1. ROI for Mobile Outreach Clinic Nancy Hardt, MD Brian McDaniel MS2 Jack Stacey (RUUM)

2. Mobile Outreach Clinic Measuring Return on Investment

3. Local Solution The University of Florida launched the Mobile Outreach Clinic in January of 2010 Stops 6 at-risk neighborhoods around Alachua County

4. Mobile Clinic Services & Budget Health Screenings Primary Care for Men, Women & children Well Women Check ups Family Planning Resources and Referrals Harvard StudyMobile Health Map Mobile Outreach Clinic Budget$334k$567k$250k # of Visits/year370231004500 Value1:351:191:34 ED & QALYS only ED & Births only

5. Mobile Clinic Number of Clinic Visits vs. Unique Patients

6. Mobile Clinic Impact on Costs to Area Hospitals & Taxpayer Measured Impact Emergency Room Visits Medicaid Births Un-Measured Impact Strokes Asthma Attacks Diabetic Complications STDs detected/treated

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

8. Have you ever had to go to the Emergency Room because you could not be seen by another doctor or clinic? Yes 41% No 59% n = 431 UF MOBILE CLINIC SURVEY

9. 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 Likely 29% Very Unlikely 37% 14% Somewhat Likely 10% Neutra l 10% Somewhat Unlikely n = 431

10. 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? Yes 53% No 47% n = 288

11. 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

12. 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)

13. The Consequences In 2006, unintended pregnancies in Florida cost taxpayers $641.5 million (Sonfield, 2011).

14. 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

15. Comparing Alachua Co To FL: Birth Count

16. Comparison between Alachua County and FL: Births Paid by Medicaid

17. Percentage of Births Paid by Medicaid

18. Birth Density Before Mobile Outreach Clinic After Mobile Outreach Clinic

19. 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)

20. 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