Editor’s note: Mobile integrated healthcare continues to be the subject of intense debate. However, there are signs of growing unity among the major associations about what it is and what it means for the profession.
Recently, the National Association of EMTs drafted a position paper on the topic. The National EMS Management Association was one of a dozen national associations that reviewed, provided input and endorsed the final product. Take a look and see what they came up with. — Keith Griffiths, Editor-in-Chief, Best Practices
Updated Jan. 13, 2015
In its simplest definition, Mobile Integrated Healthcare (MIH) is the provision of healthcare using patient-centered, mobile resources in the out-of-hospital environment. It may include, but is not limited to, services such as providing telephone advice to 9-1-1 callers instead of resource dispatch; providing community paramedicine care, chronic disease management, preventive care or post-discharge follow-up visits; or transport or referral to a broad spectrum of appropriate care, not limited to hospital emergency departments.
Key components of MIH programs include:
- Fully integrated – a vital component of the existing healthcare system, with efficient bidirectional sharing of patient health information.
- Collaborative – predicated on meeting a defined need in a local community articulated by local stakeholders and supported by formal community health needs assessments.
- Supplemental – enhancing existing healthcare systems or resources, and filling the resource gaps within the local community.
- Data driven – data collected and analyzed to develop evidence-based performance measures, research and benchmarking opportunities.
- Patient-centered – incorporating a holistic approach focused on the improvement of patient outcomes.
- Recognized as the multidisciplinary practice of medicine – overseen by engaged physicians and other practitioners involved in the MIH program, as well as the patient’s primary care network/patient-centered medical home, using telemedicine technology when appropriate and feasible.
- Team based – integrating multiple providers, both clinical and non-clinical, in meeting the holistic needs of patients who are either enrolled in or referred to MIH programs.
- Educationally appropriate – including more specialized education of community paramedicine and other MIH providers, with the approval of regulators or local stakeholders. Consistent with the Institute for Healthcare Improvement’s IHI Triple Aim philosophy of improving the patient experience of care; improving the health of populations; and reducing the per capita cost of healthcare.
- Financially sustainable – including proactive discussion and financial planning with federal payers, health systems, Accountable Care Organizations, managed care organizations, Physician Hospital Organizations, legislatures, and other stakeholders to establish MIH programs and component services as an element of the overall (IHI) Triple Aim approach.
- Legally compliant – through strong, legislated enablement of MIH component services and programs at the federal, state and local levels.
Rationale
Since the creation of modern emergency medical services, EMS has largely been considered and funded as a transportation system for people suffering from medical and trauma conditions.
Recent changes in the healthcare finance system initiated by the Patient Protection and Affordable Care Act (PPACA) have created an unprecedented opportunity for EMS to evolve from a transportation service to a fully integrated component of our nation’s healthcare system. Aligned financial incentives now focus stakeholder awareness on the value of EMS in providing “patient navigation” throughout the healthcare system, efficiently and effectively directing each patient to the right care, in the right setting at the right time.
In 1995, then-NHTSA Administrator Ricardo Martinez, NHTSA and the Department of Health and Human Services’ Health Resources and Services Administration (HRSA) commissioned a strategic plan for the future EMS system. The resulting report, Emergency Medical Services Agenda for the Future (NHTSA, 1996), outlined a vision of an EMS system fully integrated within our nation’s overall healthcare system, proactively providing community health, and adequately funded and accessible. The companion report published in 2004, the Rural and Frontier EMS Agenda for the Future, also focuses on an integrated workforce.
The Agenda for the Future, now nearly two decades old, has been effective in drawing attention to EMS within the emergency and trauma care system. Several of the Agenda’s goals, however, were difficult to realize before the implementation of the PPACA.
A subsequent implementation guide, developed by NHTSA in 1997, offered several recommendations to make the Agenda for the Future a reality and focused on three strategies:
- Improve linkages between EMS and other components of the healthcare system;
- Create a strong infrastructure; and,
- Develop new tools and resources to improve the effectiveness of EMS.
The types of changes envisioned by the Agenda and the implementation guide include:
EMS Today (1996)
Isolated from other health services
Reacts to acute illness and injury
Financed for service to individuals
EMS tomorrow
Integrated with the healthcare system
Acts to promote community health
Funded for service to the community
The healthcare finance reforms now being enacted are creating an environment more conducive for implementing the EMS Agenda for the Future. Specifically, the reforms are shifting focus to care provided to entire communities rather than individuals and to proactive rather than reactive care.
Defining the Problem
Currently, the U.S. healthcare system spends approximately $8,600 per capita1 caring for our population. This amount is nearly three times the average amount expended by other economically developed nations. Ironically, U.S. health status is among the lowest in the developed world in terms of life expectancy, obesity, preventable hospitalizations and overall wellness.
Many healthcare experts believe that the fee-for-service, quantity-based structure of our healthcare system is the main driver of this cost/outcome mismatch. Unrelenting increases in healthcare costs have compelled the need to refine the financing of our healthcare system, based on the IHI Triple Aim Model:
- Improved experience of care for the patient (including outcomes and satisfaction).
- Improved population health.
- Reduced costs.
EMS is uniquely positioned to help meet the IHI Triple Aim by transforming from a transportation system focused on stabilizing and transporting patients to a mobile integrated healthcare system focused on:
- Patient education, consultation and dispatch/telephone advice using approved clinical algorithms.
- Preventive care, chronic disease management or post-discharge follow-up care.
- Navigating patients to appropriate alternative healthcare destinations.
This transformation will enhance the value of EMS to healthcare system stakeholders and help fully realize the vision of the EMS Agenda for the Future.
The path forward
The following organizations support the vision articulated in this statement and recognize the unprecedented opportunity to bring substantial value to the healthcare system through the transformation of EMS agencies into Mobile Integrated Healthcare agencies.
- National Association of Emergency Medical Technicians (NAEMT)
- National Association of State EMS Officials (NASEMSO)
- National Association of EMS Physicians (NAEMSP)
- American College of Emergency Physicians (ACEP)
- National EMS Management Association (NEMSMA)
- National Association of EMS Educators (NAEMSE)
- International Academies of Emergency Dispatch (IAED)
- Association of Critical Care Transport (ACCT)
- North Central EMS Institute (NCEMSI)
- Paramedic Foundation
- American Ambulance Association (AAA)
We strongly encourage our members to engage in the logical, effective, and collaborative evolution of Mobile Integrated Healthcare programs and component services, to ensure that the goals of their local healthcare systems and communities are met.
These organizations will continue to provide resources, education, leadership and advocacy at the local, state and national levels to assist members and their consideration of the opportunities created from this new environment of healthcare.
