As the EMS provider for more than 880,000 people in the greater Fort Worth area, MedStar sees the use of the 9-1-1 system for medical and trauma conditions that, for the patient's benefit, could best be addressed by a response other than an ambulance trip to an emergency department. In 2008, 21 individual patients were transported to area emergency rooms more than 2,000 times by MedStar, resulting in $962,429 in ambulance charges (not including the charges from the hospital emergency departments). Majority of these bills are uncollectible. A large number of our population is using EMS as a health care safety net.
This is a scenario played out all across the country. While the national debate on health care reform continues, we at MedStar felt it important to address the problem immediately, and locally.
In July 2009, MedStar implemented the Community Health Program that identified high system users and developed individual care plans for each of those patients.
As part of that care plan, the enrolled patient receives regularly scheduled home visits by one of our Mobile Healthcare Providers. During those home visits the paramedic provides a medical assessment, ensures the patient is taking their prescribed medications and is following up with their primary care provider. They also provide some often much-needed social interaction for these patients.
That humble beginning has led to the development and implementation of several programs all centered on Patient Navigation and Mobile Integrated Healthcare:
9-1-1 Nurse Triage - Low acuity 9-1-1 callers are referred to a specially trained RN in our Call Center who helps the patient find appropriate resources for their medical issue.
"EMS Loyalty" Program - Patients who use 9-1-1 15 or more times in 90 days, or are referred into the program by ED case managers due to high ED utilization, are enrolled. MedStar's Mobile Health Providers (MHPs) conduct regular home visits, connect the patients to available resources and teach the patients how to better manage their own healthcare. Typical enrollment is 30-90 days.
CHF Readmission Avoidance - CHF patients at risk for a 30-day readmission are referred to MedStar by the patient's Case Manager or PCP. MedStar conducts a series of home visits to educate the patient and family on appropriate care management and loops the patient to their PCP. If the patient needs intervention, the MedStar MHP may coordinate in-home diuresis with the patient's PCP, along with a follow-up PCP appointment.
Hospice Revocation Avoidance - Patients/families at risk for revoking hospice status by calling 9-1-1 for an urgent trip to the ED are identified by the Hospice agency. MedStar and the Hospice agency coordinate efforts to reduce the possibility of the patient/family revoking hospice status.
Observation Admission Avoidance - Working with our local ACO, patients who may be admitted to ED observation status may instead be referred by the ED physician to the MedStar MIH program. The MHP provides an overnight visit to do an in-home assessment and coordinate the transition of care back to the patient's PCP the next day.
Home Health Partnership - Through an innovative partnership with Klarus Home Care, MedStar and Klarus collaborate to provide effective after-hours episodic care for Klarus' patients, and to notify the Klarus Home Care nurse in the event of a 9-1-1 call to a patient on Klarus' services. Working together, the Klarus staff and the MedStar MHP determine the most appropriate care for a patient on Klarus' service.
The goal of the Mobile Healthcare Program is to meet the Institute for Healthcare Improvement's Triple Aim:
- Improve patient outcomes, including their experience of care
- Improve the health of the population
- Reduce Costs
The Agency for Healthcare Research and Quality (AHRQ) has published MedStar's MIH programs on the AHRQ Innovation Exchange in 2012, 2013 and 2014. Click here to view the most recent AHRQ publication on the MIH programs.
Since its inception, MedStar's Mobile Healthcare Programs have saved more than $3.7 million in healthcare expenditures, and currently reduces 9-1-1 trasnports to the ED by enrolled patients by 29.4% during a typical 30 - 90 day "EMS Loyalty Program" enrollment and by 82.4% in 12 months after program graduation. Click on the links below to see the outcome and economic analysis of MedStar's Mobile Healthcare Programs.
MedStar has significant experience developing and implementing multiple aspects of community paramedicine with programs such as 9-1-1 Nurse Triage, "EMS Loyalty Program" members, "Observation" Admission Avoidance Program, Congestive Heart Failure patient management (including IStat point of care testing and in-home diuresis) and a new Hospice Revocation Prevention program.
Feel free to contact Matt Zavadsky for more information on how MedStar can assist you with the development and implementation of MHP programs in your local community.
MedStar has hosted more than 140 communities from 40 states and 5 foreign nations for site visits to experience first-hand how these programs work. To request a site visit, please click on the link below.
MedStar Site Visit Request
Click on the links below to view some of the local media stories on these programs, the impact they have on our patients and the healthcare system.
CBS-11 Story on 9-1-1 Nurse Triage
CBS 11 Story on CHP Program
FOX 4 Story on the CHF Program