As the EMS provider for more than 1 million 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 uncollected. Many people are 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 RNs in our Call Center who help the patient find appropriate resources for their medical issue. Since June 2012, 12,226 low-acuity 9-1-1 callers have been referred to this program, and 37.6% of these patients have had a response other than an ambulance to the emergency department. This reduction has saved $6 million in healthcare expenditures for ambulance transport and emergency department expenditures ($1,298 per enrolled patient).
High Utilizer Group (“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, 779 patients with 2 years of utilization data available (1 year pre and 1 year post enrollment) have reduced ambulance transports to the emergency department by 5,909 (49%) and 70% for patients designated as “System Abusers”. It also has reduced ED visits in this patient population by 3,496 and prevented 1,596 hospital admissions. This reduction has saved $23 million in healthcare expenditures for ambulance, ED and admissions ($29,481 per enrolled patient).
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 treatments with the patient’s PCP, along with a follow-up PCP appointment. Since October 2013, 348 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 169 had a 30-day readmission, a 52.5% 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 September 2019, 565 patients who the hospice agency felt would disenroll from hospice were enrolled in the program. Only 102 (19.3%) had a disenrollment.
Home Health Partnership
Through an innovative partnership with local home health agencies, MedStar and the agencies 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, 2,650 patients in the MedStar service area have been enrolled. Of these, 1,901 accessed the 9-1-1 system and MedStar had a specially trained MHP on scene as a co-responder for 987 calls. With the MHP on scene, care was coordinated with the agency’s on-call nurse and only 714 (72.3%) required transport to the ED. Additionally, agencies requested a MedStar MHP to an episodic request on 454 occasions and only 27 (5.9%) required transport to the ED.
The success of these programs would not be possible if it were not for our myriad of community partnership who have formed a unique collaborative to support enrolled patients with services and resources that contribute to their success! Click here to see a list of the MedStar Community Health Collaborative members.
The American Journal of Emergency Medicine published a study about MedStar’s MIH program. Click here to review the peer-reviewed study.
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.
For more information on how MedStar can assist you with the development and implementation of MHP programs in your local community, please submit a contact form and choose “Mobile Healthcare Program” as the “Topic” dropdown here
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.
Health Insight, the CMS Quality Improvement Network/Quality Improvement Organization for the State of Oregon published a comprehensive outcome report on the MIH programs in Oregon in June 2017.
Click here to view the report.
Quality Insights, CMS Quality Improvement Network/Quality Improvement Organization (QIN/QIO), recently published two EXCELLENT videos.
This one explains Community Paramedicine to patients:
And, this one is an excellent Community Paramedicine overview for providers
Additional Mobile Healthcare Downloads & Reports:
- 2017 American Journal of Emergency Medicine Study of MedStar’s Readmission Prevention Program
- MedStar MIH Program Expenditure Savings – All Programs Through September 2019
- MedStar High Utilizer Program Overview
- MedStar High Utilizer Economic Report Through September 2019
- MedStar MIH Social Determinants of Health Report Through September 2019
- MedStar MIH Patient Experience Summary Through September 2019
- MedStar EuroQol MIH Program Health Status Scores Through September 2019
- MedStar Hospice Program Overview
- MedStar Hospice Revocation Avoidance Outcomes Through September 2019
- MedStar Home Health Partnership Overview
- Home Health / MedStar Partnership Report Through September 2019
- MedStar 9-1-1 Nurse Triage Program Overview
- MedStar 9-1-1 Nurse Triage Economic Analysis Through September 2019
Help Us Help the Community
If you are a physician, hospital social worker or case manager you may refer someone into the Mobile Healthcare Program, click here to download a fillable or printable form.
To refer a patient into our Hospice Revocation Avoidance program, click here to download a fillable or printable form.
Fax either, with supporting documentation, to: 817-632-0530.
To contact a representative of the MHP program for patient updates on admissions or discharges, call the MedStar communications center at 817-927-9620 and ask for the on-duty Mobile Healthcare Provider