What is Mobile Integrated Health?
Healthcare payers looking to drive down medical care costs in the U.S. have increasingly begun partnering with EMS agencies and other providers to ensure that patients receive the proper treatment at the best location. Instead of a fee-for-service model that reimburses based on the number of services, they are shifting to outcome-based payments, looking at the quality of care delivered based on measurable patient results.
One approach proving most effective is Mobile Integrated Health (MIH) – and its associated Community Paramedicine (CP) – that aims to empower EMS agencies to make onsite treatment referrals and work via telemedicine with local providers to more effective care onsite. This often translates into a reduction in costly (and time-consuming) unneeded emergency department visits, along with a long list of additional benefits for providers, patients, and payers alike.
What is Mobile Integrated Health?
Defined as patient-centered, mobile resources in the out-of-hospital environment, MIH components can include traditional EMS response, community paramedics, advanced practice provider (PA-C, NP) responders, 911 nurse triage lines, and alternate destination/ER diversion. The approach aims to deliver higher quality and more cost-effective medical care by coordinating resources and helping patients get the right care at the right location, including assisting them in taking better care of themselves in their own homes.
Near the end of the 1990s, a handful of EMS agencies began experimenting with new “integrated healthcare delivery systems,” working with previously distinct healthcare delivery entities like hospitals, physician groups, and nursing homes. This movement’s vital component focused on preventative efforts like modifying illness and injury risks, providing acute illness and injury care and follow-up, and better treat chronic conditions. EMTs began utilizing telemedicine and alternate transport destinations to reduce the number of unneeded ED transports, saving time and resources for both the patient and providers.
Today, hundreds of EMS agencies across the nation are partnering with local health providers as well as mental health and social services providers to navigate patients to the right level of care. By leveraging the EMTs’ expertise and skills in the field, time and money are saved by getting the patients the get the care they really need more quickly.
What are the benefits of MIH?
The MIH approach delivers numerous benefits along the healthcare spectrum for providers, payers, and patients. These include:
- Reducing Unnecessary ED Visits: Emergency Departments are chronically overcrowded and overburdened. Ideally, only the most severe cases needing emergency care end up in the ED beds. Unfortunately, recent statistics show that about 30% of ED visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional costs. Additionally, mental health-related issues or non-life-threatening conditions could be redirected to other local facilities. Patients can receive more appropriate care in a timely fashion, rather than sitting in the ED waiting for a referral and additional transport.
- Reducing Hospital Readmission Rates: Patients with chronic conditions, or those sent home after a procedure, can benefit from community paramedics to improve their health and wellness at home. From follow-up visits and calls to assistance with prescriptions and medication schedules, paramedics can ensure that patients understand discharge instructions and are prepared to follow them correctly. Additionally, paramedics can offer observations from a patient’s home and lifestyle – a perspective physicians typically do not have – that provide clues into readmission causes.
- Saving Time and Money: While health care providers want the best outcome for their patients, it’s undeniable that they are trained specifically to deliver care for a defined need. Seeing a patient that will need to be sent somewhere else – or one that truly needs ongoing help rather than emergency services, for example – does nothing but waste time for the patient and the provider. Getting the right care at the right time and the right location is more efficient for all involved, and leveraging the perspective of the EMS agency onsite is invaluable in these efforts. By allowing EMTs and paramedics to make recommendations can literally save millions of dollars in expensive ED visits, transports, and consultations.
- Can Assist in a Pandemic: Never before has the value of MIH been more apparent than in the fight against COVID-19. Patients at home begin to experience symptoms and are understandably scared and confused. They call 9-1-1, not knowing what next steps to take to preserve their own health and avoid spreading to others. Rather than transporting thousands of potential cases to the ED, MIH/CP can assist in providing more effective call screening, in-home testing, vaccinations, and even counseling and monitoring to ensure that only the most severe cases end up in the ED based on genuine need. This not only lightens the load on ED providers but can reduce the virus’s spread by reducing the number of people sitting in an ED bed (some of whom may not be COVID-positive) and ensuring that family-members are appropriately tested and treated before going out into the community.
Software That Helps in the MIH Approach
EMS agencies working in the MIH/CP model typically utilize electronic patient care records (ePCRs) to note observations, recommendations, and referrals, especially when dealing with repeat patients. Today’s top ePCR software tools like ESO Electronic Health Record (EHR) help providers more easily track symptoms, medications, and treatments to make better onsite decisions.
These software tools also assist in better communication with other providers, offering secure video and photo sharing and transport alerts. Features like patient-lookup tools ensure that previous encounters are easily accessed and reviewed in real-time, bringing all responders up-to-speed quickly. Finally, ePCR software can help you document your MIH/CP visits more accurately, giving you more insight into common calls, demographics, and other metrics that help ensure funding and progress.
The Future of MIH Programs
As the integrated health approach continues to deliver cost-savings and positively impacts communities, these programs are gaining traction across the U.S. MIH-CP programs tend to be a public initiative and often rely on grant funds, EMS budget, or local jurisdiction. However, more and more agencies, payers, and government bodies see the benefit of reversing the fee-for-service model that tends to incentivize the transport and admission of most calls, even when alternative destinations might be more efficient.
Ensuring that EMS agencies will be reimbursed for delivering the right care – even if that means not transporting to the ED – payers are helping reduce waste and improve the long-term health of those they cover. EMTs and Community Paramedics are given more ability to offer insight and recommendations on the care of those they see regularly and those they encounter in an emergency situation.