Mobile Health Care Operations and Return on Investment in Predominantly Underserved Children with Asthma: The Breathmobile Program

Abstract

Underserved populations have limited access to care. Improved access to effective asthma care potentially improves quality of life and reduces costs associated with emergency department (ED) visits. The purpose of this study is to examine return on investment (ROI) for the Breathmobile Program in terms of improved patient quality-adjusted life years saved and reduced costs attributed to preventable ED visits for 2010, with extrapolation to previous years of operation. It also examines cost-benefit related to reduced morbidity (ED visits, hospitalizations, and school absenteeism) for new patients to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits). This is a retrospective analysis of data for 15,986 pediatric patients, covering 88,865 visits, participating in 4 Southern California Breathmobile Programs (November 16, 1995-December 31, 2010). The ROI calculation expressed the cost-benefit ratio as the net benefits (ED costs avoided+relative value of quality-adjusted life years saved) over the per annum program costs (∼$500,000 per mobile). The ROI across the 4 California programs in 2010 was $6.73 per dollar invested. Annual estimated emergency costs avoided in the 4 regions were $2,541,639. The relative value of quality-adjusted life years saved was $24,381,000. For patients new to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits), total annual morbidity costs avoided per patient were $1395. This study suggests that mobile health care is a cost-effective strategy to deliver medical care to underserved populations, consistent with the Triple Aims of Therapy.

Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program

“…31 However, access to care is clearly an important contributor to poor outcomes in other asthma populations given the success of mobile asthma programs in reducing missed school/work days and acute asthma-related health care use. 32,33 Although mobile programs reduce barriers, such as transportation and lack of health insurance, in addition to improving care access, results are not necessarily maintained, 34 and black patients are still less likely than white patients to achieve asthma control. 32 Access to primary care physicians and asthma specialists is also an important consideration because inability to receive a same-day appointment with an outpatient physician is a major factor in the decision to seek emergency care.…”

The scope and impact of mobile health clinics in the United States: a literature review

“…Avoidable ED visit rates signify the greater health needs of the surrounding communities, and MHCs can help fill those needs by providing tailored and easily-accessible care at costs much lower than ED visits, freeing up ED resources for those who actually require emergency care and reducing total healthcare expenditure. Breathmobiles, a program that offers medical care and monitoring on mobile clinics for children living with asthma in underserved populations, analyzed 88,865 visits by 15,986 patients from November 1995 to December 2010 on 4 of their mobile clinics in Southern California, and approximated the annual cost reduction in ED visits to be at $2,541,639 [ 81 ]. Data from the Family Van estimated that visits to their MHC avoided 2851 ED visits and thus saved about $1.4 million from January 2010 to June 2012 [ 30 ].…”

“…HABITS for Life estimated that $10 million worth of QALYs were saved based on their screening efforts in the 2011 fiscal year, with a ROI of $15 dollars per dollar invested [ 64 ]. Likewise, the aforementioned 4 Southern Californian Breathmobiles estimated that $24,381,000 worth of QALYs were saved by their services within a 5-year period, with a ROI of $6.73 per dollar invested [ 81 ].…”

Creation and implementation of SAMPRO™: A school-based asthma management program

“…12 Breathmobile programs have demonstrated a significant reduction in annual rates of emergency department visits and hospitalizations and school absenteeism and a significant return on investment resulting from reduced asthma morbidity. 13 School-based telemedicine and community health care workers are also a potential avenue to increase access to specialty asthma care in underserved populations. 14–16 …”