Most care follows a familiar sequence. A person develops symptoms, receives a diagnosis, is treated, and the outcome is recorded.

That sequence begins after disease is visible. It rarely records the conditions a patient returns to between visits: light, movement, air, terrain, social context, and the chronic stress load of daily life.

VBOHC asks a prior question. If those conditions shape biology, they belong earlier in the sequence, where they can be measured, varied, and studied.

The research program seeks to determine whether environmental exposure can become a measurable, and potentially modifiable, component of healthcare delivery.

The unanswered question is whether we are equally good at changing the conditions that produce disease.

Chronic disease and multimorbidity now define much of clinical practice. Cardiometabolic disease, chronic pain, depression and anxiety, and neurocognitive decline are managed across fragmented settings, often for decades, while utilization and cost continue to rise.

Research on social and environmental determinants of health has shown that where and how people live is associated with health outcomes. What remains less developed is a clinical method for treating environment as something a care team can prescribe, dose, measure, and pay for.

VBOHC treats that gap as a systems and research question. It does not assume the answer.

The VBOHC research agenda asks whether structured, dosed, and instrumented environmental exposure, delivered under protocol, produces changes in disease trajectory. To count as support for the hypothesis, those changes would need to be:

1. larger than those produced by attention and activity control conditions,
2. durable beyond the exposure period, and
3. detectable in objective, disease-relevant biomarkers, not only in self-report.

Each research stream below addresses one link in that chain. Evidence is graded, and established findings, inferences, hypotheses, and commercial assumptions are reported separately.

OMOHC also maintains an explicit account of how VBOHC could be wrong: which results would weaken or falsify the hypothesis, and how the program would respond.

Value-Based Outdoor Healthcare is a framework for integrating measurable environmental exposure into clinical care, disease trajectory research, outcomes measurement, and healthcare financing.

Its organizing principle is Environment First. Biology Second. Before asking what is wrong inside the patient, VBOHC asks what the patient's environment is doing to the systems that regulate stress, sleep, metabolism, pain, mood, and cognition, and whether that environment can be changed on purpose.

VBOHC is not outdoor recreation, wilderness therapy, a wellness program, or a resort concept. It is a research program with a clinical model attached, and its claims are held to the standards of clinical research.

Framework originated by Anna Hallows, August 2021. Archived record: doi.org/10.5281/zenodo.18966778.

The VBOHC economic case rests on a chain of claims: that measured clinical change is real, that it persists, and that it reduces downstream utilization enough to offset delivery cost. Each link is a hypothesis.

The proposed VBOHC National Outcomes Registry would link clinical outcomes, utilization, claims, and environmental exposure data so that economic effects can be observed rather than projected.

OMOHC publishes illustrative financial models as models. They are never presented as observed savings or outcomes.

If environmental exposure affects health, then unequal access to health-promoting environments is a health inequity. VBOHC research asks how access to the following is distributed, and for whom it is missing:

Safe outdoor spaceClean airGreen spacePhysical activityTransportationHealthcareHealthy foodSocial connection

Nature access alone does not resolve health inequity, and VBOHC does not claim that it does. The research program treats access, transportation, cost, safety, disability, and cultural relevance as design requirements, and reports outcomes by population so that gaps are visible rather than averaged away.

The platform is designed as a seven-layer data architecture that carries information from capture through indexing, modeling, and outcomes reporting. Its purpose is to make environmental exposure and physiological response legible to clinicians, researchers, and payers in the same record.

Underlying methods are the subject of a U.S. patent application in preparation by Oak Mountain Outdoor Healthcare, LLC.

The platform is being designed to exchange data using HL7 FHIR and SMART on FHIR, so that VBOHC measures can appear inside the clinical systems care teams already use, including Epic, Oracle Health, and athenahealth environments.

Planned data sources include Apple Health, Garmin, Fitbit, Oura, WHOOP, continuous glucose monitoring systems, GIS platforms, and public environmental datasets.

None of these integrations currently exists. Names are listed to describe design intent and do not indicate any partnership or endorsement.

The proposed field station sits on two privately held parcels totaling 2.99 acres in Ogden Valley, adjacent to the Nordic Valley area and the Uinta-Wasatch-Cache National Forest. Mountain terrain, forest, water, snow, and four distinct seasons make the setting suited to studying exposure across conditions.

The concept is a single elevated day facility, designed above the floodplain with no encroachment into the creek's riparian corridor, with outdoor treatment paths organized around the four clinical domains. There is no overnight lodging and no surface parking lot; access is proposed by shuttle from an off-site park-and-ride.

The site is intended as a prototype: a first facility whose design, measurement systems, and operating model could be standardized for other settings.