roi for mobile outreach clinic nancy hardt, md brian mcdaniel ms2 jack stacey (ruum)

ROI for Mobile Outreach Clinic

Nancy Hardt, MDBrian McDaniel MS2Jack Stacey (RUUM)

Mobile Outreach Clinic

Measuring Return on Investment

Local Solution

The University of Florida launched the Mobile Outreach Clinic in January of 2010

Stops 6 at-risk neighborhoods around Alachua County

Mobile ClinicServices & Budget• Health Screenings• Primary Care for Men, Women &

children• Well Women Check ups• Family Planning• Resources and Referrals

Harvard Study Mobile Health Map

Mobile Outreach Clinic

Budget $334k $567k $250k# of Visits/year 3702 3100 4500Value 1:35 1:19 1:34

ED & QALYS only ED & QALYS only ED & Births only

2010 2011 2012 2013-Projected; based on Q1

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Number of Visits

Number of Unique Pa-tients

Mobile ClinicNumber of Clinic Visits vs. Unique Patients

Mobile ClinicImpact on Costs to Area Hospitals & Taxpayer

Measured Impact• Emergency Room Visits•Medicaid Births

Un-Measured Impact• Strokes• Asthma Attacks• Diabetic Complications• STDs detected/treated

Number of Alachua County Emergency Department Visits by Payer 2005-2010

2005 2006 2007 2008 2009 20107000

9000

11000

13000

15000

17000

19000

21000

Self-Pay/No Payment

Private

Medicaid

Medicare

“Have you ever had to go to the Emergency Room because you

could not be seen by another doctor or

clinic?”

Yes41% No

59%

n = 431

UF MOBILE CLINIC SURVEY

“If the Mobile Outreach Clinic did NOT exist, how likely would you be to go to the Emergency Room for your current health issue?”

Very Likely29%

Very Unlikely

37%

14%Somewhat

Likely10%

Neutral

10%Somewhat

Unlikely

n = 431

For those patients that had visited the Mobile Outreach Clinic at least once in the last 6 months, “Have you made less visits to the Emergency Room in the last 6 months because of the Mobile Outreach Clinic?”

Yes53%

No47%

n = 288

Prevented Emergency Department Visits= (% of patients that answered “Very Likely”)*(Total Yearly MOC Patient Visits)= (29%)*(4600) = 1334 visits

Prevented Emergency Department Expenditure = (1334)*(cost per self pay ED visit) = (1334)*(3713) = 4,953,142 dollars per year

Return on Investment (ROI) FOR ED ONLY= = (4.95 million) / (MOC yearly budget) = (4,953,142) / (250,000) = $19.81

Florida Medicaid Births

106,220 taxpayer funded births in 2011 (Florida Charts, 2013)

62.9% of all taxpayer funded births in Florida were unintended in 2011

(Sonfield, 2011)

The Consequences

In 2006, unintended pregnancies in

Florida cost taxpayers $641.5

million (Sonfield, 2011).

Study Design: COMPARE Alachua County vs. State of Florida

Comparison

– Total birth count

– Total births paid by Medicaid

–Percentage of births paid by Medicaid

Data Sources

Florida Charts

FDOH

UF Family Data Center

Comparing Alachua Co To FL: Birth Count

2007 2008 2009 2010 2011 2012

5,200

5,400

5,600

5,800

6,000

6,200

6,400

6,600

Alachua County

2007 2008 2009 2010 2011 2012

200,000205,000210,000215,000220,000225,000230,000235,000240,000

Florida

Comparison between Alachua County and FL: Births Paid by Medicaid

2007 2008 2009 2010 2011 2012

2,700

2,900

3,100

3,300

3,500Alachua County

2007 2008 2009 2010 2011 2012

98,000100,000102,000104,000106,000108,000110,000

Florida

Percentage of Births Paid by Medicaid

20072008

20092010

20112012

40

42

44

46

48

50

52

54

56

Florida

Alachua County

Birth Density

Before Mobile Outreach Clinic

After Mobile Outreach Clinic

Cost Effectiveness

• The average Medicaid birth in Gainesville from 2007 through 2009 was $20,900 (Family Data Center, 2011)

• The clinic budget is approximately $250,000 per year• This is the same cost as 12 Medicaid funded births• In actuality, there were 94 less Medicaid births in Alachua

County in 2011 than 2010 which saved taxpayers $1,964,000 (7.856/1)

• In the following year, 2012, there were 175 fewer Medicaid funded births which amounted to $3,657,000 in savings (14.628/1)

ROI

• $3,657,000+ $4,953,142=$8,610,142• $8,610,142/$250,000=34.44• $19.81 (ED) plus $14.63(births)= $34.44/$1 invested• NOT COUNTING averted hospitalizations, averted heart

attacks, averted strokes