to care.
 
 That's where I, they're essential.
 
 I don't know what we're gonna do without them.
 
 And that truly is where I've seen progress happen.
 
 It's like having a relationship with someone who, the best, I think of this woman in Beckley, who's just, she's an angel, I swear, and she has been on me.
 
 I met her like in OCEAN two years ago or something at some event, and she's like, I want to do testing in Beckley, I want to do it.
 
 Just tell me how, just tell me how, can you please come up and hang out?
 
 And she's been at, she's been after me like two years, and we finally got to hang out a lot this year.
 
 And she is making such a huge impact in her community, and it's because she comes with passion and drive, because she loves her community.
 
 She's got the energy for it, she just needs the support, the support, the education, the resources, that's really all it is.
 
 And she's making a huge impact in her community, and I see that happening in Clay County and Boone County and Lincoln County, oh my goodness, Lincoln County, and just all these places that I get to work, where I see it working is with people, when we lift people up with lived experience, and they'll get to go first.
 
 Yeah.
 
 So you talked a little bit about people who are afraid to get tested.
 
 So what advice would you give to someone who is afraid to get tested?
 
 That's really real.
 
 I mean, I think immediately of the people that I know that have experienced violence because of their status, and people who have been killed because of it, and people that have been really, really harmed by it.
 
 And getting tested by someone that you trust is easily the best thing.
 
 Getting a friend to go with you, getting tested with a friend that understands.
 
 A lot of where we can make progress with that is just really simple education about how HIV is transmitted, and pick who you've shared with the most.
 
 Who have you had, who's your sexual partner you've had unprotected sex with, and who have you shared syringes with?
 
 You guys should get tested together.
 
 You're both at risk.
 
 Really, it's not doing it alone.
 
 I think people, the fear comes from the isolation and the fear of isolation, the fear of even more isolation or being ostracized and the danger that can come along with that.
 
 And so I think the people that I've seen successfully go and get tested when they were terrified to go get tested is because a friend brought them.
 
 So it's someone finding someone with lived experience and someone living with HIV is easily the best person to be able to do that kind of work because they have experience that I don't.
 
 Yeah, that's great advice.
 
 So what insurance does the program accept?
 
 All of it and none of it.
 
 So it's a pair of last resort, Ryan White Program's pair of last resort.
 
 So Medicaid, Medicare, if you don't have Medicaid, you don't qualify for it, we'll probably get you qualified for it.
 
 And if you have any health insurance where there's a gap in what you can afford, so if your insurance doesn't cover your HIV medication or like your copay is too expensive, a lot of times that's what happens.
 
 We have programs that cover that.
 
 ADAP is an excellent program that we work with, state's drug assistance program, it's been around forever.
 
 And it helps pay those copays to decrease those gaps in adherence to treatment.
 
 So people can stay on their medication.
 
 Fantastic, so it's all covered.
 
 So what about medication?
 
 How does an individual get the medication if they need it for HIV?
 
 We really, to become a patient, we need labs to prove so that we have a current viral load and we have a current CD4 count.
 
 And there's a whole lot of other labs that go along with it, but we get your labs, so we know your blood, so we know exactly how to treat you, what we need to take care of so that your HIV medication will work the best that it can.
 
 And you see a doctor that specializes in HIV care and they match you up with the medication that's gonna work for you the best.
 
 And there's all kinds of things to take into consideration.
 
 Like I have some patients that take behavioral health medication that does not work with Big Tar V, like the medication that kind of everyone, most everyone gets to take nowadays.
 
 And so our doctors worked really hard to make sure that those med interactions that all gets taken care of and they get on medication that isn't gonna interfere with their behavioral health meds.
 
 So things like that.
 
 Sometimes people can have like a reaction to Big Tar V so they get put on something else, but really just having specialty HIV care to make sure that they're on the right medication.
 
 Medication is gonna work for them, the side effects they can tolerate and they just get the best care that they need, but there's medication for everyone.
 
 Everyone, everyone.
 
 So care coordinate.
 
 So does every patient get assigned a care coordinator and what is the function of that person?
 
 Every patient does.
 
 Patients that have fewer barriers to care get assigned a medical case manager and they work with like a different pot of money through Ryan White Program and they provide all kinds of medical case management.
 
 They're phenomenal.
 
 We've got several of them all around the state and they help with housing, transportation, referrals out to other providers if you need it, the social supports, emotional supports.
 
 They provide pretty much everything.
 
 People that have more barriers to care, like they are experiencing homelessness, they're using drugs, they don't have a support system, they would get a me, the linkage to care coordinator, and we work really hard with a lot of our community agencies and partners to make sure that the gaps in care get met.
 
 So, or the gaps in care just get filled and needs get met.
 
 We, I do everything from arranging transportation to getting some lines of their fines paid off so they can get a license back.
 
 We figure out how to get their ID and their birth certificate and their social security card because no one has any of those.
 
 And you can't apply for housing if you don't have them.
 
 We're working through the whole housing process together, learning how to navigate all of these social service systems, like learning how to apply for Medicaid, learning how to keep your food stamps, just learning all of it because the goal of care coordination is empowerment and it's like building self-efficacy in someone that they can navigate these really complex systems.
 
 So, it's very individualized and tailored programs, like programs for care and everyone, I think, I think of like all the patients that come to mind right now and they all have some of the same problems, but they also all have very unique problems and also very unique strengths.
 
 So, we work really hard from a strength-based perspective to make sure that people's, their assets are maximized and then we try to fill in some of those gaps.
 
 So, a lot of it is working really, really, really hard with community agencies.
 
 I don't know what we would do without our community partners.
 
 We'd be lost.
 
 That's what we'd be lost.
 
 Yeah, another backbone of West Virginia, right?
 
 The community agencies.
 
 Yeah.
 
 So, how do individuals get in touch with the program?
 
 You can do everything from there's, we have a website.
 
 You can call the hospital and even call CAMC and ask for the Ryan White Program.
 
 They might not have heard of it, but they will find it.
 
 I promise they will.
 
 A lot of people don't know that we exist.
 
 We still run into that a lot.
 
 It's probably once a week.
 
 I'm at the hospital talking to someone and they're like, where do you work?
 
 Who is Ryan White?
 
 And that's at our own hospital.
 
 So, but once people do know about it, it's super easy to find.
 
 We are on the West side once a week.
 
 Every single Tuesday, we have yet to miss a day.
 
 In over a year and a half, we've got a huge mobile clinic that goes out through the hospital, through any federally qualified health center.
 
 They know about us because we've done our work.
 
 Any health department in any county, they should know about us.
 
 And really, it's anyone needing HIV care, regardless of your insurance status, should know about Ryan White.
 
 And we're really easy to find online.
 
 There's phone numbers, there's emails.
 
 A lot of Ryan White programs have Facebook pages.
 
 We don't yet, but I'll give you my cell phone number.
 
 Really, truly, it's that we're trying...
 
 Ryan White became...
 
 The Ryan White program became kind of irrelevant in the last, I don't know, 10, 15 years probably because medication was so accessible and the care was very accessible.
 
 And the population affected by it was very well educated.
 
 The advocacy efforts that went into the LGBTQ population, really, a lot of the HIV needs were met.
 
 And so now with the shift in population, we're really having to change our strategy and apply health literacy and education to a whole different population that does not have access to normal...
 
 I mean, they don't have access to social media and they don't have...
 
 They don't watch TV or commercials.
 
 So really, a lot of it has been just keeping a presence in the community.
 
 So anyone interested needing HIV care should reach out to CAMC Ryan White Program for information.
 
 Yep, absolutely.
 
 And even if you're not in one of our counties, we'll still get you in touch with the right people.
 
 Thank you so much, Brooke.
 
 Thank you for joining us.
 
 Thanks so much.
 
 Thank you for tuning in to Taking Healthcare by Storm, Industry Insights, with Quality Insights Medical Director, Dr.
 
 Jean Storm.
 
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