SOUTH BREWSTER COUNTY — At a Big Bend Regional Hospital District (BBRHD) meeting on December 19, the board once again discussed the challenges of providing healthcare in Terlingua and the surrounding area. County Judge and former Terlingua EMS Director Greg Henington kicked off a conversation about Hamilton Health Box, a company that specializes in setting up “microclinics” in disadvantaged and rural communities.
CEO Toby Hamilton was on hand to share his vision and answer questions. Hamilton said that his commitment to healthcare in Far West Texas was personal — he was born in Clint, just outside of El Paso, and has spent much of his career trying to improve health outcomes for rural patients.
Hamilton got his start by making “microclinics” and “microhospitals” that partnered with remote providers to blend telemedicine with in-person counsel. To keep costs low, a nurse intimately familiar with the community staffs the facility in-person while a team of online providers interpret labs, write prescriptions and offer guidance.
These “microclinics” can either come as prefabricated buildings — a literal “Health Box” — or can set up shop in existing spaces. Regardless of the path each community chooses, they are universally equipped with a large screen for telemedicine calls and all of the diagnostic equipment an on-site professional would typically need.
The goal is to keep costs low while providing consistent care to patients who might not otherwise have access to consistent, quality services. While attracting a full-time in-person doctor to the area might seem appealing, labor shortages and the rough realities of South Brewster County living makes recruitment daunting. “We practiced developing models that were very innovative and efficient and could work in communities that wouldn’t otherwise be economical,” Hamilton said.
The company’s presentation to the BBRHD comes on the heels of good news — in May, Hamilton Health Box announced that they had raised $10 million in funding. “The Series A funding will expedite the company’s expansion into rural markets, bringing its distinctive small footprint and high-touch care model to rural America and the 98 million Americans residing in Health Professional Shortage Areas (HPSAs),” they wrote in a press release.
The board didn’t vote to commit to jumping in headfirst but opted instead to gather more information and discuss the prospect again at their January meeting.
Hamilton’s pitch comes at a crossroads in the administration of a $5.5 million grant from the federal government benefitting healthcare in Presidio and Terlingua. While after-hours and walk-in care has expanded in Presidio — and both communities have benefitted from a community paramedicine program that offers primary care to people who can’t physically get to a clinic — a 2025 deadline to appropriate all of the grant funds is looming.
Terlingua has not had a reliable local clinic for decades, and most residents drive 80-plus miles to Alpine and beyond for medical care. The fledgling grant-funded project allows for a handful of patients to be seen in a small temporary space (affectionately known as “the closet”) in the South Brewster County Emergency Response Center, which also houses the busy local fire and EMS services.
The original goal had been for Preventative Care Health Services (PCHS) to expand the existing clinic from one day a week to two by the spring of 2024. With that goal not yet met, some board members are looking for other organizations that might be able grow a sustainable permanent clinic.
No matter who ultimately administrates the clinic, the project will take hard work and dedication — and some financial risk — to establish.
Contracting with Hamilton Health Box won’t be the board’s magic wand, but the company’s CEO believes that the “Health Box” model contributes to the grant’s greater goal of diverting patients from the emergency room and fostering a happier, healthier community overall. “Our thesis is that access and convenience drive engagement, meaning that if it is super accessible and convenient, people will come see us,” Hamilton said. “If you come see us, we can get you healthy.”