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.
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. Since June 2012, 2,663 low-acuity 9-1-1 callers have been referred to this program, and 40% of these patients have had a response other than an ambulance to the emergency department. This reduction has saved $1,201,000 in healthcare expenditures for ambulance transport and emergency department expenditures ($1,127 per enrolled patient).
"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. Since July 2009, 146 patients with 1 year pre and 1 year post enrollment data have reduced ambulance transports to the emergency department by 1,893. This reduction has saved $808,000 in healthcare expenditures for just the ambulance transport component ($5,536 per enrolled patient).
Readmission Avoidance - 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. Since October 2013, 49 patients who had a prior 30-day readmission AND the referring agency felt would have a 30-day readmission have been referred into the program. Of those, only 8 had a 30-day readmission, a 83.7% reduction in readmissions for this high-risk readmission cohort.
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. Through February 2015, 176 patients who the hospice agency felt would disenroll from hospice were enrolled in the program. Only 20 (11.4%) had a disenrollment.
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. Through February 2015, 128 patients have been enrolled in this program and 125 of them have had no ED visit prior to their PCP follow-up appointment.
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, an analysis of the 2,200 patients that have been enrolled in and graduated from MedStar's Mobile Healthcare Programs have saved nearly $3.28 million in healthcare expenditures. The "EMS Loyalty program has reduced 9-1-1 transports to the ED by enrolled patients by 29.4% during a typical 30 - 90 day enrollment and by 75.3% in 12 months after program graduation.
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
The National Association of EMTs has taken the lead in promoting EMS-Based Mobile Integrated Healthcare programs to help EMS meet the Institute for Healthcare Improvement's Triple Aim initiative.
Please view the video produced by NAEMT designed to educate EMS practioners and other healthcare stakeholders on how EMS-Based MIH programs are transforming the EMS profession and achieving the Triple Aim!
View the Video Here
Jones and Bartlett Publishing has released a book written by MedStar's Matt Zavadsky and Doug Hooten titled Mobile Integrated Healthcare - Approach to Implementation. This book walks you through the "why" and "how" of MIH programs.
Click here to be navigated to the Jones and Bartlett order site for MedStar's MIH book.
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