Mobile Integrated Healthcare and Community Paramedicine (MIH-CP) Insights on the development and characteristics of these innovative healthcare initiatives, based on national survey data Presented by the National Association of Emergency Medical Technicians Serving our nation’s EMS practitioners naemt.org Sponsored by Supplement to THE CLOCK IS TICKING The Countdown to the 2015 Guidelines Has Begun. Is your monitor CPR ready? The AHA says CPR monitoring should be “incorporated into every resuscitation.”1 With the 2015 Guidelines around the corner, make sure your monitor is built to help you deliver high-quality CPR. Lives depend on your CPR quality. Find out if your monitor is CPR ready at zoll.com/ClockisTicking. 1Meaney PA, et al. Circulation. 2013;128:417-35 ©2014 ZOLL Medical Corporation, Chelmsford, MA, USA. ZOLL is a trademark and/or registered MCN EP 1409 0059 trademark of ZOLL Medical Corporation in the United States and/or other countries. Authors [ EDITOR ] Kevin McGinnis, MPS, Paramedic Jenifer Goodwin Program Manager, Community IMAGE PROVIDED BY KEVIN PIEPER/THE BAXTER BULLETIN Communications Projects Manager Paramedicine, Mobile Integrated National Association of Emergency Healthcare, Rural Emergency Care Medical Technicians (NAEMT) National Association of State EMS [email protected] Officials (NASEMSO) [email protected] [ EXECUTIVE EDITOR ] Pamela Lane, MA Scott Bourn, PhD, RN, Paramedic Executive Director President National Association of Emergency National Association of EMS Medical Technicians (NAEMT) Educators (NAEMSE) [email protected] Vice President of Clinical Practices and Research [ AUTHORS ] American Medical Response (AMR) IMAGE PROVIDED BY PINNACLEHEALTH/COMMUNITY LIFETEAM Matt Zavadsky, MS-HSA, EMT Englewood, CO [email protected] Chair NAEMT MIH-CP Committee Brent Myers, MD, MPH Director of Public Affairs Contents President-elect MedStar Mobile Healthcare î National Association of EMS Introduction p. 5 Ft. Worth, Texas Physicians (NAEMSP) î Survey Targets p. 6 [email protected] Director and Medical Director î Demographics p. 7 Troy Hagen, MBA, Paramedic Wake County Department of EMS î Community Needs Raleigh, NC Immediate Past President Assessment p. 8 Adjunct Assistant Professor, National EMS Management î Emergency Medicine Medical Direction p. 9 Association (NEMSMA) University of North Carolina î Partnerships p.10 Chief Executive Officer Chapel Hill, NC î Qualifications p.13 Care Ambulance Service [email protected] î Clinical Services p.14 Orange County, CA [email protected] î Case Study: Tri-County EMS p.16 Paul Hinchey, MD, MBA î Regulatory Environment p.18 Medical Director î Funding, Reimbursement p.20 National Association of Emergency î Case Study: Medical Technicians (NAEMT) Acadian Ambulance p.22 Medical Director Austin/Travis County EMS î Measuring Data and Austin, Texas Outcomes p.24 [email protected] î Case Study: Colorado Springs FD p.26 î Lessons Learned p.28 For more information and resources î The Future of MIH-CP p.29 on MIH-CP, visit naemt.org © 2015 National Association of Emergency Medical Technicians. All rights reserved. 4 5 Mobile Integrated Healthcare and Community Paramedicine (MIH-CP): A National Survey Over the past several years, two new types that can be drawn from the data. Analysis home health agencies, hospice agencies of patient care offered by EMS agencies have was provided by our author team, which and private insurers. Those contracts may generated tremendous interest within EMS includes several of the nation’s MIH-CP include payments for MIH-CP services based and the wider health care community. Called thought leaders, medical directors and on fee-for-service, a per-patient or capitated mobile integrated healthcare and community MIH-CP program administrators. fee, or other shared savings arrangements. paramedicine (MIH-CP), many believe these Yet most EMS agencies launching innovations have the potential to transform Survey finds much enthusiasm, MIH-CP programs have and continue to EMS from a strictly emergency care service significant obstacles fund these programs out of their existing to a value-based mobile healthcare provider The survey identified more than budgets – a sign of their dedication but that is fully integrated with an array of 100 EMS agencies that have worked worrisome from a financial perspective. healthcare and social services partners to diligently over the past several years to Compounding these challenges, the improve the health of the community. determine their communities’ needs, build newness of EMTs and paramedics taking on Though still evolving, MIH and CP partnerships to launch these innovative new responsibilities, albeit ones within their programs operating around the nation programs and contribute to solving the scope of practice as defined by state laws are providing a range of patient-centered key issues facing American healthcare. and regulations, has also raised concerns services, including: The promise of these programs among some regulators, nurses and other î Sending EMTs, paramedics or has garnered the attention of a broad health professionals who question whether community paramedics into the spectrum of stakeholders, ranging from EMS should be permitted to offer MIH-CP. homes of patients to help with hospitals to physicians groups, private chronic disease management and insurers and the Centers for Medicare and Data provides a national snapshot education, or post-hospital discharge Medicaid Services (CMS). The interest has To date, the data collected by this survey follow-up, to prevent hospital enabled some MIH-CP programs to secure and analyzed in this summary represents admissions or readmissions, and to grants to cover the initial development the only compendium of information improve patients’ experience of care. and operation of their programs. The from the nation’s currently operating î Navigating patients to destinations largest and most well publicized funding MIH-CP programs. Respondents, who such as primary care, urgent care, came from the CMS Innovation Center, included EMS agency directors, medical mental health or substance abuse which awarded grants to several EMS directors, and MIH-CP program managers treatment centers instead of agencies and their partners beginning in and practitioners, represent diverse emergency departments to avoid 2012 to study the effectiveness of MIH-CP communities and provider types, from 33 costly, unnecessary hospital visits. programs in achieving the Institute for states and the District of Columbia. î Deploying telemedicine to connect Healthcare Improvement’s Triple Aim: NAEMT would like to thank the patients in their homes with improving the patient experience of care, respondents who took the time to tell caregivers elsewhere. improving the health of populations and us about their programs. We would also î Providing telephone advice or other reducing the per capita cost of healthcare. like to thank NAEMT’s Mobile Integrated assistance to non-urgent 911 callers Outside of the federal grants, other EMS Healthcare-Community Paramedicine instead of sending an ambulance crew. agencies have been successful in securing Committee for developing the survey To add to the EMS profession’s grants from foundations, or in negotiating questionnaire, and our author team understanding of the development, contracts with partners such as hospitals, for generously providing their time and characteristics and status of MIH-CP in Medicaid managed care organizations, insights in analyzing the data. the United States, NAEMT conducted a comprehensive survey in late 2014 of the nation’s currently operating MIH-CP programs. Mobile Integrated Healthcare and Community Paramedicine (MIH-CP): This summary analysis reports the A National Survey results of that survey, and the conclusions Community paramedics from Baxter Regional Medical Center in Arkansas provide post-discharge follow-up visits and connect patients to primary care. of the NAEMT MIH-CP Committee and included more than 50 questions asking respondents to describe all aspects of their MIH-CP program, including program activities, partners, agency demographics, medical direction, funding, revenue, goals and data collection. IMAGE PROVIDED BY KEVIN PIEPER/THE BAXTER BULLETIN In September and October 2014, the survey was distributed to approximately Survey Targets driven; patient-centered and team-based. 150 agencies that were either known Between April and October 2014, Examples of MIH-CP activities can include, or thought to have an MIH-CP program. NAEMT conducted a thorough search but are not limited to, providing telephone During that time, NAEMT continued to do to identify MIH and CP programs in the advice instead of resource dispatch; outreach to refine the list of agencies with United States. Sources included: providing chronic disease management, confirmed MIH-CP programs. î An earlier NAEMT MIH-CP survey preventive care or post-discharge follow-up; As of November 2014, we received widely distributed in 2013 by or transport or referral to care beyond a total of 137 responses. Of those, 26 NAEMT and several other national hospital emergency departments. did not have MIH-CP programs; 111 EMS organizations as part of the Because there is no strict definition did. Two did not provide any identifying Joint National EMS Leadership of MIH-CP, however, we had to make information and were eliminated; two Forum. judgment calls about inclusion. For were significantly incomplete and could î Media reports