Mobile integrated healthcare (MIH) is a movement that aims to deliver higher quality and more cost effective medical care by coordinating resources among emergency medical care (EMS) providers, hospitals, in-home carers, and insurance companies. There are many elements that go into coordinating the care for individuals with chronic and complex medical conditions. Unfortunately, this isn’t always simple, especially when health insurance providers resist footing the bill for costs they deem excessive.
Coordinated care is beneficial for patients, but it’s also a concept that insurance companies actually support. Insurance providers want people to get care from in-network providers, which means care will be streamlined for the patient as well. If coordinating care through mobile integrated healthcare or MIH allows for the patient’s needs to be met without sending them to an emergency department, it is more cost effective for the insurance company. This benefits the insurer by eliminating expensive and unnecessary tests, potentially eliminating an ambulance transport and cutting down on time spent organizing or coordinating between teams.
According to the American College of Emergency Physicians, a simple way of defining MIH is the use of patient-centered, mobile resources that are used outside of the hospital. These can include communications with services that provide medical advice for 9-1-1 dispatch callers, community paramedicine, chronic disease or pain management resources, preventive or follow-up visits, or transportation services to a referred medical program or facility.
In particular Community Paramedicine (CP) or the treatment of chronic conditions have a lot to gain from this practice. CP is an effort for those with ongoing chronic conditions to receive appropriate care and minimize the amount of emergency room time. Seeking help at an ER is an expensive and time-consuming proposition for patients, and it isn’t always necessary. This is where MIH can provide solutions for people with chronic illnesses. Paramedicine is great idea for those who need non-emergency care (most people with medical concerns, most of the time), and those who do not need a transport to a hospital.
Unfortunately, when someone calls 9-1-1, the dispatcher doesn’t know if that person is already enrolled in a MIH process, so 9-1-1 is largely unable to assist with this process. It’s something that a publicly-available but secure safety profile, such as Smart911 could fix.
MIH-CP programs tend to be a public initiative, and therefore rely on grant funds, from an EMS budget, or from a local jurisdiction. These initiatives are ongoing, but right now they are disconnected from 9-1-1 call centers and dispatchers. 9-1-1 isn’t in a position to do anything other dispatching limited (and expensive) Fire and EMS resources that will likely result in a transport to the ER, which is the least cost effective option of the time.
How Does Mobile Integrated Health Affect In-Home Health Workers & Patients
For people enrolled in a hospice program, it can be a disservice not to have this mobile integrated healthcare process in place. For example, if an individual wants to die with dignity at home, but there is an emergency where someone panics and calls 911, the person who is sick will be transported to hospital against their wishes. If 911 had known they had been a part of community paramedicine, community health care, or hospice program the dispatcher can make an informed decision that could save money, time, and respect the person’s request.
These innovations connect community paramedicine programs with 9-1-1 response and have the potential to shift EMS from an emergency service to a value-based MIH provider. MIH would be able to send paramedics into the homes of people with chronic diseases, providing streamlined, effective care for patients and help hospital emergency centers that already struggle with an influx of patients and strained resources.
It could also help patients struggling with mental health or substance abuse issues. If these people could be evaluated on the site of the emergency call, they can be transferred to a treatment facility directly. In many of these situations, police end up being the first line of response in mental health and substance abuse emergencies, which are often outside the realm of their expertise. This program saves the patient wasted time in an emergency room, and allows them to be on the route to recovery faster.
These programs could also help other patients get the appropriate care faster – ideally, the person would be able to connect with EMS and 9-1-1, who could help them navigate to a primary care physician, urgent care center, or other facility if it is more appropriate than transport to an emergency room.
How Competing Interests & Stakeholders Complicate MIH
Unfortunately, EMS workers are only reimbursed patients are transported to an emergency department. This means, even if it isn’t the most appropriate method of providing care, EMS doesn’t have a viable alternative to transporting to the emergency department. At the same time, a large percentage of a hospital’s admissions (and revenue) starts with an individual presenting to the emergency department, so it’s not necessarily against their interests to see the same patients over and over again.
There are also difficulties at the dispatch level. 9-1-1 wants to render the most appropriate care, but many lack alternatives to dispatching a full emergency response. This raises obvious concerns around liability if a first responder decided not to send a full emergency response, but rather community paramedicine and then there was a negative outcome.
Some community organizations are innovators and are willing to take risks, but this potential is limited. There’s often a stalemate about who should take charge, who is funding the initiative, who is the most, and who is taking on the risk. According to the National Association of Emergency Medical Technicians, newness of EMTs and paramedics taking on new responsibilities compounds these challenges, as they are working within their scope of practice as defined by state laws and regulation. This has raised concerns among some regulators, nurses and other health professionals who question whether EMS should be permitted to offer Mobile Integrated Healthcare or Community Paramedicine.
Mobile Integrated Health Successes
Quincy, Massachusetts
In Quincy, Massachusetts, paramedics are taking on a new role by treating patients at home. The town is taking part in a pilot program that allows traveling medical teams to treat patients with urgent medical needs in residences. The program was recently approved in a state budget and will become more common as the funds process. This is an excellent example of mobile integrated mobile healthcare. Under the supervision of physicians and with special training, paramedics can examine patients, administer medicine, and provide follow-up care instructions.
The program has major benefits for local communities, saving patients expensive trips to the emergency room or hospital, while also treating them where they are most comfortable. Community paramedicine is most likely to benefit the elderly or those who have chronic conditions, live in remote areas, or need care at night when doctor’s offices are closed. While there are concerns about paramedics receiving appropriate training, the program is expected to cut healthcare costs and improve patient care overall.
Downey, CA
Downey, California emergency response has works closely with an accountable care organization via CareMore. These organizations allow you to pay them a set fee and they take on the full cost of your expenses.
CareMore acts as both an insurance provider and a network of healthcare providers. By being their own horizontal market they are more incentivized to deliver cost-effective healthcare. If an individual is transported via EMS, they still have to pay the cost of that, so they want to make sure all of their folks are CareMore patients and understand this protocol.
Kern County, CA
Kern County, CA is using technology to improve outcomes for patients with mental health or cognitive conditions. The county is using this technology to flag certain approaches for telecommunicators to relay to first responders when responding to someone dealing with a mental health emergency. They are starting to send out Crisis Intervention Teams (CIT) who are trained to help those in mental crisis, along with police officers based on the nature of the call.
These programs have been successful when they are funded, but the money is hard find and usually comes from a grant or unique funding program. The biggest challenge is finding a way to provide a service that is standard and works well for vulnerable populations, who may be in more dire need of these services. It will also be a unique challenge to bring these programs into communities with prior relationships with hospitals or 9-1-1 facilities, but there are use cases that suggest the community benefits outweigh potential obstacles.
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