Davette Roundtree, a health educator and certified HIV tester, works with a patient in the Family Van, a mobile clinic supported by the Harvard Medical School that provides free health care and education in the Boston area.

Putting a value on prevention could keep programs running

A team of researchers is crafting a calculator that determines a return on investment for mobile health van services.

By Susan J. Landers — Posted Aug. 10, 2009

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An ounce of preventive health care is probably worth at least a pound of cure. But how does that translate into dollars?

Nancy Oriol, MD, is working with colleagues to find the answer. Dr. Oriol, dean of students at Harvard Medical School in Boston, is especially interested in figuring out the return on investment for the Family Van, a mobile clinic she founded at the school 17 years ago.

The van provides free preventive health care and education to people living in disadvantaged areas in Boston. Its staff can handle 7,000 patient visits annually if the operation is fully funded.


Dr. Oriol

But raising the nearly $600,000 necessary each year to cover operating costs involves a time-consuming round of applying for grants from numerous philanthropic organizations. So an approach was needed to tell funding groups how much bang for the buck the van delivers.

Using data from other research, Dr. Oriol and colleagues who operate vans in other cities developed a "return on investment calculator" they believe can provide a dollar figure for the preventive services their vans provide. A study on the prototype calculator was published online June 2 by the journal BMC Medicine (link).

Determining a dollar amount

Researchers calculated the value of mobile health clinic services by comparing them with the costs of emergency department services that were avoided and the potential life years saved by providing the services. They used data on the value of preventive practices developed by the National Commission on Prevention Priorities, an initiative of the Partnership for Prevention, a Washington, D.C.-based organization of businesses, nonprofit groups and government agencies.

When they put the calculator through a test run recently, the physicians found that services provided by Boston's Family Van in 2008 would, in the long run, return $36 for every $1 spent. The algorithm on which the calculator is based still needs to be tested additionally and refined.

Even with the calculator, pinning down the dollar value of a mobile clinic's services is not yet an exact art. The Boston van's patients are treated anonymously, and staff members don't know whether patients follow through on referrals.

"We can't do traditional health outcomes research," said Dr. Oriol, an obstetric anesthesiologist at Beth Israel Deaconess Medical Center in Boston.

Co-investigator Anthony Vavasis, MD, clinical director of the Health Outreach to Teens program, a van that provides services to teens and young adults in New York City, said: "There was no real data to support what we do. We have to clearly establish costs."

The researchers' next step is to put the calculator on the Internet for other mobile clinics to use. That could happen within the year.

"The van programs will be able to plug in their data on what they did and who they served, and it will be enough to make quality estimates," said Dr. Oriol, who received the AMA Foundation's Pride in the Profession Award in March for her work with underserved patients.

Dr. Oriol and her colleagues' work in prevention has attracted attention from Congress and others at a time that prevention is being discussed as part of health system reform proposals. Meanwhile, a survey released on June 8 indicated that the public ranks prevention as the most important health care reform priority.

"We found out that 77% of those surveyed believe prevention will save money and 72% said it was worth doing even if it doesn't save money," said Jeff Levi, PhD, executive director of the Trust for America's Health, which conducted the survey with the Robert Wood Johnson Foundation.

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External links

"Calculating the return on investment of mobile healthcare," BMC Medicine, June 2 (link)

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