MedStar Collaboration Gets COVID Vaccines to Cook Children's Homebound Patients

Sonji Gentry rarely leaves home with her 9-year-old twin boys, Hayden and Morgan. And that was true even before the pandemic. The risk of exposing Morgan, who is medically fragile, to viruses and illnesses circulating within the community is too great.

Morgan was born with a very rare and life-threatening condition called Maple Syrup Urine Disease (MSUD). Because of this metabolic disorder, Morgan’s body lacks the enzymes necessary to break down amino acids found in protein. Those amino acids build up, become toxic and cause severe health issues.

Catching COVID-19 could land Morgan in the hospital or cause life-threatening complications. It was a risk his mother wanted to minimize, so when the COVID-19 vaccine became available Sonji jumped at the chance to get vaccinated. After speaking with Morgan’s physician, she wanted the same for him and his brother. But getting Morgan out of the house is a daunting task. He is developmentally delayed, wheelchair dependent and relies on a feeding tube for nutrition. On top of that, Sonji worried about the potential exposure to the virus while out in public to get the vaccine. She found herself in a Catch-22.

Then came a call from the Gentry twins’ insurance provider — Cook Children’s Health Plan (CCHP). The health plan offered to have the COVID-19 vaccine delivered and given to Morgan and Hayden in their home thanks to a unique partnership between CCHP and MedStar, a Tarrant County emergency medical services (EMS) agency.

The partnership is the result of a simple ask.

“I’m trying to sort out options on how to provide COVID vaccinations to our homebound members. Might MedStar be able to assist?” read a text message from Kimberly Aaron, M.D., to her long-time colleague Matt Zavadsky.

Dr. Aaron is the vice president of clinical affairs at CCHP and Zavadsky is the chief transformation officer for MedStar. The two have a history of working together within their various roles in the health care industry.

Zavadsky responded with a quick yes and, within minutes, that single text put into motion a partnership between the two organizations to offer medically fragile and homebound children access to the COVID-19 vaccine without ever having to leave their home.

The program is a unique one, according to Zavadsky.

“I'm pretty well plugged in nationally in EMS circles and this isn't happening in most communities,” he said. “This type of innovation is what Cook Children’s is known for.”

The program targets CCHP STAR Kids members who are either ventilator dependent or technology-dependent for continuous feedings or other medications.

“It’s hard for a child dependent on this type of technology to get out and go to a pharmacy to get a vaccine,” Dr. Aaron explained. “It’s just too cumbersome.”

There’s the issue of exposure, too. These families often do not elect to leave their home for anything other than visits with their health providers because medically complex children are at high risk for severe disease when exposed to any virus, not just COVID-19.

“We wanted to see what we could do to remove these barriers, such that the only barrier was whether or not the family was comfortable getting the vaccine for the child,” Dr. Aaron said.

That’s where MedStar comes in. The nature of their business makes MedStar uniquely suited to help CCHP get vaccinations to their homebound members. After all, who better to take health care to the home front than those who already do it every day?

“We’re used to working in a mobile environment and inside people’s homes,” Zavadsky said. “It’s what we do. It’s a natural fit for us to go into the community and provide medical care.”

Most people know MedStar, especially families with homebound children who have likely had an experience with the agency responding to an emergency call at their residence. They’re a familiar and trusted community service. That trust goes a long way when opening the door to someone offering your child a vaccine.

MedStar is also an authorized vaccine provider. This gives the agency ample access to free vaccine materials directly from the federal government, which means no vaccine cost is passed on to CCHP or its members. Not all EMS agencies in the country have this authorization.

The process is simple. CCHP identifies qualifying members according to their medical condition and makes initial contact with the family to see if they are interested in the service. If yes, CCHP notifies the child’s primary care physician that the family has opted in to receive the vaccination at home. MedStar then makes contact with the family to schedule the home visit where emergency medical technicians (EMTs) administer the vaccine to the child and any other household members, like parents and siblings, who want it. MedStar administered both rounds of Morgan and Hayden’s vaccination and boosted their mom and dad.

The health plan reimburses MedStar for the administration of the vaccine, so it’s all done at no cost to CCHP members. The service is completed by EMTs who wish to pick up extra shifts. No personnel or MedStar units are taken out of normal daily service to make home vaccination visits.

MedStar administered the first in-home vaccination on Dec. 22, for a total of 16 to date.

“For every member we vaccinate, we feel like it’s worth the effort to do our best to make sure these families and their children have access to the vaccine in a way that doesn’t further marginalize them in terms of their ability to get that protection,” Dr. Aaron said.

Response to the program has been positive.

“I love it,” Sonji said. “We don't have to wait in lines. We don't have to be standing or sitting around other people. We get to stay in the privacy of our home. It was very convenient.”

Like the Gentrys, other families participating in the program are grateful for CCHP’s efforts to bring the vaccine to their doorstep and for MedStar going above and beyond to vaccinate other members of the household.

“These families are so appreciative,” Zavadsky said. “In many cases, I've heard from the EMTs that have gone out and given the vaccine that the families are shocked that CCHP would make this arrangement to have someone from MedStar come to their house and do preventive care. They're so used to seeing us when somebody is hurt or having trouble breathing or has an allergic reaction. The fact that we're coming out and doing something that will prevent a 911 call, I think it's like the best partnership ever.”