Calculating preventative medicine’s return on investment

BOSTON, Mass. (June 2, 2009) — There are many reasons why health care costs in the US are spiraling out of control: ineffective use of resources, unmanaged chronic conditions and infrequent implementations of proven prevention strategies all contribute. While it stands to reason that preventative actions are one solution, no one has yet quantified the value of investing in non-traditional prevention programs.

Researchers from Harvard Medical School have led the development of a prototype “return on investment calculator” that can measure the value of prevention services. Using a Boston-based mobile health program called the “Family Van” to test the tool, the team found that for the services provided in 2008, this program, in the long run, will return $36 for every dollar invested.

“People talk about the value of preventative measures all the time, but no one has ever really captured the important contribution of the many non-traditional prevention-based programs like the Family Van,” says study first-author Nancy Oriol, HMS dean of students and an obstetric anesthesiologist at Beth Israel Deaconess Medical Center. “This value is underscored by the unique role that mobile health plays in reducing disparities in health outcomes, increasing access to care, and its ability to reach out to particularly vulnerable, at-risk communities.”

Findings were published online June 2 in the open access journal BMC Medicine.

The Family Van, a program of HMS, is a mobile clinic providing preventative health care and education to disadvantaged areas throughout Boston. The Van provides screening, testing, and education in areas such as nutrition, weight management, diabetes, heart disease, pregnancy, and STDs, to name a few. Their goal is to train and educate people in taking the steps necessary to prevent or better manage chronic disease.

When Oriol, co-founder of the Family Van, decided that there needed to be some way to quantify the benefits of this and similar programs, she and executive director Jennifer Bennet teamed up with the Mobile Health Clinics Network, a membership-based organization of mobile health clinics and liaison to hundreds of mobile health clinics across the country; Paul Cote, former Massachusetts Commissioner of Public Health; and Isaac Kohane, director of the Countway Library of Medicine at HMS, and a health IT expert.

Using published data from the National Commission on Prevention Priorities (NCPP), which assigns values to a broad array of preventative practices, as well as published data on the cost-savings of preventing avoidable emergency room visits, the team developed an algorithm that “calculates” a return on investment ratio, thereby quantifying the value of mobile health care to the overall health care system.

“These data provide evidence for what we have long suspected, that is, preventative health services are perhaps the most cost-effective way to address both our ailing health care system and the needs of disadvantaged communities,” says Cote.

The researchers emphasize that the Family Van data presented here is simply a proof-of-principle demonstrating the feasibility of this online calculation tool, which they intend to have publicly available in less than a year. In fact, Oriol’s team is in the process of developing a web-based version of the calculator in order to measure the impact of the more than 2,000 mobile health programs across the nation.

Ronald McDonald House Charities funded the initial phase of the project. Work is now continuing with support from the Harvard Provost Fund for Interfaculty Collaboration and the Boeing Company.

Written by David Cameron

Full citation:

BMC Medicine, online publication, June 2, 2009

“Calculating the return on investment of mobile healthcare”

Nancy E Oriol(1), Paul J Cote(2), Anthony P Vavasis(3), Jennifer Bennet(4),

Darien DeLorenzo(5), Philip Blanc(6) and Isaac Kohane(7)

1-Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA

2-Independent Health Care Consultant, Boston, MA

3-Health Outreach to Teens, Callen-Lorde Community Health Center, New York, NY

4-The Family Van, Harvard Medical School, Boston, MA

5- Mobile Health Clinics Network, San Francisco, CA

6-Robert Wood Johnson Medical School, Camden, NJ

7-Countway Library of Medicine, Harvard Medical School, Boston, MA

Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School’s Boston campus or in one of 47 hospital-based clinical departments at 17 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Cambridge Health Alliance, Children’s Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children’s Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

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