our most costly customers. Many of these costly customers have complex and chronic medical conditions that result in overutilization of hospital services in ways that are largely preventable. Care coordination, transitional care and patient education are three proven methods that help reduce hospitalization rates, and innovative programs with EMS agencies have been able to implement each of these methods and bring value to us as payers as well as, more importantly, our customers (i.e. patients). value in our health care system by providing higher quality, less expensive care. Mobile integrated health care models have been clearly demonstrated to better coordinate care and avoid unnecessary ED visits and hospital admissions. Health plans should seek EMS partners willing to innovate and provide primary care, chronic disease management, mental health support, or patient navigation services on top of traditional emergency transport. We must stop looking at EMS agencies as just a transportation service and start utilizing EMS agencies in ways that ultimately improve the health outcomes of our customers at a markedly reduced cost. Health plans should consider innovative programs and contracts with EMS agencies that will increase HOSPITALS AND ACCOUNTABLE CARE ORGANIZATIONS The best hospital discharge or outpatient plan on paper is of little value if it doesn’t translate into a patient’s real-life ability to follow the plan. Hospital and even personal outpatient providers may have too little awareness of the family, social, financial, cognitive, dietary, logistic, transportation, emotional, and even spiritual obstacles a patient may face. EMS has unique access to patients’ living situations (including when homeless) and can both Mike Edgeworth, MD Medical Director, Cigna-HealthSpring Tele-neurologist, HCA
inform providers of challenges and potentially help overcome these challenges with innovative links to the providers and to community resources. Health plans should evaluate the role EMS in this broader sense (not just as a 911 responder and ambulance) might play within their internal structures that are built to address these issues. There are difficult workforce issues, information exchange challenges, branding and cultural issues to address when considering incorporating EMS into a health plan’s approach to its population. The intersection of EMS as a community provider with a health plan is complex, and will likely be different for different kinds of health plans. Plans should be open to the possibilities, though, and consider pilot projects. For hospitals, and accountable care organizations, whose goals are to sustainably maintain the health of their constituents, incentives of the community are entirely aligned with those of the health plan. There is really no “us” or “them.” “Value” is care that improves outcomes in the insured population and also meets patients’ (and families’) service and convenience needs (or patients will take their business—and revenue—elsewhere). When obstacles to health in the patient’s environment are not identified, they cannot be addressed. EMS may be a critical component to identifying these needs. Health plans should be willing to consider how EMS can increase their success as they expand their perspective to include the complex personal realities of their patients’ lives.
Jay Goldman, M.D. Medical Director of EMS and Ambulance, Kaiser Permanente Northern California HEALTH SYSTEM CHIEF EXECUTIVE OFFICER
Innovation is the cornerstone of EMS in both pre- hospital and hospital-based emergency care. In fact, in the absence of innovation and its diffusion - there would be no EMS framework, system or real-world capability to address community
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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