FINANCIAL SUSTAINABILITY: THE CASE OF REMSA
the investment of resources and capital to get a pilot off the ground. To achieve sustainability, an agency must be able use data to measure the effect of the innovation, improve the innovation, and demonstrate value to the community and to stakeholders. Engage Payers Early An effective strategy that can both help with the securing of data and demonstration of outcomes while also laying the groundwork for sustainability, is to invite potential payers to serve on a steering committee or advisory board of a pilot study. These could be traditional payers or healthcare provider group such as a nursing home, hospital, or independent physicians association, that are beginning to take on financial risk for the cost of care of their patients. An EMS agency can benefit from their wisdom and sharing of data while also beginning to secure their long-term buy-in. These partners can help establish benchmarks and milestones early in the process that would define success from their perspective, for which they might one day be willing to pay. INNOVATION IN PROGRESS EMS sits at the intersection of public health, public safety, and healthcare. There is ample opportunity for innovation across all of these fronts. Throughout the document, examples of innovation are included. In this section, we preview some of the innovation in progress and a few that may be just beyond the horizon. However, in no way should the examples described here or elsewhere in the document be considered the only areas worthy of focus. Clinical Acute Care The core of EMS has always been providing high quality emergency care for acute time-sensitive conditions such as cardiac arrest and trauma. More recently, acute myocardial infarction and stroke have become core clinical areas of focus for EMS. In these and other areas, EMS should be pushing the
The Regional Emergency Medical Services Authority (REMSA) was founded in 1986 as a community-based private non-profit EMS service serving Washoe County (Reno) Nevada. REMSA won a Round 1 Health Care Innovation Award (HCIA) (one of six awarded to EMS in the country) in July, 2012 to launch Community Health Programs including a community paramedicine program, a Nurse Health Line, and an alternative transport destination initiative. The HCIA was awarded by the CMS Innovation Center to develop “new models of care and payment that continuously improve health and healthcare for all Americans.”
Analysis & Planning
Build the evidence-base for value-based community health programs Achieve improved stakeholder knowledge of new Community Health Programs
Community Outreach Business Development
Secure contracts with new sources of revenue
Generate support for reform of government payment systems
Public Policy
REMSA planned from the beginning of the grant to build a program that would be sustainable by the time the grant expired. To achieve sustainability, they decided to build a strong evidence base to demonstrate value, then work closely with local stakeholders to form partnerships based on the value they provided. By providing integrated patient-centered, quality care, REMSA saved the health system an estimated $9.6 million over four years and prevented 6,202 ED visits, as of June 2016. Because of its success, REMSA was able to secure contracts with local hospitals and commercial insurers that allowed it to continue to serve the community once the grant expired in July of 2016. On a larger scale, REMSA committed itself to advocating for reforming payment models that reward value, which will create a healthcare environment that makes these programs more sustainable in the future. In August 2016, CMS approved a Nevada Medicaid State Plan Amendment (SPA) that updates coverage and reimbursement to include Community Paramedicine services. In addition, Medicaid and all commercial insurers are reimbursing REMSA for transport to alternative destinations.
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CHAPTER 1
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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