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October 18, 2017

How to avoid the 'Million-Dollar Patient'? Mobile clinics, MD says

Daily Briefing

    Hospitals and health systems are increasingly investing in mobile health clinics to provide preventive care to people who might otherwise not be able to access health care services—and cut down on avoidable ED use, Scott Rodd writes for the Pew Charitable Trusts' "Stateline."

    What they do

    According to Rodd, mobile clinics provide a variety of preventive services, including blood pressure tests, HIV counseling, and asthma treatment. Because the clinics are mobile, and are therefore able to provide care to patients in familiar settings, they can help overcome barriers to care, including cost, transportation, and even mistrust of the medical institution, Rodd writes.

    In addition, mobile clinics increasingly are seen as an efficient way to curb avoidable ED use, Rodd writes, which can help the health care industry curb overall costs. Ultimately, according to Anthony Vavasis, an internist at Mount Sinai Beth Israel, mobile clinics enable heath systems to avoid the "million-dollar patient"—a patient whose first encounter with a provider occurs only after he or she has developed a serious condition that requires costly urgent care. However, "if you build connections early on, then you can avoid having them come to the [ED] for complications later," Vavasis said.

    Success stories

    Research indicates that mobile clinics are successful at fulfilling that need: identifying and addressing otherwise undiagnosed illnesses, Rodd writes.

    For instance, Rodd cites a 2017 study from the Advisory Board that found 12 percent of patients seeking care from Harvard Medical School's mobile clinic, called The Family Van, were diagnosed with a previously undiagnosed condition, and 25 percent received referrals for follow-up care.

    Further, a separate 2014 study found patients of The Family Van who were diagnosed with high blood pressure presented with substantially lower blood pressure over the course of their follow up visits. And because their blood pressure was lower, those patients were able to lower their risk for related health emergencies, including a 32 percent decline in their relative risk for heart attack and a 45 percent decline in their relative risk of stroke.

    Further, a 2017 study from the Advisory Board found that 12 percent of patients seeking care from the Family Van were diagnosed with a previously undiagnosed condition, and 25 percent received referrals for follow-up care.

    The same study also found that between 2015 and 2016, Circle Health Service's mobile needle exchange in Ohio reported a 38 percent increase in exchanged needles and a 25 percent increase in patients served. According to Rodd, a key feature of the clinic is the presence of two staff members who previously misused drugs. These nonclinical employees have helped established trust with the clinic's patients, reaching out to them about the needle exchange and various preventive services, such as hepatitis C screenings and flu shots.

    Meanwhile, Matt Siemer, the executive director of Mobile Care Chicago, reported similar success for patients seeking care at the organization's Asthma Van, which serves more than 6,000 low-income students in Chicago. More than 60 percent of Asthma Van patients had previously relied on an ED as their primary source of asthma care, Siemer said, and among patients who had received care at the mobile clinic for at least a year, less than five percent returned to the ED. According to Siemer, the Asthma Van saves around $450,000 each year in ED diversions alone.

    And in Dallas, Parkland Health and Hospital System uses a mobile program called HOMES to serve the homeless population in the area, providing care to more than 9,000 patients in 2015, over 75 percent of whom did not have insurance. "We use mobile clinics to go to locations where homeless people congregate," said Susan Spalding, the medical director of HOMES.

    Obstacles remain

    Despite the success of mobile clinics, there are still a fair number of obstacles to overcome, Rodd writes.

    For example, Advisory Board research indicates that launching a mobile clinic can cost about $300,000, with another $450,000 in operation costs each year. According to Rodd, those high costs can dissuade health administers, particularly because—despite a bevy of smaller, short-term studies—there are not many long-term, large-scale studies on the effects of such initiatives.

    Moreover, Spalding cautioned that mobile clinics, while helpful in overcoming some obstacles to care, are not a cure-all for the problems of the health care system. Nonetheless, if "thoughtfully applied, they are an important component of care for the most vulnerable populations in our country," she said (Rodd, "Stateline," Pew Charitable Trusts, 10/11).

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