Promoting Innovation in EMS

Primary Care & Population Health There is an immense need to improve access to primary care and to improve the efficiency of coordinating care with primary care physicians. In the setting of increasingly realigned incentives that encourage physicians, hospitals, and health plans to focus more on population health and coordinating care in the community, EMS has an opportunity to reposition itself as a mobile health care resource capable of providing the type of on- demand coordinate care that patients and their health care teams are looking for. In particular, there is a natural partnership and alliance between EMS and home based primary care (HBPC) practitioners. Both groups are familiar with caring for patients in the out-of-hospital environment and patients who qualify for HBPC programs are usually homebound, frail elderly adults who require ambulance or other medical transport assistance to leave the home. Thus, it could be envisioned that HBPC physicians could use EMS providers to help meet urgent or chronic care needs among their patient populations and that EMS could reach out to HBPC providers to coordinate care when called to respond to HBPC patients. Because of this natural partnership, there are pockets of collaboration already under way including 1) the Mount Sinai Visiting Doctors group, which has partnered with a local private EMS organization, to provide telehealth enhanced community paramedic urgent assessments; 2) the Wake County EMS partnership with an HBPC group to reduce transports for minor falls in assisted living facilities; 26 and 3) Northwell Health which has an internally run HBPC group known as “House Calls” and an accredited EMS agency under the same organizational umbrella. 27

To go even further, future collaboration between EMS and primary care / population health would benefit from the ability to deploy increased diagnostic and other capabilities to the patient bedside to support disposition decisions. There is a need for developing shared care plans between physicians and community providers like EMS and shared electronic platforms with which to share those care plans. Primary care might be able to utilize EMS to extend primary care or perform safety checks in the home. Home Health & Hospice In the setting of an increased emphasis on improving transitions of care and end-of-life care, EMS has an opportunity to improve its relationship with providers of home health care, palliative care, and hospice care. Improved communication, easy access to Medical (or Physician) Orders for Life Sustaining Treatment (MOLST, POLST) documents, and standardized care protocols are worthwhile areas of focus for EMS innovators. Perhaps EMS could help address gaps in home health and hospice care on-call coverage or support post-discharge transitions of care back to the community for patients with chronic conditions. This could include the provision of services for patients who would benefit from having health care delivered in their homes, but who do not currently qualify for home care. There should be recognition of EMS, home health, and hospice as being important parts of the same health care continuum. Mental Health Behavioral health remains one of the biggest gaps in our health care system. As a result, a significant portion of the nation’s overall health care burden is related to untreated behavioral health conditions. Many super-utilizers of EMS and a substantial

26 Williams, Jefferson G., Michael W. Bachman, A. Wooten Jones, J. Brent Myers, Alan K. Kronhaus, Diane L. Miller, Benjamin Currie et al. “Retrospective validation of a protocol to limit unnecessary transport of assisted-living residents who fall.” Prehospital Emergency Care 19, no. 1 (2015): 68-78. 27 Abrashkin, Karen A., Jonathan Washko, Jenny Zhang, Asantewaa Poku, Hyun Kim, and Kristofer L. Smith. “Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program—Preliminary Data.” Journal of the American Geriatrics Society 64, no. 12 (2016): 2572-2576.




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