Trending Topics

Creating a new EMS value proposition with mobile integrated healthcare

911 nurse triage and a high utilizer group program are exponentially reducing transports and healthcare expenditures while increasing patient satisfaction

67882420_1161914377333505_2299578322671108096_o (1).jpg

Data being published on the outcomes of MIH programs are revealing not only dramatic reduction in acute care utilization, but also improvements in patient outcomes and experience of care.


What is your agency doing to enhance your value proposition? Share in the comments below. If you are not an EMS1 verified member, it’s free and easy to join EMS1 for immediate access to reader comments.

This article originally appeared in the Nov. 7, 2019, issue of the Paramedic Chief Leadership Briefing, Paramedic career mapping | MIH value | Affordable community paramedicine. Read the full briefing and add the Paramedic Chief eNewsletter to your subscriptions.

They exist in almost every EMS system across the country. Your medics are dispatched to that all-too-familiar address, typically for a low-acuity medical call. While responding to the call (and taking the precious ambulance resource out of the mix for a potentially higher acuity response), one of the crew members says, “Ya know, someone should do something for this patient to keep us from having to respond all the time.”

EMS-based mobile integrated healthcare (MIH) programs have been around for almost a decade, and some have published outcomes from their programs. While high-profile studies have questioned the value of “traditional” EMS from a patient outcome perspective, data being published on the outcomes of MIH programs are revealing not only dramatic reduction in acute care utilization, but also improvements in patient outcomes and experience of care. These data may create the new value proposition for EMS in the U.S.

MedStar’s MIH outcome data

MedStar Mobile Healthcare in Fort Worth has been operating an MIH program since 2009. The program includes the management of high utilizer group (HUG) patients, and a robust 911 Nurse Triage Program.

Patients who use 911 15 or more times in 90 days, or those who are referred into the program by ED or payer case managers due to high ED utilization, are enrolled in the HUG program. MedStar’s Mobile Healthcare Providers 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.

HUG outcomes:

  • Since July 2009, 779 patients with two 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”
  • The program has also 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)

Low-acuity 911 callers are referred to a specially trained RN in MedStar’s PSAP. These nurses are specially trained in triaging patients in a non-visual (dispatch) environment and use a robust decision support software system by Priority Solutions called LowCode to help find appropriate resources for the patient’s medical issue.

911 Nurse Triage Program outcomes:

  • Since June 2012, 12,226 low-acuity 911 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)

Increased patient satisfaction through MIH

In healthcare’s transforming economic model, patient experience and improvement in health status is exceptionally important. Patients enrolled in MedStar’s HUG program report a 36% improvement in their health status, a 96% patient satisfaction rating and 98% of the enrolled patients would recommend the service to others.

For the 911 Nurse Triage Program, you might think that people who call 911 for an ambulance, and instead get a Lyft to a clinic, might be dissatisfied. However, the patient experience scores for the Nurse Triage Program maintain an overall patient experience rating of 93.6%, with 87% of the patients stating the alternative disposition saved them time and money and that the call should not have been handled any differently.

Perhaps widespread adoption of programs like these will be able to enhance the value proposition for EMS, in terms of economics, patient experience of care and health status!

Want to learn more? Visit to see more details about MedStar’s MIH programs.

Matt Zavadsky, MS-HSA, EMT, is the chief transformation officer at MedStar Mobile Healthcare, the exclusive emergency and non-emergency Public Utility Model EMS system for Fort Worth and 14 other cities in North Texas that provides service to 436 square miles and more than 1 million residents and responds to over 170,000 calls a year with a fleet of 65 ambulances. MedStar is a high-performance, high-value Emergency Medical Services system, providing advanced clinical care with high economic efficiency.

MedStar is one of the most well-known EMS agencies in the county, and operates a high-performance system with no tax subsidy, and the recipient of the EMS World/NAEMT Paid EMS system of the Year, and the only agency to be named an EMS10 Innovator by JEMS Magazine.

He is also the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation” published by Jones and Bartlett Publishing.

He has 42 years’ experience in EMS and holds a master’s degree in Health Service Administration with a Graduate Certificate in Health Care Data Management. Matt is a frequent speaker at national conferences and has done consulting in numerous EMS issues, specializing in high-performance EMS operations, finance, mobile integrated healthcare, public/media relations, public policy, transformative economic strategies, and EMS research.

Matt is also immediate past president of the National Association of EMTs, and chairs their EMS Economics Committee.