How a Nontraditional Model May Help Solve the Healthcare Crisis

Every week, The Family Van, a mobile health clinic, travels Boston neighborhoods. Like other mobile health service providers, the Family Van has the opportunity to make an impact in more than one community precisely because of its mobile nature. Instead of waiting for doctor visits, community members with chronic illnesses, such as hypertension and diabetes, are able to keep track of their blood pressure and blood sugar levels weekly—and only steps from home.

After 18 years rolling around the streets of Boston, the Family Van has established itself as a mainstay in the communities it serves. It provides a constant reminder to community members to stay on top of their health. In essence, the van acts as a three-dimensional, interactive advertisement for preventive care. Services provided aboard the van are focused on empowering community members to better manage chronic illnesses. While Family Van staff members and volunteers never diagnose or treat, the risk assessment, education and counseling that this nonprofit provides may explain Newsweek’s recent claim that this “little van” is making “a big impact.” Family Van staff assists those with preexisting diagnoses to manage their health.

They also encourage others who may be at risk to receive screenings and education, which, at times, reveal precursors to chronic disease. With the help of the dedicated staff, the Family Van devotes itself to compassionate curbside care based on a process of disease management of healthy behaviors.

Cost-Effective Care on Wheels

In its infancy, the Family Van was a pioneer in mobile health. Today, however, the van is one of an estimated 2,000 mobile health clinics across the United States. These clinics offer a range of services, including preventive medical services, dental care and mammograms. While these services can be found elsewhere in the American healthcare community, mobile clinics offer the added—and otherwise elusive—benefit of remarkable cost-effectiveness.

According to www.mobilehealthmap.org—an initiative founded by the Family Van in an effort to centralize information about mobile clinics across the country—these clinics offer, on average, a $21 return for every $1 invested. The Family Van itself boasts a $36 return on investment. The enormous difference between money in and services out among mobile clinics can be explained partially by the number of emergency room visits avoided. When an individual chooses to seek care aboard the Family Van instead of an ER, he or she is saving Massachusetts taxpayers, on average, over $900.

Indeed, while a visit to the emergency room costs an average of $923, an encounter on a mobile health clinic costs the organization an average of around $117. The remaining savings can be accounted for by additional quality-adjusted life years (QALY), or years where major health crises were avoided, resulting in a higher quality of life and reduced healthcare costs. Patients with chronic illness who utilize services on the van are better able to manage their health and thus enjoy a higher quality of life. The return-on-investment calculator is available to all members of www.mobilehealthmap.org. It is our hope that such successful figures assist the mobile health community as a whole in securing recognition and funding for mobile health projects across the country.

Outcomes in Constant Motion

On board the Family Van one Tuesday morning in Hyde Park, Boston, a young African-American man came in to check his blood pressure, blood sugar and cholesterol levels. He had recently been diagnosed with high cholesterol and was especially eager to find out his results of the cholesterol screening. After waiting a few moments, the machine finally displayed a total cholesterol level of right around 200 mg/dL—good news for this client. As the volunteer filled out a “My Screenings” card—a business card-sized souvenir given to each visitor with space to record multiple readings from multiple visits—the young man asked, “So, should I share this information with my doctor?” And, of course, the reply was an emphatic, “Yes, please!” While this young man came onto the van seeking assistance, ultimately he is taking charge of his own health and we are just along for the ride.

The Family Van, www.mobilehealthmap.org members, and other mobile clinics cannot solve every crisis within the American healthcare system, nor do they intend to. But by providing basic and essential services, mobile clinics help empower individuals to take responsibility for their own health, as evidenced by the gentleman who took ownership over his cholesterol levels. Through counseling and administering services as well as simply acting as a constant reminder, mobile clinics are finding a crucial niche in intervening on a community level and conveying the importance of human health.

Ultimately, as our nation struggles with mounting healthcare costs and searches for new solutions and alternative avenues, we hope that mobile health clinics will receive a place in these resolutions, offering a viable, cost-effective model for how to deliver patient care and advance healthcare systems in the United States.

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Amanda Pillsbury, a medical education consultant, is a four-year veteran of The Family Van team. Jennifer L. Bennet is executive director of The Family Van, a pioneer in the growing trend in public health practice, at Harvard Medical School. (Contact: Jennifer_Bennet@hms.harvard.edu)