Taking Healthcare by Storm: Industry Insights with Dr. Michael McShane

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 Michael McShane, MD, EdM, Assistant Professor of Medicine at the Penn State College of Medicine.

A Note from Neeli: Advancing rural health through the LION Mobile Clinic
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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-ARPA-012425-GK

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.

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 Hello and welcome to Taking Healthcare by Storm. I am Dr. Jean Storm, the Medical Director of Quality Insights, and today we are joined by Dr. Michael McShane. He is an Assistant Professor of Medicine at the Penn State College of Medicine, and he leads a very important, exciting project called the Lion Mobile Clinic.

The Lion Mobile Clinic is transforming healthcare of access in Snowshoe Township, which is a rural community in Pennsylvania. And he in the clinic are they're bringing essential services directly to residents in need. And so today Dr. McShane is going to share with us how this mobile clinic not only addresses health care disparities.

but also provides invaluable learning opportunities for medical students. We're also going to be touching on the important role the clinic plays in combating vaccine hesitancy and misinformation, something that is so very important right now in these underserved communities. Dr. McShane, thank you so much for being with us today.

Hey, thank you so much. I appreciate you guys giving the space to share the work that we're doing here at Penn State. Not just me, but Um, some of the great faculty, students and staff who are, who are lending a hand figuring out a way to try and find some solutions for, for complex issues around Center County.

Yes, most definitely. So can you start by explaining the origins of the Lion Mobile Clinic and how it came about in response to the health care challenges faced by Snowshoe Township and I know you are eager and I'm excited to hear about it. Sharing your philosophy of tailgate medicine. I think that sounds so interesting.

Thanks, Jean. Yeah, we're happy to share. Yeah. You know, so, uh, this all started, um, as a result of a community that was in need, uh, a town called Snowshoe, Pennsylvania, just North of our campus here in center County at the main university at Penn state university. Um, snowshoe. Like many rural communities, um, it's been hit hard.

Used to be a big coal mining and lumber industry in that community. And as those industries declined, so did the community. So over the past three, four, five decades, there'd been this steady decline that had been happening in snowshoe. Fast forward to around 2020. And fortunate such electrical fire burned down the one remaining grocery store, whole supermarket.

It was too costly for, for the owners to rebuild it. Uh, also what was in that area was in the in haul supermarket was a hardware store and a subway restaurant. It's really kind of a key node in that community for people to congregate, share messages, um, and, and get a, get a sense of what's happening in the community.

Shortly thereafter, there was a bank in town that left town. And then soon after there was a federally qualified health center, only in center County and a pharmacy that also left town. So within the span of gosh, maybe about a year, year and a half, that community lost huge pillars. Um, they lost a grocery store, hardware store, a bank, a pharmacy, and then finally the clinic.

And so, you know, I teach at the College of Medicine. We have a regional campus based out of the University Park, uh, main campus. And, uh, we have a whole cadre of students and faculty. And I think as we saw what was happening in Snowshoe, we, we came to the conclusion we needed to do something to help. So we, we, we figured out a way to, to rent an RV in collaboration with Evangelical Community Hospital in Lewisburg, Pennsylvania, and at least provide some prevention, uh, to the community.

And then also, Uh, really kind of show up and try to understand the needs of that community. So when we first went up to snowshoe, we rolled with a whole team that include, uh, rural sociologists and other researchers to help us understand, okay, you know, what are the priorities in this community? Is there, are there things that we can do to help?

So we start off with red prevention and grow them from there, flu shots, COVID boosters, and, and, and, um, other healthcare resources that community, um, and I think what has been, um, you know, really valuable is, is trying to engage with others within the community to, to figure out, um, needs and solutions.

Since then, we, we've expanded other locations. And I think, you know, it really is just the reflection that, um, you know, across our rural communities that really. have been hit hard for many reasons. And there's this steady decline that's happening. And so we're hoping that this, you know, this, this mobile clinic initiative is, is kind of that, that spark plug that jumpstart to help to provide other resources, to figure out other solutions to communities across, across the Pennsylvania that may need, may need help like this.

And I will argue probably across the country, they're definitely needed. So what specific health care services does the Lyon Mobile Clinic provide to the community? And are there any particular health needs that the clinic focuses on due to the rural nature of Snowshoe? That's a great question, Gina. You know, so I think we really, we really strive to think about the social drivers of health.

So, um, this goes the concept of social determinants of health, uh, thinking about the aspects of, um, someone's overall health and well being that are affected. By things like financial stability, food and security, um, the built home environment and also healthcare access and healthcare quality. And, you know, if you look at someone's, I know I'm probably preaching to the choir here, but if you look at someone's overall health and wellbeing.

Maybe 20 percent of that is related to healthcare quality and access. The others are related to behaviors, to the built home, to financial stability, to food stability. And so as we've been growing this initiative, we've really strived. tried to kind of lean into those concepts of what other ways can we intervene, um, on the healthcare challenges that we're seeing.

And it kind of goes to the testament as me as an internal medicine physician. Sure, I can, you know, work on titrating someone's insulin or increase a blood pressure medication. But in reality, you know, if someone doesn't have, uh, uh, uh, food on their table or can't afford a medication, none of that really matters.

And so, you know, we, we really try to look to see if there are ways that we can intervene from a, from a healthcare delivery perspective. So we focus on prevention. We focus a lot on, um, on different health education topics. So, you know, I think we, we do things like, uh, sun safety. We'll do skin cancer screenings.

We do gun safety. We provide gun locks. Um, we do, uh, a lot of, uh, different, um, educational interventions on healthy eating and, um, and ways to, um, address different cardiovascular risk factors. The other aspect we, we partner with Center Volunteers in Medicine, which is a free clinic to provide primary care services to those that don't have health insurance.

And then one other aspect is we've, we've been able to partner with Penn State Health and do some home visits for those that are in the community, um, and may not be able to access our brick and mortar clinics. So it's sort of like a, um, you know, uh, different types of services, depending upon where we're located.

And then also, um, kind of understanding and understanding the needs, uh, of the communities that we're going to. And, you know, one thing I'll, I'll say to Jean about this is that, um, as we've gotten more and more involved in mobile clinics, gosh, it's, it's, it's shocking that, that, um, well, maybe not shocking, but as flexible and as mobile, the physical mobile clinics are, there are still people that can't quite reach it.

And so what we have sort of adopted in, um, is this model of tailgate mice. And I can kind of share more about it, but it's really that aspect of, you know, how can we be as. Flexible and agile to meet the needs of people where they're located, even for those that can't physically reach the mobile clinic.

Yeah, I think that that's so very important. You've got to meet people where they are. Like, that's Basic common sense. Um, so I love that, that concept of tailgate medicine. Um, so the Lyon Mobile Clinic, it not only provides health care, but it serves as a training opportunity for medical students. So how does this integration of service and education benefit both the students and the residents of Snowshoe?

Yeah, it's a great question. You know, I think, um, one of the concepts that that we try to, or maybe one of the principles that we focus in on is, um, this idea that of all teach, all learn. So, you know, I think when we are out in the community, we, uh, recognize that there are so many folks that we're meeting with and interacting with that have amazing experience and expertise.

And, um, and are there ways that we can, um, really align that with also the amazing expertise and experience that our students have. So I think a prime example of this is, um, you know, as I mentioned, there are locations that we'll go to, including Snowshoe, that there may be folks that have limited access to fresh fruits and vegetables.

And so we have this culinary medicine cooking class and our, our students are involved with the, the focus is to provide, um, healthy eating options. teach a class about the different concepts, um, from a nutrition perspective, cook a meal with those folks and then send them home with the recipe and another, um, enough food to cook it again.

So it's one small way that we're trying to tackle this need for fresh foods and vegetables, but it's a, it's a kind of a, um, unique way to, to, to pair it together. Uh, so as much as the students are there to share their knowledge and expertise when it comes to different nutrition concepts. I'll tell you, they, they, they learned so many lessons about how to cook.

So, you know, there's this, this sharing of information, this, this bi directional relationship that happens. That we really try to facilitate and and other aspects to so you know that you know when we embed students with us as much as they are there, helping to deliver some service or be involved in a in a research element.

They're also there to learn from the community and so we we try to set up circumstances where that airs that bi directional relationship. The same I'll say you know genius true for our. Faculty that are involved from a research perspective. We really, you know, principally focused on this concept of community based participatory research, where you know we're focused on trying to understand the needs of the community and then align research interests or researchers within the universe that may be able to help.

And so that that aspect of, we need to learn, it needs to be a bi directional relationship I think has been really key to sort of the methods of what we do from a teaching and research perspective. Yeah, I love that idea. And so just go going with the research component. And you say, you know, it's crucial to success.

So how did the collaboration with the researchers from other Penn State colleges enhance the clinics ability to meet the needs of the snowshoe residents? Yeah, I'll tell you, there is this, um,

You learn so much by being on the ground. And I think, um, uh, what we really needed was, um, was our researchers to help us hear what's happening on the ground and make adjustments from a service perspective so we could be there for the community. And so there's only so much that you can do in terms of planning to predict what might those needs might be.

But I think what we found was having that element of research allowed us to. Yeah. Get a better grasp of what does the community really need? And what can we do to adjust to meet those needs? Um, so, um, as we, you know, as we grow and we've gone to other communities, that's been a critical element of as we deliver service, as we lead with service, um, have that backbone of research to help us understand how we need to shift the focus and meet the needs of the communities that we're interacting with.

Yeah, again, meeting people where they are. You have to know where they are or you can meet them. So you, you know, talking about, about trust, um, you know, trust in health care is like in the news now. It's so very important. So, you know, it's essential in providing health care is building trust within the community.

Did the clinic team have any issues? Um, you guys have any challenges? Um, you know, or hesitation with the new mobile health services being provided? And how did the team address initial skepticism or hesitation? Yeah, I know. So no surprise. Yeah, of course, you know, I think, and, um, you know, some of the communities that we we go to, they've been burned.

And so, you know, uh, good on them for for being skeptical and uncertain. It's also, you know, mobile clinics across the country deal with this, too, is that, uh, showing up in a huge RVs. not the most approachable situation. Um, and you know, I think we recognize that as we're coming into it, but also felt like the, the need to be there and present was more important.

Um, so, so yeah, you know, I think, um, you know, That we we've for better for worse. I think you know, we hear this a lot, but especially for academia talk about this concept of ivory tower and I one of our researchers commented on this before she talks about this concept of the poke and prod that too often.

Academia has gone to communities, including rural communities, have done the poke collected data, done some sort of research, have done the prod and then have left. There's no feedback. There's no, you know, follow up. If there is, it's minimal. And so, you know, this, it creates this, this dynamic of all, all take and no give.

And so, you know, as we, as we thought was really critical is that we cannot, in order to build trust, we need to be present. We need to continue to show up. And show that we're not going anywhere. And I think that was really critical to the success of what we did. The second piece too, is that feedback. So, you know, that, uh, as I mentioned, what I think is part of this bi directional relationship from a research perspective is as we were learning things from the community, we're feeding that back to the service element and saying, okay, community X is saying that this is something that they need.

Let's figure out how to do it. And so we'd roll up the sleeves, we'd, we'd work with different parts of the university and say, this is a service that this community needs. How can we fulfill it? Um, and so that, that sort of a real time feedback and then, you know, seeing the service and action as a result of that, that conversation, I think has really helped us to, to develop some trust in communities that have been burned.

So. Um, so much in the past. So, um, I think kind of twofold is that like showing up, being present, having the conversations with people. And then the second part of. Really making sure that we we create this bidirectional relationship with the communities that we're we're acting with. So jumping off of that in the same vein, we have to talk about this information about vaccines and vaccine hesitancy.

So I want to start with vaccine hesitancy. It's, you know, especially challenging in rural areas. So how has the mobile clinic, how have you worked to educate the community on the importance of vaccination? Including covid and flu vaccines, you know, that are so right now. Yeah. Thanks. Gene. You know, it's it's um, I could even say you could probably extend that to not just any vaccine, but you know, other medical interventions across the board.

And, um, you know, there's the, the, for some communities, the amount of medical distrust is significant. I think some of the ways that we've, we've tried to work around that is. Again, just showing up, being present, having the conversation, not being pushy, you know, if someone wants to, has an opinion about something, uh, being there to share the space with them.

Uh, I, I think that we try to, we strive to do that. You know, we're, we show up with flu shots. If you don't want one, that's fine. You know, we're just, we're just here to, here to learn and, and, and share what, what we can. So I think that that element of showing up and building trust has been key. The other thing that I think we've found is that there are, there are some pieces of information that, um, we can pretty much easily correct by having a conversation.

And we found this a lot out with, with COVID boosters was, you know, there was a, there was a fair amount of the population that felt like if they didn't get the first booster and they couldn't get any more in the future. And so when the second booster came out and the third booster, we'd have those conversations about, you know, what that meant for them personally and, and tried to correct some of that information.

And the other thing that we've been trying to do is, is really lean into the expertise of, um, of our university. I'll give a great shout out to the College of Liberal Arts and Applied Linguistics. So there's a department that really does this focus of like, how do you apply language and what does it mean?

So we have a current grant right now that is focused on that aspect and immunizations of When we're as, as, as we are going out to the community and sharing information about flu shots, you know, how's that information being applied? And, um, is it helping or hurting the conversation? And then even the materials that we're presenting, is it helping or hurting the conversations when we move forward?

So again, it's kind of leading into the expertise of the university to help us understand how best to communicate with our patients. And then those that may not speak English as a primary language. So we see a fair amount of folks from Spanish speaking countries and trying to understand how we communicate with them effectively, make sure we're relaying the information effectively and, and really, um, make sure the message that we want to present is getting across.

I love that idea using the linguistics department. I think that's a great idea. Do you find a lot of misinformation and just healthcare vaccinations in general in the populations you serve? A fair amount. Yeah, yeah, it's, it's, um, and it's interesting, you know, I think the challenge too is, um, you know, some of this is also helping people understand.

How to obtain information that can have them make the most informed decision and helping them understand different sources of information, how that information is presented. And so we have conversations like that too. And I think that's been, that's been pretty valuable. We've also noticed is that, um, you know, sometimes And this is the sad part for, for some populations, it's not because that they, they don't want it.

It's just that they can't access it. And so that, that to me is the really tough part is like, you know, give an example. Um, one of the early years when we were doing flu shots, it was winter time. It was, I think, late December and we were at an event. And, um, we somehow heard about, um, an older adult in the community.

She was in her nineties. had just had a hip fracture repaired, had a hip replacement, got discharged from the hospital back to her home. Um, she needed a flu shot. Hadn't gotten it all season yet. We go to her house. The stairs are icy. She can't leave. She doesn't have a car. She doesn't drive anymore. And, um, we enter in and her winter coat is in her closet up in the attic.

She can't even reach it. So even if she wanted to get out, she couldn't. And so, you know, this is an end of one, How many older adults are isolated in our community and just can't access basic preventive care? And so, you know, this is the type of things that I think we're, we're just scratching the surface on.

How do we reach those folks that, that need, that would like to get the care that they need, but just can't access it? And so, um, you know, much of the work that we do in terms of messaging and thinking about like the applied linguistics folks too is, is how do we communicate that information to those.

That, that if they knew where to go, they could get the care that they need, or where can we be to make it more usable and more accommodating for, for those folks? I love that. So one of the ongoing challenges in rural healthcare is getting the word out about active available services. So what methods have you found to be most effective in spreading the word about the mobile clinic, especially in a small tight knit community like Snowshoe?

It's tough, you know, I, the, for a community like Snowshoe, it, you know, Hall Supermarket, It was the location to get information out. It was that node within the community that was able to spread the message. And I think as, as that had gone away, so did that real opportunity. So, you know, we, we try to figure out other mechanisms, Facebook.

But, um, or their social media, uh, we tried mail, uh, you know, it, it, it ends up newspapers, local newspapers, all these different sources, probably the best has been, uh, uh, what one of our, um, faculty had mentioned was trying to figure out what the sticky message is, what's the way that the word of mouth can help spread it.

Cause I, you know, we encounter folks too, that don't have a cell phone may only have a landline. And at our heart of hearing. So it's even hard to communicate that that way and are skeptical of things that they receive in the mail. So, you know, the sticky message has been a kind of a key element of how do we build enough trust in the community that folks will, will share the words to neighbors, to friends, to, to folks around, to feel comfortable, to come over and approach us and that, that takes time.

Takes commitment and, um, you know, in this work, it's one of those that you have to be comfortable with, uh, continue to show up and build that trust over time. So probably not a great answer, Jean, but just the, I think the recognition that. Um, especially in some rural communities. It's hard to it's hard to get that message across.

And sometimes the word of mouth is the best best method. Yeah, I would agree. So as you continue to integrate education, research, health care, what lessons have you learned from snowshoe that could potentially help other rural communities address similar health care access issues? And do you think that mobile health clinics are the future of long term solutions for underserved populations?

Man, loaded question. I feel like I'll, um, you know, I'll probably be the first to say that, you know, what we do in snowshoe and other communities is, is really a bandaid to much greater challenges that exists within that community. Because in reality, you know, what snowshoe needs is they need a grocery store.

They need economic growth and development. They need a stronger school system. They need all these resources that can help to prop up that community and, and, and make it to a point where. You know, a health system decides it's a good, uh, financial investment to have a clinic there until then we're, we're sort of a band aid, but I, you know, I will say, so not to be all negative, I think, you know, so, you know, one of the, I think what I'm trying to reflect there is that much of what we see in communities are multi sector challenges, and it really takes investment from, from multiple sectors to, to make a change.

Well, my hope is, is that. Um, as a academic institution, um, that we can be that catalyst towards change to, to make a spark and, um, and really help to, to make things happen across sectors. The, the other thing I'll say, though, you know, so, um, I'll, I, you know, I have, I have to mention this. So I'm a Penn Stater.

I went to Penn State undergrad, went to Penn State for med school and back here as faculty. I don't think there's anyone that tailgates better than us at Penn State. And now if, if you have folks, I'm sure from, you know, WVU may have some, um, some arguments and, and, uh, I'm sure SEC schools or big 10 schools may have an argument to that, but you know, Penn State really tailgates with the best and, um, there's this concept from the military called tailgate medicine.

And I think really what we're doing is implementing this model of tailgate medicine. And the concept from, from tailgate medicine for the military was really this idea of You know, healthcare and the ways that we can deliver healthcare, um, can, can go beyond the brick and mortar clinics. Just think of all the street medicine teams right now that are rolling with point of care, testing, point of care, ultrasound, how health has expanded dramatically.

Um, there's ways to deliver all sorts of healthcare beyond the brick and mortar walls and provide the same quality of healthcare with military has been doing this for decades. A prime example is the concept of stop the bleed kits. And so the idea of stopping a bleed in the field and then ensuring that someone can get back to a tertiary care or a major hospital center to do the surgery.

Those stop the bleed kits are remarkable. Able to really stop the bleed and save a life if not a limb. And those have been, you know, brought to the community. So is this really this, uh, increase in technology and its availability to extend beyond the care and then the agility of, of mobile clinics is being able to, to reach sort of farther out locations we see is that, um, you know, why not be the leaders in tailgate medicine, uh, really being able to deliver.

The same quality of care, but outside the brick and mortar clinic. And I think, you know, so as Penn Staters, I think we tailgate with the best. So this is a really, I think, a way for us to lean in and think about, you know, how do we deliver the care that we need by even dropping the tailgate of a truck and delivering the care where we're located.

So that's the model that we've been sort of focusing in on and thinking strategically of. You know, how can we deliver what, where, and with what flexibility so that we can reach those folks that just broke a hip and have icy stairs, but really just need a flu shot, how can we make sure we do that? Or, you know, it's the summertime, and there's, you know, an older adult that's in the middle of a heat, heat advisory, how can we make sure that they stay cool?

and have enough water, hydration to stay healthy. Those sort of things I think we're, we are really trying hard and I think is where we may see, you know, healthcare moving in the future of what types of things can we deliver with the same quality of care In more remote places with mobile clinic with a truck Whatever vehicle I love again.

I love the tailgate medicine and that i'm not going to comment. Who's the best tailgater? I practice in west virginia. I live in pennsylvania now. My daughter goes to penn state. I went to Rutgers So I'm just saying, Okay, being partial about it. I got it. I got it. Yeah, I think you have to be. Yeah. Yeah. So looking forward, how do you envision the future of mobile health care services?

Are there any plans to expand the clinic services? Or do you have a wish list for the new year? Yeah, no, it's great. You know, I think we hope to expand. Um, I think, too, we hope to expand it really. I think we kind of view these mobile clinics as as sort of a platform from a service from a research and from an educational perspective, uh, to be embedded in the communities to understand those needs to have that bidirectional relationship.

And figure out ways that we can help. And you know, there's no shortage of amazing faculty, staff, students across the university and our commonwealth campuses that are doing amazing things. So my hope is that this platform can be a way to augment what the great work that's already happening across the university, uh, but do it in more communities.

And places that are close to our commonwealth campuses that are close to our main campus that are in our communities that are across the state. And so my hope is that, you know, as we move forward, that even from a tailgate medicine, from a clinical care delivery perspective, that we expand what we can do and provide more care to those folks that need it most.

Excellent. So how can individuals find more information, reach out if they want to do so? Ah, thanks. Yeah, so, uh, Please, you know, check out our website. We're at med.psu.edu/lion mobile. Um, we have a, uh, email address to, uh, lion Mobile Clinic at Penn State health.psu.edu. And then, of course, me as well, more than happy to answer any questions or, um, folks wanna reach out.

We, we'd love to help. You know, I think to, I hope recognized that, you know, a lot of this work. I, um. Gosh, there are a lot of folks out there that are need that are in need. So if there is any way that, that there's other folks that are working in this lane or think of ways that they might be able to collaborate and make impacts we're game.

So let us know more than happy to figure out a way to expand what we're doing. Excellent. I'm so, so glad. I'm so glad that you were doing the work that you were doing. And we are going to link all that information in the podcast. Also that link to, um, story about the, um, the mobile clinic and Dr. Michael McShane.

Thank you very much for joining us today. I really enjoyed the conversation. You too. Thanks, Gina. Appreciate the space. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

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