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Mobile Health Clinics in the Era of Reform
*Caterina F. Hill, MSc, MA (Cantab); *Brian W. Powers, AB; Sachin H. Jain, MD, MBA; Jennifer Bennet, BS; Anthony Vavasis, MD; and Nancy E. Oriol, MD (*Joint first authors)
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Mobile Health Clinics in the Era of Reform

*Caterina F. Hill, MSc, MA (Cantab); *Brian W. Powers, AB; Sachin H. Jain, MD, MBA; Jennifer Bennet, BS; Anthony Vavasis, MD; and Nancy E. Oriol, MD (*Joint first authors)
This article reviews the mobile clinic sector's impact on access, quality, and costs, and explores postreform opportunities for leveraging them nationally.
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.17 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.21-23

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.

Author Affiliations: 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).

Source of Funding: 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.

Author Disclosures: 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.

Authorship Information: 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).

Address correspondence to: Nancy E. Oriol, MD, Dean of Students, Harvard Medical School, Ste 244, 260 Longwood Ave, Boston, MA 02115. Email: Nancy_Oriol@hms.harvard.edu.
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