Lackey Free Clinic describes hybrid, virtual and digital care for uninsured working adults

Lackey Free Clinic executives told the Poquoson City Council on Monday night that the clinic provides extended primary-care visits, integrated dental and behavioral health, and technology-driven follow-up for uninsured working adults who fall into the so-called ALICE category — asset-limited, income-constrained, employed.

“We focus on adults who are uninsured who are working and so they are above the Medicaid limit,” said Larry Trumbore, chief executive officer of Lackey Free Clinic. “About 87% of our patients are working. We see about 1,600 unduplicated patients in our clinic each year and about 700 additional virtual care patients.”

The clinic’s pitch to the council emphasized three elements: long in-person appointments, continuity across medical, dental and pharmacy services, and technology to maintain contact between visits. Trumbore said the clinic schedules about 45 minutes per primary-care appointment to allow time for social-determinants screening (transportation, child care, housing and food insecurity) and to build patient trust.

“We also do screening for other factors,” Trumbore said. “If somebody needs food, we can refer them to the food bank. If they need transportation, we have grants that cover that.”

Trumbore said Lackey operates an in-house pharmacy that enrolls patients in manufacturer assistance programs and obtains donated brand-name medications for patients who qualify; he estimated the clinic obtains more than $9 million in donated medications annually and dispenses those prescriptions directly after a visit.

Amber Martin, who joined Trumbore for the presentation, described two technology programs the clinic uses to extend care between visits. The clinic uses Florence, a text-based automated program that messages patients on protocol-driven schedules (medication reminders, blood-pressure self-report prompts and simple education). Trumbore said a small test group of 25 patients with stage 2 hypertension saw 72% of participants move to stage 1 over roughly six months after enrollment in the Florence protocol, though he acknowledged the result likely reflected a combination of factors including medication adherence and broader clinic supports.

“Florence engages the person and we’ve had some older people say that’s the only text they get,” Trumbore said.

Lackey Virtual Care, the clinic’s asynchronous statewide telehealth service, allows adults anywhere in Virginia to complete an online symptom-driven interview at any hour; a clinician then reviews the aggregated information and sends a diagnosis, a self-care plan and prescriptions where appropriate. Trumbore said the service has recorded nearly 2,000 visits so far this year.

“We launched it because when people are sick on weekends or after hours, their only options are urgent care or the emergency room,” Martin said. “This platform lets the doctor and patient interact at different times and avoid unnecessary ER visits.”

Trumbore described Lackey’s volunteer base (about 300–350 volunteers annually, including pre-med students and older volunteers seeking service), funding (about 48% donations, 51% grants and 1% patient contributions), and charity-care partnerships with local hospitals that accept (and treat) Lackey patients’ specialty needs without charge under hospitals’ community-benefit/charity-care arrangements.

The presentation concluded with a short video of patient testimonials and questions from councilors. Council members thanked the presenters and noted local volunteers who serve at the clinic.

The council did not take formal action on the presentation; staff and council members invited residents to visit the clinic and encouraged continued coordination with local volunteers and health partners.