As the EMS provider for more than 938,000 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 the population is using EMS as a health care safety net.
In July 2009, MedStar implemented the Mobile Integrated Healthcare 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, 6,539 low-acuity 9-1-1 callers have been referred to this program, and 34.5% of these patients have had a response other than an ambulance to the emergency department. This reduction has saved $2.6 million in healthcare expenditures for ambulance transport and emergency department expenditures ($1,163 per enrolled patient).
"EMS Loyalty" Program - Patients who use 9-1-1 15 or more times in 90 days, or who are referred into the program by ED case managers due to high ED utilization, are enrolled. MedStar's Mobile Healthcare 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, 507 patients with 1 year pre - and 1 year post - enrollment data have reduced ambulance transports to the emergency department by 4,932 (53.7%) and 76.1% for patients designated as "System Abusers". It also has reduced ED visits in this patient population by 1,917 and prevented 462 hospital admissions. This reduction has saved $8.8 million in healthcare expenditures for ambulance, ED and admissions ($17,308 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 or other treatents with the patient's PCP, along with a follow-up PCP appointment. Since October 2013, 104 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 38 had a 30-day readmission, a 63.5% 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 November 2016, 270 patients who the hospice agency felt would disenroll from hospice were enrolled in the program. Only 52 (19.3%) 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 a local home health agency, MedStar and the agency collaborate to provide effective after-hours episodic care for the agency's patients, and to notify the agency's on-call nurse in the event of a 9-1-1 call to a patient enrolled in this program. Working together, the agency staff and the MedStar Mobile Health Paramedic (MHP) determine the most appropriate care for a patient on the agency's service. Since program inception, 1,375 patients in the MedStar service area have been enrolled. Of these, 1,034 accessed the 9-1-1 system and MedStar had a specially trained MHP on scene as a co-responder for 496 calls. With the MHP on scene, care was coordinated with the agency on-call nurse and only 199 (40.1%) required transport to the ED. Additionally, the agency requested a MedStar MHP to an episodic request on 290 occasions and only 28 (9.7%) required transport to the ED.
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, 2014, 2015 and 2016. Click Here to view the most recent AHRQ publication on the MIH programs.
Since its inception, more than 6,500 patients that have been enrolled in and graduated from MedStar's Mobile Healthcare Programs.
MedStar has significant experience developing and implementing multiple aspects of Mobile Integrated Healthcare with programs such as 9-1-1 Nurse Triage, "Super Utilizer Program" members, "Observation" Admission Avoidance Program, Readmission Reduction patient management (including i-STAT point of care testing and in-home treatments such as diuresis, breathing treatments and diabetic care) and a 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 186 communities from 42 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 Status of MedStar MIH Programs
FOX 4 Story on the CHF Program