When Tony Stupski, D.O., of Sea Mar Community Health Centers in Vancouver, Wash., needs to consult a specialist about one of his patients, he often reaches out to a national nonprofit organization called the MAVEN Project, which connects providers in community health centers with volunteer specialists to help with challenging diagnoses or help decide on the best course of treatment.
MAVEN (Medical Alumni Volunteer Expert Network) Project arranges for the primary care clinicians to hold synchronous video meetings or do asynchronous e-consults with a specialist who is part of its network. It doesn’t bill anyone for its work and is funded through philanthropy.
“We've had trouble connecting with specialists for some of our patients,” said Stupski, who is medical director for Sea Mar’s Southern Region. “There are specialists in our community, but not all of them are accepting state insurance, and we also have uninsured patients. We have some real barriers for certain specialties — dermatology, rheumatology and urology, in particular— where we were not having any place to send people, or if we did, it would be pretty far away. The MAVEN Project allows us to get a consult from somebody and help us sort out how important it is for the person to be seen in person or not. Sometimes these patients might be able to get into a specialist, but the appointment may be six months out. The consult will enable us to take some first steps, such as starting a medication,” he said.
The MAVEN Project was founded in 2014 by Laurie Green, M.D., who is currently vice-chair of the OB/GYN Department at California Pacific Medical Center and one of seven public health commissioners for the City and County of San Francisco. At the time, she was the president of the Harvard Medical School Alumni Association, and was able to use her connections there to begin to build a network of active and retired physicians who are determination to serve clinics in under-resourced communities. In under a decade, MAVEN Project has grown to serve safety net clinics and health centers across 21 states and Puerto Rico.
Meredith Schanda, senior director of clinical operations, for the MAVEN Project, said that the model has evolved since 2014, but the underlying core is the same. “We have a network of amazing physician volunteers from across the country, and we connect them via telehealth to front-line community health center providers to help improve the quality, comprehensiveness and timeliness of care for underserved communities,” she said.
Schanda’s role is working with more than 350 clinics in the healthcare safety net, which includes free clinics, charitable clinics, Federally Qualified Health Centers, and Indian Health Services clinics. “I'm responsible for identifying clinics that would find value in our services, meeting with those clinics, helping them understand how MAVEN Project can help build capacity within their provider cohort, help them with provider retention and recruitment, and help them improve population health outcomes,” she said. “Then we go through the implementation and training process with those clinics. We continue throughout the entire lifecycle of being partners with those clinics, doing continual needs assessments with the clinic leadership and the frontline providers themselves to understand where the pain points are and where we can help augment their skill set and support them so they can deliver the best care possible.”
Some of their work involves helping mobile clinics and clinicians practicing street medicine working with unhoused people. “Many of our clinics have mobile vans that go out into the communities or satellite sites that they might stand up ad hoc, depending on where the needs arise," Schanda said. “There are definitely unique challenges to those clinic sites. Some of the challenges are with the patient population in particular. Oftentimes, those or providers need answers to their critical questions immediately, because the likelihood of them seeing those patients again down the line is usually slim. Maven Project is trying to innovate in that space, because we know how imperative it is for clinicians to get answers to their questions while the patients are still in front of them to help change their plan of care,” she added. “But the biggest thing with mobile outreach is not only the fact that patients are typically transient, but also that street medicine is a really unique style of medicine. The recommendations a specialist might make to a provider that's treating a patient in a brick-and-mortar facility may oftentimes vary from ones they make to a street medicine team.”
Schanda stressed that the consultations are purely provider to provider and there's no direct patient care being provided. “That's intentional, because we're trying to be able to equip the PCPs with that knowledge and confidence to treat that patient and also equip them with the ability to manage those cases further on down the line, should they run into similar challenges in the future,” she explained. For the asynchronous consults, their average turnaround time is typically less than eight hours. “So you're usually getting a response from our physician specialists the same day,” she said. "You can schedule in advance a video consult for a provider to meet with a specialist, and we're trying to help facilitate this relationship-building between the front-line providers and our MAVEN Project volunteers.”
Stupski says the mentoring element is an important aspect of the relationship. “Through the consults, you can learn what to do in the future for a patient like that. Also, they have formal education sessions. You can request individual learning, or they post talks that are being given by specialists in the MAVEN Project, and there are mentoring sessions you can you can schedule to have ongoing conversations.”
Stupski calls what MAVEN Project is doing “really incredible. And they've really grown and refined their model over time. They're amazing.”
A month ago, MAVEN Project launched a new telehealth platform based on the feedback that from its users. “We spent a lot of time deliberately working with focus groups with our front-line clinicians,” Schanda said. “We also meet with our clinic advisory committee, which is comprised of all different types of providers from different types of clinics that are project partners,” she said. “We've tried to understand what are the biggest barriers to utilization of our system because we often hear that we are solving very unique need and they absolutely love our services, but that doesn't always translate to high levels of utilization. We are trying to understand where that breakdown is. Understanding the busy lives of primary care providers and trying to optimize their services is really paramount for us moving forward. This new platform is the first step for us in working towards that and being able to solve for some of those problems to help increase adoption and utilization of the services in the safety net, because one of the things we're really cognizant of is that e-consults and telehealth are a really hot topic now. We don't want the healthcare safety net to be left in the dust as those systems continue to evolve. We need to understand what's unique about this patient population and these types of clinics and develop a solution that works for them.”
