*Brian W. Powers, AB

There has been substantial growth in the number of physicians pursing Master of Business Administration (MBA) degrees over the past decade, but there is continuing debate over the utility of these programs and the career outcomes of their graduates. The authors analyzed the clinical and professional activities of a large cohort of physician-MBAs by gathering information on 206 physician graduates from the Harvard Business School MBA program who obtained their degrees between 1941 and 2014. Key outcome measures that were examined include medical specialty, current professional activity, and clinical practice. Chi square tests were used to assess the correlations in the data. Among the careers that were tracked (n = 195), there was significant heterogeneity in current primary employment. The most common sectors were clinical (27.7%), investment banking/finance (27.0%), hospital/provider administration (11.7%), biotech/device/pharmaceutical (10.9%), and entrepreneurship (9.5%). Overall, 84% of physician-MBAs entered residency; approximately half (49.3%) remained clinically active in some capacity and only one-fourth (27.7%) reported clinical medicine as their primary professional role. Among those who pursued residency training, the most common specialties were internal medicine (39.3%), emergency medicine (10.4%), orthopedic surgery (9.2%), and general surgery (8.6%). Physician-MBAs trained in internal medicine were significantly more likely to remain clinically active (63.8% vs 42.4%; 

 = .01). Clinical activity and primary employment in a clinical role decreased after degree conferment. After completing their education, a majority of physician-MBAs divert their primary professional focus away from clinical activity. These findings reveal new insights into the career outcomes of physician-MBAs.

	This analysis of all physician-graduates from Harvard Business School provides new perspectives on the careers of physicians with a Master of Business Administration (MBA) degree. 

		There was significant heterogeneity in current primary employment sectors. The most common sectors were clinical, investment banking/finance, and hospital/provider administration. 

		The majority of physician-MBAs enter residency, but less than half remain clinically active in some capacity. Those trained in internal medicine were significantly more likely to remain clinically active over time. 

		Clinical activity and primary employment in a clinical role decreased after degree conferment. After completing their education, a majority of physician-MBAs divert their primary professional focus away from clinical activity.

Confronting the contemporary challenges facing healthcare delivery—variable clinical quality, high costs, and poor patient experience&mdash;will require skilled physician leaders who can seamlessly blend clinical knowledge and management acumen. Many observers have argued that formal management and leadership training for physicians is an important strategy to address this need.

Although management education is slowly being integrated into medical school curricula, the prevailing approach for teaching these skills remains in Master of Business Administration (MBA) programs.

 Over the past decade, there has been tremendous growth in the number of physicians pursuing dual training in medicine and management; in 2000, there were fewer than 30 joint MD/MBA programs, but by 2012, the number had more than doubled to 65.

 An increasing number of physicians are also returning to business school after completing their clinical training through full- or part-time MBA programs.

There is continued debate over the benefits for, and career outcomes of, students enrolled in these programs.

 Many medical schools launched joint degree programs in order to train the next generation of clinical leaders—as skilled in management as they are in medicine. Anecdotally, healthcare professionals often suggest that MBA degrees lead physicians to choose jobs in industries such as consulting, finance, or the pharmaceutical industry, that are more lucrative than those in clinical practice and management. Despite these assertions, few studies have rigorously explored careers pursued by physician-MBAs.

To better understand this issue, we gathered information on the clinical training and current professional activities of 197 of the 206 physicians who have received an MBA degree from Harvard Business School (96% sample). We used self-reported graduate information from the school’s alumni database. When informational gaps were identified in that database, we used LinkedIn, Doximity and Google searches to fill in individual work histories.

Several illustrative trends emerged from our analysis. Among these physician-MBAs, there is significant heterogeneity in primary employment and specialties. The 5 most frequent primary professional roles were clinical (27.7%), investment banking/finance (27.0%), hospital/provider administration (11.7%), biotech/device/pharmaceutical (10.9%), and entrepreneurship (9.5%). Surprisingly, only 4.4% worked primarily as management consultants. Among the 166 individuals who pursued residency training, the most common specialties were internal medicine (39.3%), emergency medicine (10.4%), orthopedic surgery (9.2%), and general surgery (8.6%).

We found significant time-related trends in clinical activity. Overall, 84% of physician-MBAs entered residency; roughly half (49.3%) remained clinically active in some capacity, but only a quarter (27.7%) reported clinical medicine as their primary professional role. Our data also indicate that physicians with management training reduce their clinical activity over the course of their careers (

). From the time of obtaining their terminal degree, clinical activity and primary employment in a clinical role decreased significantly, reaching nadirs of 20.69% and 6.90% after 10 to 14 years. Interestingly, an increase in activity was noted 15 or more years after the physicians completed their education. The observed pattern could represent a combination of changes in the professional aspirations of students enrolled in joint MD/MBA degree programs over time—perhaps due to changes in macroeconomic factors affecting clinical and nonclinical sectors at the time of their graduation&mdash;as well as a career trend in which MD/MBA alumni become increasingly likely to forgo clinical practice in later stages of their careers. Our data do not allow us to test these various explanations directly.

Physician-MBAs trained in internal medicine were significantly more likely to remain clinically active than their peers who trained in other fields (63.8% vs 42.4%; 

 = .01). This association could stem from different career priorities for individuals training in internal medicine, or it could represent the fact that, compared with other fields (eg, surgical specialties), it is more feasible to integrate part-time clinical work into a career in internal medicine.

The limitations of these data are 2-fold. First, they represent the experience of a single business school that may not be representative of the broader physician-MBA population. Second, the motivations for pursuing an MBA degree and the eventual career paths of physician-MBAs are dynamic. For example, whereas previous generations of physicians may have pursued management training to escape clinical practice, today, others may do so in preparation for positions of clinical leadership or as policy makers.

These outcomes raise important questions, the interpretation of which, depends on one’s perspective on the appropriate role of physician-MBAs. If we assume that role is to provide clinical leadership and management within delivery systems, then we might be discouraged by the fact that only 11.7% of physician-MBAs hold management positions in provider groups, hospitals, or health systems.

If, however, we take the view that other domains of the healthcare industry benefit from additional clinical perspective delivered by physician executives, then the observed trends could be viewed more positively. This perspective is akin to the established benefits of training MD/PhD physician-scientists, whose laboratory careers take them out of the clinic, yet their work is still informed by clinical insight. Our view is consistent with this latter perspective.

As the healthcare industry occupies an increasing share of the US economy, we will be well-served if physicians with clinical perspective are integrated into other sectors of the healthcare economy. These physicians can provide critical clinical insight into management decision making that has previously lacked such input. That said, medical educators should pay careful attention to the overall numbers of physicians whose training involves management education and consider developing alternative pathways for clinical management education that keeps trainees firmly grounded in healthcare settings. A delicate balance is needed to ensure that the proliferation of formal management training for physicians is effectively and efficiently translated into achieving the national goals of better care and lower costs.

The authors would like to thank the office of external relations at Harvard Business School and Cara Sterling, Director of the Health Care Initiative at Harvard Business School, for their help obtaining the data analyzed in this project.

 Harvard Medical School (DL, BWP), Boston, MA; Harvard Business School (DL, BWP, RH), Boston, MA; Google Ventures (BR, KY), Boston, MA; Massachusetts General Hospital (BR), Boston, MA; McLean Hospital (BR), Belmont, MA; Brigham and Women’s Hospital (KY), Boston, MA; CareMore Health System (SHJ), Cerritos, CA; Stanford University School of Medicine (SHJ), Palo Alto, CA.

 Drs Jain, Yeshwant, and Robbins are graduates of Harvard Business School. Mr Powers is an MD/MBA student at Harvard and Mr Ljuboja is an MD student at Harvard who will dual enroll in the MBA program in the fall. Dr Huckman is employed by Harvard University, which is presented as the source of the paper's data and sponsors an MD/MBA program. The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. The views expressed in this article represent the authors’ views and not necessarily the views or policies of their respective affiliated institutions.

 Concept and design (DL, BR, SHJ, RH, KY); acquisition of data (DL, BR, SHJ, RH, KY); analysis and interpretation of data (DL, BR, BWP, SHJ, KY); drafting of the manuscript (DL, BR, BWP, SHJ, KY); critical revision of the manuscript for important intellectual content (DL, BR, BWP, SHJ, RH, KY); statistical analysis (BR, BWP, KY); provision of patients or study materials (BR, KY); administrative, technical, or logistic support (BWP, SHJ); and supervision (SHJ, RH).

 Sachin H. Jain, MD, MBA, CareMore Health System, 12900 Park Plaza Dr, Ste 150, Cerritos, CA 90703. E-mail: sachin.jain@caremore.com.

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Articles

Large-scale analysis of Harvard Business School’s physician graduates yields new insights into physician-MBA career choices and the utility of these programs.

When Doctors Go to Business School: Career Choices of Physician-MBAs

Healthcare delivery is a networked enterprise. The connections between providers, payers, and purchasers have a profound influence on the quality and value of care patients receive.

 American sociologist Mark Granovetter has developed a useful typology for understanding how these networks function: through strong and weak ties.

 Strong ties are relationships between individuals of the same group (eg families, friends, or colleagues) and are small, frequent, intimate, and durable. Weak ties represent the connections between individuals of different groups, and are distributed, sporadic, and often fleeting.

The value of strong ties is intuitive; such connections provide reliable structures for socialization and support. Granovetter argues that weak ties, although more nuanced, are just as important. By bridging different groups, weak ties provide exposure to new people and new ideas. For example, Granovetter’s research demonstrates that weak ties are more impactful than strong ties in helping individuals find new opportunities for employment.

 Ultimately, neither strong nor weak ties are categorically more important, nor is either a substitute for the other. Each has unique benefits, and the most effective individuals and organizations tend to operate in networks enriched by both.

Granovetter’s paradigm of strong and weak ties has important implications for healthcare delivery and the ways in which it is changing. If we consider strong ties as the connections between physicians in the same practice, provider group, or hospital, then weak ties are the connections between physicians across organizations, including former colleagues, classmates, or naturally occurring referral networks. As healthcare reform unfolds, the nature of these relationships is changing. For most of American medical history, weak ties have dominated physician networks. Individual and small-group practices were the norm. Physicians had admitting privileges at hospitals, but that was often where their formal connection to other providers and institutions ended. Amidst this climate, informal networks of physicians emerged, based more on shared patients and social connections than on market forces and payment structures.

Over the past 2 decades, network dynamics have shifted from weak to strong ties. Whereas the majority of physicians worked in physician-owned practices in the 1990s, today, most are employed by hospitals.

 The Affordable Care Act and related private-sector reforms have accelerated these trends, most notably, through the growth of accountable care organizations (ACOs) and continued consolidation in the care delivery market.

ACOs and other high-profile delivery system innovations have been designed to promote coordinated care. To achieve these aims, they create formal networks of physicians and strive to confine care delivery to small networks. New networks created under these models are often substantially different than the organic referral networks they replace.

 Confidence in the potential of ACOs is grounded in a belief in the power of strong ties and the added control they afford over healthcare utilization. Success is predicated on the notion that formal networks of providers will lead to more coordinated and effective care.

Although a shift toward strong ties promises benefits, there are unintended consequences to the concomitant abandonment of weak ties. A tremendous amount of learning, improvement, and innovation is needed to achieve the national goals of better care, better health, and lower costs. Physician networks are central conduits to these efforts—the means by which information on what works best in healthcare is created and shared.

 Optimal knowledge generation and dissemination requires a delicate balance between strong and weak ties.

Strong ties promote learning and diffusion within groups, whereas weak ties foster knowledge transfer between groups. As such, weak ties can help individuals acquire useful knowledge more rapidly, innovate swiftly, and nimbly respond to challenges—a pattern demonstrated empirically in healthcare and other industries.

 Efforts to improve the identification, adoption, and spread of new innovations and best practices will be hamstrung within physician networks dominated by strong ties. Even Granovetter observed that “social systems lacking in weak ties will be become fragmented and incoherent, new ideas will spread slowly, scientific endeavors will be handicapped.”

 Structuring away informal knowledge sharing networks has the potential to create insular nodes of practice, with poor communication among different organizations and groups of physicians.

This may be especially problematic for the care of patients who do not fit neatly into clinical guidelines. Whereas the creation and adoption of clinical guidelines is likely to be accelerated through strong ties, care for complicated patients necessitates weak ties. Physicians have historically managed these nuanced patients through informal consultations and referrals, tapping into networks of friends and colleagues forged during training and clinical practice. In doing so, they learn from the experiences of physicians within and outside of their organization, and adapt their practice accordingly. Within physician networks increasingly dominated by strong ties, these patients may be promptly whisked away to in-system specialists, often through automated referral protocols. Therefore, what is gained by stopping “leakage” is also a lost opportunity for systemwide learning.

Consolidation and strict affiliation risk the endurance of weak ties, as well as the natural innovation and learning that occurs through them. As care delivery models continue to evolve, it will be important to consider strategies to preserve, or reintroduce, weak ties among physicians. Learning networks can help bridge the gaps between clusters of strong ties, and increased clinical data sharing and reporting will allow physicians to see and learn how colleagues at other institutions provide care. Most important will be the need for payers and policy makers to design rules and regulations that, instead of promoting excessive consolidation, allow for independent physician groups to survive, and even thrive, in new delivery models.

Both strong and weak ties have their roles in the organization and structure of healthcare delivery—and the most effective and efficient models will recognize and accentuate the value created by each. Prevailing strategies for delivery reform focus on the power of strong ties by tightening and formalizing relationships among physicians and health systems. Ignoring the importance of weak ties will jeopardize the long-term success of these initiatives. Granovetter urged us to remember the strength of weak ties, so as health reform moves forward, it will behoove policy makers and health system leaders to do the same.

 Harvard Medical School (BWP), Boston, MA; Harvard School of Public Health (AKJ), Boston, MA; CareMore Health System (SHJ), Cerritos, CA; Stanford University School of Medicine (SHJ), Palo Alto, CA.

 Dr Jain is an employee of CareMore Health System. Mr Powers and Dr Jha report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

 Concept and design (BWP, SHJ); acquisition of data (BWP); analysis and interpretation of data (BWP, SHJ); drafting of the manuscript (BWP, SHJ); critical revision of the manuscript for important intellectual content (BWP, SHJ, AKJ); administrative, technical, or logistic support (BWP, SHJ, AKJ); and supervision (SHJ, AKJ).

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New delivery models are altering the connections between physicians, which may lead to a decreased capacity for innovation and the slower spread of new ideas.

Remembering the Strength of Weak Ties

 Despite the role of mobile clinics in delivering care to the full spectrum of at-risk populations, the collective impact of mobile clinics has never been assessed. This study characterizes the scope of the mobile clinic sector and its impact on access, costs, and quality. It explores the role of mobile clinics in the era of delivery reform and expanded insurance coverage.

 A synthesis of observational data collected through Mobile Health Map and published literature related to mobile clinics.

Analysis of data from the Mobile Health Map Project, an online platform that aggregates data on mobile health clinics in the United States, supplemented by a comprehensive literature review.

 Mobile clinics represent an integral component of the healthcare system that serves vulnerable populations and promotes high-quality care at low cost. There are an estimated 1500 mobile clinics receiving 5 million visits nationwide per year. Mobile clinics improve access for vulnerable populations, bolster prevention and chronic disease management, and reduce costs. Expanded coverage and delivery reform increase opportunities for mobile clinics to partner with hospitals, health systems, and insurers to improve care and lower costs.

 Mobile clinics have a critical role to play in providing high-quality, low-cost care to vulnerable populations. The postreform environment, with increasing accountability for population health management and expanded access among historically underserved populations, should strengthen the ability for mobile clinics to partner with hospitals, health systems, and payers to improve care and lower costs.

Mobile clinics are an integral component of the healthcare system, serving vulnerable populations and promoting high-quality care at low cost.

		There are an estimated 1500 mobile clinics, receiving 5 million or more annual visits nationwide.

		Mobile clinics improve access for vulnerable populations, bolster prevention and chronic disease management, and reduce costs.

		Expanded coverage and delivery reform increase opportunities for mobile clinics to partner with hospitals, health systems, and insurers to improve care and lower costs.

The Affordable Care Act (ACA) has expanded insurance coverage to millions, but other barriers to access remain. Mobile clinics are customized vehicles that travel to the heart of communities, both urban and rural, and provide prevention and healthcare services where people work, live, and play. They overcome barriers of time, money, and trust, and provide community-tailored care to vulnerable populations.

Despite their scope and importance in delivering care to the full spectrum of at-risk populations, the collective impact of mobile clinics has never been assessed. Mobile clinics have historically lacked resources for evaluation, advocacy, and dissemination of best practices, which has reduced their visibility in the healthcare landscape. Recent collaborations and data sharing initiatives within the mobile clinic community provide the first opportunity to gather data and characterize the mobile clinic sector in the United States.

The Mobile Health Map project was launched to enable the first opportunity for the mobile clinic community to gather data about itself. Mobile Health Map is an online platform where the community of mobile clinics aggregates its data for the purpose of documenting the scope, geographic reach, and value of the services provided. In this article, we use data collected through this project as well as the small body of published research to provide the first comprehensive description of the mobile clinic sector and its role in the evolving care delivery environment. Specifically, we provide a description of the demographics of the mobile clinic sector and document its impact on access, quality, and costs. In the discussion, we use these results to explore the role of mobile clinics in the era of delivery form and expanded access.

Analysis in the study is based on data retrieved from the Mobile Health Map project as of March 11, 2013. As of this date, 644 clinics were registered on Mobile Health Map. The number of mobile clinics providing data as well as the type of data provided was as follows: 528 on service type, 282 on average annual number of visitors, 65 on visitor insurance status, 69 on visitor gender, 38 on visitor race, 72 on Hispanic status, 69 on visitor age, and 104 on rural/urban status. The data from the Mobile Health Map project were supplemented by a comprehensive literature review on mobile health clinics and their impact on access, quality, and costs.

Scale and Scope of the Mobile Clinic Sector

Scale. Mobile clinics operate in every state across the country, and in Washington, DC, and Puerto Rico (Figure). Epidemiological modeling estimates that 1500 to 2000 mobile clinics exist nationwide, based on the 644 mobile clinics currently registered on the Mobile Health Map project.

 Each mobile clinic serves an average of 3100 visitors per year, totaling approximately 5 to 6 million visits annually for the sector as a whole.

. Mobile clinics serve communities that have the poorest access to health services in the United States. Target populations include those of racial and ethnic minority backgrounds, the homeless, displaced populations, recent immigrants, migrant workers, people lacking insurance, and children. The clinics typically serve uninsured and lower-income individuals: 57% of visits are made by uninsured persons, and 35% by publically insured persons. Men utilize mobile clinics almost as much as women (46% of visits are made by men, 54% by women). People from racial and ethnic minority backgrounds are a key demographic for mobile clinics: 37% of visits are made by individuals that identify as non-white, while 43% are made by individuals identifying as Hispanic or Latino. Mobile clinics reach individuals of all ages: 42% of visits are by those younger than age 18, 50% by those aged 18 to 65, and 8% by those older than age 65. Mobile clinics serve both rural and urban populations: 14% of clinics serve rural areas, 41% serve urban areas, and 44% serve both.

. Mobile clinics provide a wide range of services tailored to community needs. Some function as comprehensive patient-centered medical homes, while others focus on specific diseases, such as pediatric asthma. Overall, 44% of mobile clinics provide primary care, 42% provide prevention services, and 31% provide dental care. Many also provide mammography, mental health, and a variety of specialty services.

. Mobile clinics have a diverse spectrum of organizational and funding arrangements. They can exist as independent entities (45%) or be operated by hospitals (25%), community health centers (16%), or academic medical centers (15%). Funding sources are similarly varied. Mobile clinics are primarily funded through philanthropy (38%), but state and federal programs (17%) as well as independent companies and private insurance providers (10%) are common sources of financial support.

Impact of Mobile Clinics on Access, Quality, and Costs 

Expanding access for vulnerable populations

. Mobile clinics are particularly successful in reaching vulnerable populations that have poorer health and less-than-optimal access to healthcare (

). By traveling to these communities and offering affordable, or, oftentimes, free services, mobile clinics remove logistical constraints such as transportation issues, difficulties making appointments, long wait times, complex administrative processes, and financial barriers such as health insurance requirements and copayments.

Mobile clinics also overcome subtler barrier challenges in maintaining trusting relationships between healthcare providers and community members. Qualitative research has found that the mobile clinic staff’s marriage of professional and personal discourses fosters trusting relationships, allowing them to stay engaged with clients and to support them through behavior changes and navigation of the healthcare system.

Promoting prevention. There has been considerable national focus on the need for safety-net programs to provide communitybased prevention, screening, and chronic disease management, particularly for low-income, minority, and rural communities. Several studies have found that mobile clinics are successful at improving screening and identifying high rates of chronic and infectious disease among underserved populations.

Improved screening allows mobile clinics to deploy interventions that improve treatment and prognosis. For example, studies found that underserved women utilizing the van services for prenatal care initiated care earlier than women using other services.

. Many mobile clinics provide ongoing support for chronic disease management to vulnerable populations. Patients who presented at the Family Van clinic in Boston with high blood pressure experienced reductions in their systolic and diastolic blood pressure of 10.7 and 6.2 mm Hg, respectively, during followup visits. This correlated with a 32% reduction in the relative risk for heart attack and a 45% reduction in the relative risk for stroke.

 Similarly, a school-based mobile asthma-care clinic for urban underprivileged children was associated with increased daily anti-inflammatory medication usage, decreased emergency department (ED) visits, hospitalizations, and school absenteeism compared with before enrollment.

. Mobile clinics can produce significant cost savings as a result of their ability to provide community-tailored care in high-risk areas. The principal source of savings is a reduction in avoidable hospital and ED visits. An asthma-oriented mobile clinic generated savings of $3500 per child due to reduced ED visits and hospitalizations resulting from improved asthma control.

 A study that aggregated data from 10 larger, more comprehensive mobile clinics estimated cost savings of $6.8 million from avoidable ED visits over a 1-year period.

 Significant cost savings are also possible from improved disease management and increased use of preventive services. The improved hypertension control in the Family Van mobile clinic was associated with a lower-bound return on investment estimate of 1.3 when combined with avoided ED visits.

When the long-term benefit of prevention is considered, the return on investment is more substantial. A study of the Family Van in Boston used estimates of the value of quality life-years saved from preventive services and the cost of avoidable ED visits to estimate a staggering return on investment of $30 for every $1 invested in the program.

Mobile clinics represent an integral component of the healthcare system that delivers care to populations that are hard to reach by the traditional system, improving access and supporting prevention and chronic disease management. Mobile clinics are able to leverage their ability to overcome barriers to access and build trusting relationships to reduce disparities, improve health, and reduce costs.

Despite this potential, many mobile clinics often struggle to forge financially sustainable arrangements with care delivery organizations and payers. Recent reforms to the delivery system and health insurance coverage have the potential to improve the integration of mobile clinics into existing care delivery structures.

Since the passage of the ACA in 2010, federal and private payers are increasingly negotiating at-risk accountable care contracts with hospitals and health systems. The expectation of these arrangements is that not only will they improve the health and experience of care for individuals, but also that they will improve the health of populations while reducing the rate of cost growth. But hospitals and health systems often lack access to, or expertise in, the levers necessary to control health at the community level. Instead of struggling to develop these capacities, care delivery organizations can partner with mobile clinics that have experience in addressing the health needs of communities. Mobile clinics are uniquely qualified to provide high-quality care to underserved populations, and they can do so with considerable cost savings. St. Joseph Health, a $4.4-billion nonprofit Catholic health system with 14 hospitals serving California, Texas, and New Mexico, is a prime example. St Joseph Health invests $5 million annually in mobile health clinics, 11% of which is offset by reimbursements. These mobile clinics provide care through their more than 32,000 patient encounters annually, and offer services such as primary care and dental and vision care to people in need.

Historically, one of the major challenges for mobile clinics has been demonstrating return to investors. Delivery reform focused on population health management has the potential to help mobile clinics secure stable funding streams. There is evidence that mobile clinics can generate cost savings and substantial return on investment. Traditionally, however, these savings did not accrue to the delivery organization. The expansion of contracts that tie hospital compensation to performance on quality and costs will bolster the business case for investments in mobile clinics; savings generated by mobile clinics will accrue directly to the hospital.

A closely related recent development is the expansion of health insurance coverage. Mobile clinics serve mainly the publically insured and uninsured. This mix will shift as previously uninsured individuals enroll in Medicaid programs during the implementation of ACA coverage reforms. It is notable that the Family Van clinic in Massachusetts did not see a decline in visitors after healthcare reform took effect in 2006—92% of individuals visiting the Van have health insurance.

 Even with expanded coverage, there are still barriers to primary care services, such as waiting times, copayments, complexities of navigating the system, and feelings of intimidation.

A growing Medicaid population should facilitate partnerships with care-delivery organizations and strengthen funding streams. State Medicaid programs are turning to contracting mechanisms that place providers at financial risk for population health management and cost control. These reforms should promote partnerships between mobile clinics and health centers that care for large Medicaid populations under accountable care contracts. Similarly, as Medicaid programs look to improve value amid increasingly tight state budgets, policy makers should consider increasing funding to mobile clinics. Sick, disadvantaged patients with complicated social circumstances account for a majority of Medicaid spending. The ability of mobile clinics to reach vulnerable populations and promote improved disease management suggests that they will be effective in addressing the needs of this population.

 Harvard Medical School, Boston, MA (CFH, BWP, SHJ, JB, NEO); Boston-VA Medical Center, Boston, MA (SHJ); Merck and Co, Inc, Boston, MA (SHJ); Callen-Lorde Community Health Center, New York, NY (AV); Beth Israel Deaconess Medical Center, Boston, MA (NEO).

 The Mobile Health Map project has been supported by the Boeing Company, the President & Fellows of Harvard College, Provost Fund, Ronald McDonald House Charities, and the US Department of Health and Human Services’ Office for Minority Health through the Hispanic Association of Colleges and Universities Award # 6PCMP111058-01-02.

 Dr Vavasis reports being the board chair of the Mobile Health Clinics Association, which stands to benefit financially from increased membership, a possible result of this article. Ms Hill reports doing paid work for the Family Van mobile health program and applying for and receiving grants to support mobile healthcare programs. The other authors (BWP, SHJ, JB, NEO) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

 Concept and design (CFH, BWP, AV, NEO); acquisition of data (CFH, NEO); analysis and interpretation of data (CFH, BWP, NEO); drafting of the manuscript (CFH, BWP, AV, NEO); critical revision of the manuscript for important intellectual content (CFH, BWP, JB, AV, NEO); statistical analysis (CFH); obtaining funding (JB, NEO); administrative, technical, or logistic support (CFH); supervision (JB, NEO).

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This article reviews the mobile clinic sector's impact on access, quality, and costs, and explores postreform opportunities for leveraging them nationally.

*Brian W. Powers, AB

Articles

When Doctors Go to Business School: Career Choices of Physician-MBAs

Remembering the Strength of Weak Ties

Mobile Health Clinics in the Era of Reform