Population Care

Parents’ inability to pay won’t stop these doctors from caring for kids

Andis Robeznieks , Senior News Writer

AMA News Wire

Parents’ inability to pay won’t stop these doctors from caring for kids

May 30, 2024

When Desiree L. Evans, MD, MPH, started her pediatric practice with the Texas Children’s Community Cares program, it was called “Project Medical Home” and operated out of a small office with three exam rooms, a waiting room and a small space for the nurses.

Some 20-plus years later, the program has eight Houston-area locations where services are provided regardless of parents’ ability to pay. This includes well visits, nutrition education and a social worker who helps families connect to low-cost insurance and other community resources.

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Community Cares provides high-quality pediatric medical services for children whose family may otherwise seek care at the emergency department or skip care altogether.

The facilities are open until 8 p.m. Monday through Thursday, and Saturday mornings offering convenience to working parents. (They are open 8:30 to 5 p.m. on Fridays.)

“We realized that a lot of our families had jobs where they couldn't take off—they couldn't just say: Oh, my child is sick. I can't come in,” Dr. Evans said. “So we provided time where families could bring their children in, and so this was actually a huge, huge win for a lot of our patients, because it was it was necessary so that they could both take care of their kids, but also keep their jobs and support their families.”

Years later, Dr. Evans said she often made use of the late and weekend hours when her own children were ill.

Texas Children’s Pediatrics is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Texas Children’s Hospitals Community Cares Program staff
Desiree L. Evans, MD, right, pictured with a front desk staffer, leads Texas Children’s Community Cares Program.

Dr. Evans now practices at the Community Cares location in Palm Center, a business and technology hub in Southeast Houston. She recalled how the original Community Cares office was located near the Texas Medical Center complex that is home to Texas Children’s Hospital and many other great hospitals, yet there were few affordable options for the area’s residents.

“Even though it’s right across the bridge from one of the biggest medical centers in the world, the area was considered a health care desert,” she said.

When she started, Dr. Evans worked with a nurse practitioner and the program’s founder, pediatrician Robert F. Austin, MD, who died last year. The original location is now named after him.

“His undeniable commitment to serving all who need help, and his ability to be an advocate for the underserved, not only made a profound impact on how Texas Children’s Pediatrics provides care to those most in need—it also made a profound impact on me,” Dr. Evans wrote on the Texas Children’s Hospital blog.

In a video and article on the Texas Children’s Hospital website, Dr. Evans tells how she believes that, as long Community Cares is serving patients, health equity is being advanced with each patient they help.

“We continued to grow,” Dr. Evans said. “Then Texas Children’s realized how wonderful it was, and we realized too that we were helping take some of the pressure off of the emergency room.”

Further growth was spurred by investments made by Texas Children’s Pediatrics, whose leaders saw the benefits of the program.

“This was something that was working great, and something that we wanted to keep,” Dr. Evans. “We now have in each clinic, on average, two to six physicians—some are part-time, some are full-time. We have a social worker in most of our clinics, plus office managers and everything.”

If families have transportation problems, Texas Children’s will provide rides via Lyft from home to clinic, from clinic to pharmacy, and from pharmacy back home.

The insurance status of families in the Community Cares program patient population fluctuates with the economy. Some may start in the program having private insurance through work and then lose it if they are laid off. Then they may transition on and off Medicaid and the Children’s Health Insurance Program (CHIP) or enroll in a low-cost plan on the Affordable Care Act marketplace.

This source of care is particularly important while the AMA and the Texas Medical Association continue to advocate for the state to expand Medicaid benefits to more Texans.

“No matter what's going on in your life, we are that steady, consistent force,” Dr. Evans said. “No matter what's happening—if you lose your job, if you lose a loved one, if you have an accident, if something happens in your life, if you need a resource, if you need something—you know that we're there.”

This steady presence has created a solid foundation of loyalty between families and Community Cares.

“So these same families, when they were able to get on their feet, they stayed with us,” Dr. Evans said.

Dr. Evans noted that a focus of Community Cares is “addressing unmet needs.” For children, these can be nutritional, emotional or educational. Schools can often address all three. So, when children come in for a well visit, they are always asked how they are doing in school and what school they attend.

“We want to know what schools are feeding into our clinic, because we want to try to have a relationship with the principals, with the school nurses in our community, so that way we know what's going on with the school,” Dr. Evans said.  “We have schools and school nurses and principals that have called us because they know that we are that anchor in the community.”

Doing poorly in school can mean a student has undiagnosed learning disabilities, autism or behavioral issues that are manifesting in their difficulties with learning, Dr. Evans explained.

Similarly, poor nutrition within families can lead to chronic illness and low academic achievement.

Dr. Evans also lauded the social workers for going the extra mile by conducting coat drives, connecting young parents with low-cost diaper services and finding summer day camps that offer children nutritious meals when school is not in session.

She offered similar praise for everyone who works at Community Cares clinics.

“Sometimes people think if you are in what they call a ‘community clinic,’ or clinic in an under-resourced area, people think that you're not going to get great care,” Dr. Evans said. “We feel like just because parents may have problems with paying, every child deserves great health care from great physicians and people that care about them.”

As a long-time pediatrician who has had a long-term relationship with a particular neighborhood, Dr. Evans is now in the stage of her career where her former patients are starting families of their own.

“It’s funny, I was going through the airport and the lady who was bringing me through security goes ‘Dr. Evans! I'm pregnant and I'm coming to you soon,’” Dr. Evans said.

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