Mobile clinics can address health equity and cut costs

Harvard Medical School's Family Van, which provides healthcare and screenings in Boston.

At a time when healthcare leaders are facing growing pressure to address health equity, advocates for mobile clinics say they can help improve patient care and cut costs.

Harvard Medical School’s Mobile Health Map and the Mobile Healthcare Association published a new report this week looking at the success of mobile clinics. The report also looked at how mobile clinics mesh with the business objectives of healthcare organizations by promoting their brand, reducing expenses in emergency department care and engaging patients in novel ways.

Mollie Williams, executive director of Harvard Medical School's The Family Van

Mollie Williams, executive director of the Mobile Health Map and Harvard’s Family Van mobile clinic, and Elizabeth Wallace, executive director of the Mobile Healthcare Association, spoke with Chief Healthcare Executive about mobile clinics and how they can make a differencel.

“Mobile clinics have been a successful tool in creating access to care and creating trust in communities,” Wallace said.

Nationwide, about 2,000 mobile clinics are providing healthcare services.

Health organizations and government agencies have utilized mobile clinics throughout the COVID-19 pandemic to deliver vaccines. Williams said the pandemic appears to be driving more interest in health organizations using mobile clinics. She said she’s seen more calls from groups wanting to start mobile clinics in the past couple of years.

The pandemic “shined a light on the problems of health and equality,” Williams said. “It has accelerated the pace of change.”

Mobile health clinics and services have been around for decades, with some targeting specific groups, such as members of minority groups, the LGBTQ community, or veterans.

In the past, health leaders behind mobile clinics have had to struggle to show the return on investment of mobile clinics.

Both Williams and Wallace point to the potential of reducing costs to health systems. If healthcare systems can address health needs in underserved communities with mobile clinics, then they can reduce the odds that some of those patients may end up in the hospitals for lengthy and costly stays.

Mobile clinics typically have startup costs of $150,000 to $200,000, which is far less than a fixed physical location, Williams notes. “You can try some things, see if it works,” she said.

Since the clinic is mobile, there’s the ability to park somewhere else if there’s a neighborhood with a more pressing need for health services.

“The amount you spend on a mobile clinic is not substantial when you consider how much states and hospitals are spending on uncompensated care,” Williams said.

As Wallace notes, mobile clinics can help stem some of the “frequent flyers to emergency departments.”

The Family Van estimates it has saved $2.8 million in emergency department costs over five years.

Some research has shown the healthcare benefits of mobile clinics. A 2014 study in The American Journal for Managed Care noted that patients screened for high blood pressure by the Family Van showed better numbers in follow-up visits, reducing their risk of heart attack and stroke.

Mobile clinics record 5 million to 7 million visits annually, according to a 2020 study by the International Journal for Equity in Health. More than 60% of the patients seen by mobile clinics in that study were Black or Latino.

While most healthcare leaders say improving equity is one of their primary goals, many healthcare leaders aren’t specifically budgeting for it. Leaders looking to make progress in reducing disparities in outcomes should look to mobile clinics, Wallace said.

Making mobile clinics work

Healthcare leaders need to plan carefully before setting up a mobile clinic, Wallace said.

Elizabeth Wallace, executive director of the Mobile Healthcare Association

“Before your mobile clinic ever has wheels, go out into the community,” Wallace said. “Just because you build it doesn’t mean they’re going to come.”

Healthcare systems and hospitals need to engage the community, including schools, church leaders, or organizations such as the YWCA, to get a handle on community needs. While a mobile clinic aimed at women’s health may be a laudable goal, community leaders and those who live in the neighborhood may say there’s a greater need to help those with respiratory problems, such as asthma, or dental care.

Healthcare leaders should be “asking the community what they want and not making that decision from the C-suite,” Wallace said.

It’s also important to figure out the financial sustainability of a clinic. Mobile clinics are typically financed by philanthropy, federal, state or local government funds, insurers or patient payments.

As the report on mobile clinic notes, some grants may cover the purchase of a vehicle or the first year of operations.

As Wallace said, “You have to think about how we’re going to keep it on the road.”

Healthcare organizations should strive to get funding from multiple sources. “Relying on one grant is often a recipe for not succeeding,” Wallace said.

Health systems can work with state and local governments or other social service agencies or non-profit organizations to finance mobile clinics. Healthcare organizations can also work with private insurers on mobile clinics that can help keep patients out of the hospital.

In any event, healthcare leaders looking to operate mobile clinics need more than a vehicle, Wallace said. They need a years-long plan.

“We advise you always have to be looking three, five years down the road,” Wallace said.

Healthcare leaders shouldn’t treat mobile clinics as pilot programs, said Williams, who runs the Mobile Health Map. Those clinics should be aligned with the health system’s larger strategy for achieving health equity.

If the mobile clinic isn’t part of a health system’s broader strategy, Williams said, “It may be successful but it won’t be sustainable.”

Patient-centered approach

Williams, who operates Harvard’s Family Van, said the mobile clinic embraces a whole patient approach.

“The clinical encounters that happen in that van are night and day from when I go to a doctor’s office,” she said.

While a typical appointment with a physician can be focused on a singular health issue, Williams said with the Family Van, “the first thing we say is open-ended: How can we help you today?”

The goal is building a relationship and establishing trust with patients.

“Taking in the whole person makes a huge difference,” Williams said.

Some members of underserved communities view the healthcare system with skepticism.

“Trust is a serious issue,” Williams said. “We knew that before the pandemic. The pandemic has exacerbated that.”

Because mobile clinics are immersed in their communities, they can foster relationships with patients, Williams said. For some of those patients, the mobile clinic becomes their medical home, while a mobile clinic can help direct patients to other services.

Mobile clinics are able to form deep relationships with the people in their communities, Williams said.

“Mobile clinics go where people live, work, play and pray,” she said.