EFFECTIVE PARTNERSHIPS WITH HEALTH SYSTEMS MedStar Mobile Healthcare in Fort Worth has partnered with hospitals in their service area to fund and operate several MIH programs and collaborate closely with nurses and physicians to provide better quality care to their patients. 9-1-1 Nurse Triage Low acuity 9-1-1 callers are referred to a specially trained RN in our Call Center who helps the patient find appropriate resources for their medical issue. Since June 2012, 5,175 low-acuity 9-1-1 callers have been referred to this program, and 35.7% of these patients have had a response other than an ambulance to the emergency department. Hospitals fund this program through annual cost offset payments. High Utilizer Program Patients who use 9-1-1 15 or more times in 90 days, or are referred into the program by ED case managers due to high ED utilization, are enrolled for 30-90 days. MedStar’s Mobile Healthcare Providers (MHPs) conduct regular home visits, connect the patients to available resources and teach the patients how to better manage their own healthcare. The program reports having helped to avoid more than 4,800 ambulance transports, 1,917 ED visits and 462 admissions since 2009. Hospitals and others pay enrollment fees for referred patients. Readmission Avoidance Patients at high risk for a 30-day readmission are referred to MedStar by the patient’s Case Manager or PCP. MedStar conducts a series of home visits to educate the patient and family on appropriate care management and loops the patient to their PCP. If appropriate, the MedStar MHP can coordinate in- home diuresis or other treatments with the patient’s PCP, and arrange follow-up. Hospitals and others pay enrollment fees for referred patients.
medical and injury emergencies in a timely, life- and limb-saving manner. The first major innovation that created EMS as we know it today was the combining of disparate components such as communication, technology, specialized transportation, training and physician oversight into one interlinked emergency response system. Since the early 1970s there have been considerable public and private resources focused on EMS development and operation. Funding, research, technology, education, leadership and public policy have been integral parts of the process. In America’s hospitals and health care systems, EMS development fostered the rise of emergency departments and trauma, cardiac, burn, stroke and rehabilitation centers. People experiencing true emergencies are often dependent on every element of the modern EMS system for their survival. Communities and hospitals across the country should share in the responsibility of assuring the availability and effectiveness of comprehensive EMS systems. Ironically, the success of EMS has also created a platform capable of spawning innovation related to non-emergency care. The best current example is mobile integrated health (MIH). This innovation brings together paramedics with additional primary care training, nurses, and physicians to provide field-based care designed to avoid unnecessary ambulance transport, emergency department visits, hospitalizations and readmissions. MIH is designed to improve patient outcomes and their care experience while reducing resource utilization and health care costs. For EMS innovations to flourish, meaningful input from leaders across the health care spectrum is essential. This means that physicians, nurses, planners, administrative leaders and others will need to be actively engaged in discussions and actions. There is no question that the national health care system can improve, but to get there
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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