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The Emerging Business Models and Value Proposition of Mobile Health Clinics
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The Emerging Business Models and Value Proposition of Mobile Health Clinics

Khin-Kyemon Aung AB; Caterina Hill, MSC, MA; Jennifer Bennet, BS; Zirui Song, MD, PhD; and Nancy E. Oriol, MD
Mobile health clinics represent promising vehicles through which high quality, cost-effective care can be delivered to patients, especially in underserved areas.
ABSTRACT

Mobile health clinics are increasingly used to deliver healthcare to urban and rural populations. An estimated 2000 vehicles in the United States are now delivering between 5 and 6 million visits annually; however, despite this growth, mobile health clinics represent an underutilized resource that could transform the way healthcare is delivered, especially in underserved areas. Preliminary research has shown that mobile health clinics have the potential to reduce costs and improve health out­comes. Their value lies primarily in their mobility, their ability to be flexibly deployed and customized to fit the evolving needs of populations and health systems, and their ability to link clinical and community settings. Few studies have identified how mobile health clinics can be sustainably utilized. We discuss the value proposition of mobile health clinics and propose 3 potential business models for them—adoption by accountable care organizations, payers, and employers.
Population health management is an increasingly important framework in healthcare. As insurers transition from paying for volume to paying for outcomes and quality, healthcare organizations will need ways to effectively manage the health and wellbeing of patient populations. Effective population health man­agement requires coordination of care across the entire spectrum of medical, behavioral, and social services as well as the incorporation of acute care with primary care and preventive care; additionally, it will require an emphasis on care management and care coordination services, and education programs. Aside from re-imagining the ser­vices that are offered, organizations invested in population health management will need to rethink the way services are delivered and help patients overcome the many barriers that prevent them from accessing care.

At the community level, major impediments to care include af­fordability, accessibility (eg, geography, time, distance, transporta­tion, language), availability of providers or appointments, health literacy, and lack of trust.1-4 To engage communities that have long been disenfranchised from the traditional healthcare system and identify at-risk populations, healthcare organizations must be able to successfully mitigate some of these barriers. Mobile health clinics are a community-centered solution that can eliminate barriers to access, reduce health disparities, and improve care delivery while decreasing costs. These clinics on wheels travel into the heart of communities, often delivering preventative care and health education, filling crit­ical gaps in care, and in many cases, addressing social determinants of health, such as food insecurity, legal needs, and housing.

Although mobile health clinics represent a promising delivery model, with a couple of exceptions, they have yet to be incorpo­rated into the delivery models of major healthcare organizations. Few studies have examined the value mobile clinics may add to these organizations and to the emerging business models for mobile clinics. In this paper, we explore the potential value proposition of widespread deployment and utilization of mobile health clinics and discuss 3 business models through which mobile health clinics may most generate value.

An Overview of Mobile Health Clinics

There are an estimated 2000 mobile health clinics in the United States serving approximately 5 to 6 million people annually.5 These vehicles vary in size and scope according to the communities and catchment area served. In some cases, like the Boston University Outreach Van which provides food and basic supplies, connects clients to com­munity services, and provides health education, the programs are centered on transactions and are similar in size to a food truck; other larger models—the size of a city bus or flat-bed truck—house large equipment such as mammogram units, exam tables, dialysis clinics, and blood collection units. Overall, the most frequent services pro­vided by mobile health clinics are primary care and preventive care, but they may also provide dental care, mental health services, chron­ic disease management, and maternal and infant health.6 Specialty clinics also exist for a variety of services, including substance abuse treatment, asthma and allergy care, pap smear tests, pediatric care, urgent care, HIV testing, and speech therapy.7 Nearly half of mobile clinics provide more than one type of service and most patients to other healthcare services and social services agencies.

Population Served

Mobile health clinics usually serve the medically disenfranchised— individuals who are underinsured, uninsured, or who are otherwise disconnected from the healthcare system due to access barriers.5 Fif­ty-seven percent of visits to mobile health clinics are made by unin­sured individuals, 42% by individuals aged under 18 years, and 37% identify themselves as non-white while 43% identify themselves as Latino or Hispanic.5 In some areas, mobile health clinics have be­come a provider of last resort, delivering care to individuals who do not have a primary care provider or who must resort to visiting the emergency department (ED) for nonemergent health needs. One study of a mobile health clinic showed that, over a 2.5 year period, 27% of patients who visited the mobile clinic would have sought care at an ED had the mobile clinic not been available.6

Cost-Effectiveness

Research shows that mobile health clinics can provide a significant return on investment (ROI). The Family Van—a mobile health clinic serving the Greater Boston area—modeled the quality adjusted life-years gained by the prevention activities conducted and the savings from unnecessary ED visits and found that their services resulted in a $30 return on investment for every $1 invested.7 This was equal to $3 million saved through reduction in visits to the ED and more than $17 million saved in total annual value of life-years saved.7 A follow-up study found that the blood pressure screenings and hyper­tension counseling provided on the Family Van led to a 32.2% de­cline in the relative risk of myocardial infarction and a 44.6% decline in the relative risk of stroke among patients.6 These reductions cou­pled with reduced unnecessary ED visits translated to $1.6 million in savings over 36 months, or a ROI of $1.3 per $1 invested.6 Aside from the Family Van, other data also suggest cost-effectiveness of mobile clinics. Aggregate data collected by the Mobile Health Map8 based on an algorithm developed by Oriol et al (2009)7 indicate a national estimate of $14 ROI per $1 invested in a mobile clinic.8

 

Focus on Prevention


Mobile health clinics show promise in their potential to reach indi­viduals with high risk for chronic disease who have previously un­detected risk factors. Of the clients screened on the Family Van, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated levels of blood glucose, and 38% had previously undetected elevated total cholesterol.5 Other reports indicate that mobile clinics may improve outcomes and lead to early detection of cancer in patients.9,10 Mobile clinics have also been used to deliver prenatal care.11 Their overall focus on wellness and preven­tion is a valuable asset for the communities in which they operate.

Trust and Cultural Competence

One of the most critical features of mobile health clinics is their ability to build trust with the community and link clinical and com­munity settings. Mobile health clinics are embedded in the heart of communities, often parked in front of frequented shopping plazas, grocery stores, and churches. They often collaborate with local com­munity health centers, hospitals, and social services to provide holis­tic care, and they also work closely with community health workers to deliver culturally and linguistically appropriate care. The Family Van coined their approach to client services as the “Knowledgeable Neighbor Model.”12 Key components of the model include building trust, and emphasizing culturally competent health literacy, motiva­tional interviewing, advocacy, and navigational support. Visitors to the Family Van cite the organization’s convenience of location and “easy to talk to” staff as some of the reasons they keep returning.12 Other qualitative studies have reported similarly positive patient experiences indicating that mobile clinics are an alternative model for delivering accessible and affordable care.13,14 In addition to di­rectly delivering health services, mobile clinics play a critical role in referring patients to social services and primary and specialty care. In fact, the Massachusetts Partnership for Health Promotion and Chronic Disease Prevention named mobile health clinics as a state wide best practice in helping to prevent and control chronic disease and to connect community resources to clinical settings.15

Drivers of and Barriers to Adoption of Mobile Health Clin­ics

Drivers

The greatest advantage of mobile health clinics is their mobility, which allows them to more easily reach populations that do not have access to other forms of healthcare, and to be deployed flexibly as the needs of a community change over time. Given that geogra­phy, time, distance, and transportation are major impediments to accessing healthcare, mobile health clinics are unique in their abil­ity to reduce some of these barriers. Another important advantage is the versatility in services they can offer. The interior of vehicles can be outfitted to accommodate everything from exam rooms to mammography machines. Thus, mobile clinics can be customized to meet the needs of both providers and the communities being served. Their ability to link clinical and community settings and foster trust among the patients are also assets. Much of the value of mobile health clinics comes from their flexibility in where they can go, what they can do, and their ability to foster trust among patients.

Barriers

Organizations interested in piloting mobile health clinic programs may face some operational and logistical challenges. For one, the healthcare industry and employers lack familiarity with operating a mobile health unit; understanding how and where to strategical­ly deploy vans will present an operational challenge. Furthermore, equipping the vans with information technology and assuring connectivity to the Internet on the road can be challenging as well. Fi­nally, the current payment system remains a barrier to adoption. Al­though emerging value-based payments provide organizations with the opportunity to invest in new community-oriented technologies and programs, mobile health clinics are likely unsustainable under a fee-for-service model that does not reward quality or outcomes.

Emerging Business Models and Value Propositions

Accountable Care Organizations

Accountable care organizations (ACOs) are financially and clinically responsible for populations of patients and represent a payment and delivery model designed to incentivize cost-savings and improved quality. ACOs are unique in that they take responsibility for the total costs of care for their assigned population. As a result, ACOs must be able to identify and manage the health and social needs of their high-cost patients and reduce low-value spending. ACOs piloting population health management tools may be interested in deploying mobile health clinics, as they could potentially use these clinics to deliver health education, chronic disease management, primary care, preventive care, or other services with the goal of keeping their pa­tients healthy while delivering more cost-effective care. The benefit of using mobile clinics as opposed to, or in addition to, fixed-site clinics is that the former is capable of moving from area to area as high-risk populations shift over time and visiting different high-risk sites without having to invest in permanent clinic infrastructure in those areas.

Payers

 
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