What if there were roving health clinics that brought medical advice and preventive services directly to the people who need them most—those living in inner city neighborhoods and the remote rural corners of America? What if these facilities screened so many vulnerable and forgotten people that they spotted public health epidemics before they became obvious? What if these peripatetic clinics saved the country millions of dollars in emergency room visits and early-detection efforts and yet depended for their existence on the fluctuating support of private donations rather than reliable insurance or government funds?
That’s exactly what is happening in cities and communities across the country. Fleets of medical vans venture out daily, carrying social workers, nurses, and medical students who dispense medical advice and support, screen people for a wide variety of conditions—pregnancy, hypertension, diabetes, glaucoma, high cholesterol—and at the same time collect information about medical conditions occurring among these populations. But many of these programs struggle for survival due to lack of funds.
Several years ago, Nancy Oriol, founder of the Boston-based Family Van, hit upon a way to turn this situation around—namely, by calculating exactly how much each van is saving the healthcare system. Now, she and colleagues, with a $400,000 grant from the Boeing Corporation, are building their “return on investment (ROI) calculator,” essentially a set of algorithms that will turn data about van visits and services into a dollars-and-cents figure that shows how much the Family Van, or any other mobile health clinic, is saving the country.
“Our funders will love this because we will finally have an answer to the question, ‘How much good did you do this year?’” said Oriol, HMS associate professor of anesthesia at Beth Israel Deaconess Medical Center and dean for students.
She had the first glimmers of the idea in 2004 while attending a conference of the Mobile Health Clinic Network (MHCN). Though the Family Van had been the darling of philanthropists in the early 1990s when it first hit the streets, it has required continual focused fund-raising since the late 1990s, as have many vans. “I realized we all had the same problem of proving our worth,” she said. She knew that the Family Van, which receives more than 6,000 patient visits each year, was saving the healthcare system thousands of dollars. She also knew if the van prevented just one pregnant woman from having a very low–birth weight baby—by educating her about nutrition and self care and referring her to an obstetrician—it could save $250,000, half the annual cost of the van itself.
The Family Van counsels many women and men each year and performs many other cost-effective medical screenings. Working with Jennifer Bennet, executive director of the van, Oriol and colleagues, including Anthony Vavasis of the MHCN, came up with the idea of an ROI calculator.
It works like this: using published data from health policy studies that estimate the number of dollars saved by each of a variety of interventions, such as hypertension screening, the calculator multiplies that dollar amount by the number of interventions performed by a given van. Preliminary runs show that the rate of return for the Family Van is more than 30 to 1. “For every dollar spent by us, we save the healthcare system more than $30,” said Oriol.
There is an additional payoff. “Vans are at curbs so we see health problems before anyone else does,” she said. Working with John Brownstein, HMS assistant professor of pediatrics, and Isaac Kohane, the Lawrence J. Henderson professor of pediatrics, both at Children’s Hospital Boston, Oriol, Vavasis, and colleagues are developing an early-sensing system—essentially an interactive map that locates public health problems as they happen, much the way Brownstein and Kohane’s healthmap.org does for outbreaks of infectious disease.
This unusual combination of global and community outreach appealed to Boeing. “Boeing works to ensure that families are economically empowered and recognizes that good health is a crucial part of a person’s ability to work and provide for his or her family,” said Anne Roosevelt, vice president of global corporate citizenship. “We are pleased to partner with the Family Van and other mobile health units around the country to reach people, both rural and urban, who otherwise lack access to crucial healthcare.”
Students may contact Jennifer Bennet at jennifer_bennet@hms.harvard.edu for more information.
