Nonprofit Using Telehealth to Treat Low-Income Patients

CAT WISE: Every day, 44-year-old Donna Akers, known to friends as Dallas, makes multiple trips up and down the stairs in her Seattle apartment building. And each step is hard. Akers has a painful arthritic condition in her legs, feet, and hands. After spending 14 years in prison, she recently turned her life around earning, earning a full-ride scholarship to the University of Washington. While her future looks brighter, Akers' health issues remain a daily challenge.

DALLAS AKERS: I have lupus, and I have psoriatic arthritis, as well as some severe rheumatoid arthritis issues. And with my medical conditions, it's not something that the majority of doctors in a community clinic are well versed on.

CAT WISE: She knows that because since been released, Akers has been getting care at a community clinic, one she really likes. For nearly 50 years, the federally funded Country Doctor Community Clinic in the heart of Seattle has served mostly low-income patients, who often have complex care needs.

LAURA MORGAN: How has everything been going this week?

DALLAS AKERS: Started school, so I'm way more active. And it's, I think it's put a little more pressure my joints, because I'm having a little bit more pain.

CAT WISE: Dr. Laura Morgan is Akers' new primary care doctor.

LAURA MORGAN: Now remind me, what areas are most painful for you?

CAT WISE: Like many family physicians caring for underserved patient populations, Dr. Morgan has treated a wide range of ailments, but she and her colleagues, who include nurse practitioners, can only do so much. And getting their patients into specialists is often a big challenge.

LAURA MORGAN: Most of my patients now either have insurance or have access to insurance, and still, they're dealing with difficulties, especially those on Medicaid. Depending on the specialty, there are often long wait times or limited options, oftentimes resulting in patients having to travel pretty far from their home to get the care they need.

DALLAS AKERS: Hi.

CAT WISE: For Akers, who has Medicaid, the wait is four months to see a rheumatologist. But now, Dr. Morgan has a new tool in her medical bag that's making it easier to help patients who need specialty care.

Hi, Dr. Morgan, may I call you Laura?

LAURA MORGAN: Yes, absolutely.

CAT WISE: Dr. Katherine Upchurch is a rheumatologist who happens to live 3,000 miles away in Concord, Massachusetts. The two were brought together by a nonprofit called the Maven Project, which connects volunteer doctors with health providers in underserved communities around the country via telehealth, video conferencing, and phone calls.

KATHERINE UPCHURCH: Tell me about how her feet looked.

CAT WISE: Their 30-minute scheduled consult gave Dr. Morgan plenty of time to get advice from Dr. Upchurch.

KATHERINE UPCHURCH: I would check a rheumatoid factor. And I would also check a test called an anti CCP, or Cyclic Citrullinated Protein.

LAURA MORGAN: OK.

KATHERINE UPCHURCH: And that's kind of hard to order in the electronic systems. But if you look hard enough, you'll find it.

CAT WISE: Dr. Upchurch is one of about 100 doctors giving their time and expertise for free to 40 clinics through the Maven Project. Started four years ago, the philanthropic and grant funded organization is small, but uses its ties to many of the big medical school alumni associations to recruit doctors, most of whom are retired and semi-retired.

DOCTOR: I wanted to talk to you partly because I wanted to establish a Maven relationship with a gastroenterologist, a GI expert.

CAT WISE: In addition to consults, Maven Project doctors, who are carefully vetted, provide educational sessions and one-on-one mentoring. But the Maven Project is unique, in its focus on the country's most vulnerable patients, and its use of volunteers, like Dr. Upchurch, who has been practicing medicine for more than 40 years. She's a professor at the University of Massachusetts Medical School.

KATHERINE UPCHURCH: How many repetitions?

MAN: Let's go for 30.

KATHERINE UPCHURCH: 30? Oh, my gosh.

CAT WISE: She's currently on medical leave and spends about four hours a month on Maven consults.

KATHERINE UPCHURCH: You have a growing cohort of well-trained, aging rheumatologists and other specialists, and primary care physicians, who have been in the trenches with all the toil, and sweat, and blood that goes along with that, enjoying their careers, but not wanting to do that forever, and wanting to continue to use their skills, but at the same time, wanting to smell some roses.

CAT WISE: Dr. Upchurch is one of many doctors around the country who are at the end of a long career in medicine. In fact, about 40% of physicians are age 55 or older.

LAURIE GREEN: We think of ourselves as Match.com meets the Peace Corps.

CAT WISE: Dr. Laurie Green is the founder of the Maven Project.

LAURIE GREEN: How are you guys doing?

PATIENT: Hey, good, how are you?

CAT WISE: By day, she's a busy OB/GYN in San Francisco. But every minute she can spare, she's involved in all things Maven. Green came up with the idea in 2012, when she was President of the Harvard Medical School Alumni Association.

LAURIE GREEN: A group of medical school alumni presidents started recognizing that when the Affordable Care Act was implemented, millions of people would suddenly have insurance coverage and very little access to the type of specialty care they would need to treat their illnesses. And at the same time, we recognized that so many of our colleagues were retiring. I heard repeatedly how doctors felt so wistful when they were leaving practice. Then we had one other element that would never have existed 10 years ago. We had technology.

CAT WISE: After 30 years of treating cardiology patients in California's Bay Area, Dr. Bob Cooper recently traded his medical instruments for gardening tools. He now consults with a free clinic in Miami, Florida.

BOB COOPER: Can you rotate the EKG? So there's atrial fibrillation as well.

DOCTOR: There's atrial fibrillation and ventricular [INAUDIBLE].

BOB COOPER: Yeah, absolutely.

DOCTOR: And now, I'm going to show you some pictures.

BOB COOPER: The underserved populations have higher incidences of many, many cardiac problems because of lack of care. Cholesterol medicines tend to be expensive. And so, they want answers that, within what the patient can afford, what would you suggest next. Because maybe they can't use the most expensive drug.

CAT WISE: Back in Seattle, Dr. Morgan says the advice she's getting from Maven Project doctors is one of many ways she's trying to provide care for her patients.

LAURA MORGAN: We are always using this information, just as a piece of our own clinical judgment. Well, I really appreciate your help.

CAT WISE: The Maven Project is currently partnering with clinics in six states, but they hope to be in all 50 by 2023.

[INAUDIBLE].