Mobile clinics assume greater role in preventive health care

WASHINGTON — One afternoon last month, the Family Van stopped at the corner of Washington and Roxbury streets in Boston. The regulars had already formed a line, waiting in the lingering summer heat for the red and green RV to arrive.

The Family Van, which is funded in part by Harvard Medical School, provides free blood pressure tests, HIV counseling and basic medical care to underserved neighborhoods across Boston. The van has been operating since 1992, and mobile health clinics like it have been around for decades, but they are assuming a more prominent role as the U.S. health care system places a greater emphasis on preventive care.

Encouraged by incentives in the Affordable Care Act, health care providers and insurers are trying to treat health care problems before they turn into costly health crises. Mobile clinics are an effective way to reach patients who may forgo preventive care because they can’t afford it or can’t get to a doctor’s office.

A primary goal is to avoid expensive emergency room visits. One 2012 study estimated that between 14 and 27 percent of ER visits could have been handled somewhere else, saving an estimated $4.4 billion annually.

Dr. Anthony Vavasis, an internist at Mount Sinai Beth Israel in New York City who has studied the impact of mobile clinics, said they help health systems avoid the “million-dollar patient” — patients who make their first contact with the health care system when a serious condition develops and medical attention becomes urgent. The cost of treating related complications can skyrocket over time.

“If you build connections early on, then you can avoid having them come to the emergency room for complications later,” Vavasis said.

Studies have shown the success of mobile clinics in identifying and improving previously undiagnosed conditions. A 2014 study published in The American Journal of Managed Care found that Family Van patients who were diagnosed with high blood pressure had significantly lower blood pressure on follow-up visits. That led to fewer health crises, including a 32 percent reduction in the relative risk for heart attack and a 45 percent reduction in the relative risk of stroke.

A 2017 study by the Advisory Board Company, a health care consulting company, found that 12 percent of Family Van patients learned about a previously undiagnosed condition, such as diabetes or glaucoma, and a quarter were referred to followup services.

Mobile Care Chicago’s Asthma Van program, which delivers care to more than 6,000 underprivileged students in Chicago every year, has reported similar success in identifying asthma-related issues early on and diverting patients from the emergency room.

According to Matt Siemer, executive director of Mobile Care Chicago, more than 60 percent of the program’s patients had been using an ER as their primary treatment site for asthma before going to the Asthma Van. Of those who relied on the mobile clinic for their asthma care needs for a year or more, less than 5 percent ended up back in the ER.

Recently Mobile Care Chicago started working with hospitals and health plans to target ZIP codes where high concentrations of children cycle through the ER for asthma-related issues. Siemer estimates that the Asthma Van program produces at least $450,000 a year in savings through ER diversions alone.