title: Calculating the return on investment of mobile healthcare.
abstract: BACKGROUND
  Mobile health clinics provide an alternative portal into the healthcare system for the medically disenfranchised, that is, people who are underinsured, uninsured or who are otherwise outside of mainstream healthcare due to issues of trust, language, immigration status or simply location. Mobile health clinics as providers of last resort are an essential component of the healthcare safety net providing prevention, screening, and appropriate triage into mainstream services. Despite the face value of providing services to underserved populations, a focused analysis of the relative value of the mobile health clinic model has not been elucidated. The question that the return on investment algorithm has been designed to answer is: can the value of the services provided by mobile health programs be quantified in terms of quality adjusted life years saved and estimated emergency department expenditures avoided?
  
  
  METHODS
  Using a sample mobile health clinic and published research that quantifies health outcomes, we developed and tested an algorithm to calculate the return on investment of a typical broad-service mobile health clinic: the relative value of mobile health clinic services = annual projected emergency department costs avoided + value of potential life years saved from the services provided. Return on investment ratio = the relative value of the mobile health clinic services/annual cost to run the mobile health clinic.
  
  
  RESULTS
  Based on service data provided by The Family Van for 2008 we calculated the annual cost savings from preventing emergency room visits, $3,125,668 plus the relative value of providing 7 of the top 25 priority prevention services during the same period, US$17,780,000 for a total annual value of $20,339,968. Given that the annual cost to run the program was $567,700, the calculated return on investment of The Family Van was 36:1.
  
  
  CONCLUSIONS
  By using published data that quantify the value of prevention practices and the value of preventing unnecessary use of emergency departments, an empirical method was developed to determine the value of a typical mobile health clinic. The Family Van, a mobile health clinic that has been serving the medically disenfranchised of Boston for 16 years, was evaluated accordingly and found to have return on investment of $36 for every $1 invested in the program.
authors.affiliation: Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. nancy_oriol@hms.harvard.edu
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Oriol
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Cote
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Vavasis
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bennet
authors.forename: Darien
authors.initials: D
authors.lastname: Delorenzo
authors.forename: Philip
authors.initials: P
authors.lastname: Blanc
authors.forename: Isaac
authors.initials: I
authors.lastname: Kohane
mesh_terms: D001900:Boston; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006801:Humans; D008952:Mobile Health Units / Q000191:economics*; D011788:Quality of Life