One of the core principles of population health is reducing unnecessary utilization by trading high-cost care for lower-cost services. For this shift to occur, patients must have access to a consistent source of care in the first place—but data show that many already-vulnerable populations do not.
For instance, more than 50% of uninsured non-elderly patients lack a usual source of health care, and 25% of low-income patients miss or reschedule appointments because they lack transportation. Others are unable to adjust work schedules to accommodate traditional clinic hours or are distrustful of the health care system at large.
However, connecting patients to existing sites of care may not always solve these problems. That's why many providers are bringing care to patients through the use of mobile health clinics.
These programs are costly but have been shown to be an effective method for reaching the underserved. The average cost for operating a mobile program is $429,000—but the average return is 12:1.
In order to run a successful operation, however, provider organizations must identify the specific structural barriers in the communities they serve and zero in on a core goal and target population. Based on our interviews with program leaders from across the country, there are three common objectives that typically guide mobile clinic deployment:
1. Gaining patient trust
For patients who may be disengaged from or distrustful of the health care system, mobile clinics may serve as a comfortable entry point, since they can be stationed in the communities where families live and work. In addition, most mobile clinics are incredibly purposeful in their cultural competency efforts.
Harvard Medical School's The Family Van, for instance, positions itself as a "knowledgeable neighbor" and seeks to engage low-income Boston communities in a variety of ways beyond just offering preventive services, education, and social services connections. Staff speak languages common in the communities and are trained in cultural sensitivity. In addition, patients prioritize what they'd like support with at any given visit, and community input determines service offerings.
2. Removing logistical barriers to care
For some communities, the primary challenge is physical access to care. Mobile health clinics can directly address transportation or distance barriers by providing care in an accessible location for this target population.
For example, Parkland Health & Hospital System's HOMES Program visits 31 different community organizations to serve existing concentrations of individuals with unstable housing. Nurses, physicians, or advanced practitioners deliver clinical care, psychosocial services, medication access, and referrals to other programs on site. In 2015, the HOMES program served 9,377 individuals, 78% of whom were uninsured.
3. Filling a service gap in the community
Most commonly, mobile clinics provide general preventive screenings, primary care, and/or dental services. However, some target highly prevalent conditions or service lines for which there is insufficient access in a given community.
For example, a shortage of asthma specialists in a particular part of Chicago led to significant ED visits and deaths. In response, Mobile Care Chicago began offering free medical and preventive care, education, and support to low-income children through a partnership with local schools. The local health care system saved an estimated $6.7 million in one year due to decreased ED use.
For more information on these programs or others we researched, please contact Clare Wirth at WirthCl@advisory.com.
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