Abstract
BackgroundMobile health clinics provide an alternative portal into the healthcare system for the medically disenfranchised, that is, people who are underinsured, uninsured or who are otherwise outside of mainstream healthcare due to issues of trust, language, immigration status or simply location. Mobile health clinics as providers of last resort are an essential component of the healthcare safety net providing prevention, screening, and appropriate triage into mainstream services. Despite the face value of providing services to underserved populations, a focused analysis of the relative value of the mobile health clinic model has not been elucidated. The question that the return on investment algorithm has been designed to answer is: can the value of the services provided by mobile health programs be quantified in terms of quality adjusted life years saved and estimated emergency department expenditures avoided?MethodsUsing a sample mobile health clinic and published research that quantifies health outcomes, we developed and tested an algorithm to calculate the return on investment of a typical broad-service mobile health clinic: the relative value of mobile health clinic services = annual projected emergency department costs avoided + value of potential life years saved from the services provided. Return on investment ratio = the relative value of the mobile health clinic services/annual cost to run the mobile health clinic.ResultsBased on service data provided by The Family Van for 2008 we calculated the annual cost savings from preventing emergency room visits, $3,125,668 plus the relative value of providing 7 of the top 25 priority prevention services during the same period, US$17,780,000 for a total annual value of $20,339,968. Given that the annual cost to run the program was $567,700, the calculated return on investment of The Family Van was 36:1.ConclusionBy using published data that quantify the value of prevention practices and the value of preventing unnecessary use of emergency departments, an empirical method was developed to determine the value of a typical mobile health clinic. The Family Van, a mobile health clinic that has been serving the medically disenfranchised of Boston for 16 years, was evaluated accordingly and found to have return on investment of $36 for every $1 invested in the program.
Highlights
Mobile health clinics provide an alternative portal into the healthcare system for the medically disenfranchised, that is, people who are underinsured, uninsured or who are otherwise outside of mainstream healthcare due to issues of trust, language, immigration status or location
Using published data we applied a value of statistical life years saved (VSLYS) and avoidable cost of emergency department (ED) visits prevented to quantify the return on investment (ROI) of our sample mobile healthcare program
Data from the 2007 Massachusetts Division of Health Care Finance and Policy publication Analysis of 2005 Preventable Emergency Department Visits was used as the source for the cost of preventable ED visits [9], Actual service data from The Family Van were extracted to match the intervention categories used by the National Commission on Prevention Priorities (NCPP) to allow the estimation of quality adjusted life years saved (QALYS) and the calculation of their projected 'value' [8]
Summary
Mobile health clinics provide an alternative portal into the healthcare system for the medically disenfranchised, that is, people who are underinsured, uninsured or who are otherwise outside of mainstream healthcare due to issues of trust, language, immigration status or location. Mobile health clinics (MHCs) serve the full spectrum of at risk populations from the disenfranchised African-American with diabetes, to the homeless person, to the child living in a rural environment who has no health insurance They are often the provider of last resort when the mainstream system has failed to provide an environment that engenders trust or when there is no healthcare service at all. MHCs have emerged in response to the inherent needs of local communities and have provided millions of America's most vulnerable individuals with access to healthcare These clinics address both acute and chronic medical conditions using nonjudgmental and client-led approaches, which can empower their clients to overcome stigmas against traditional healthcare institutions in order receive treatment. In addition to their role as an alternative source for healthcare delivery, MHCs serve as intermediary portals for patients to access more mainstream services (through hospitals, community health centers, etc.)
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