Donna G Tidwell, MS, RN, Paramedic Director Office of Emergency Medical Services Partners in Healthcare- Filling unmet needs with untapped resources

MOBILE INTEGRATED HEALTH CARE VS COMMUNITY PARAMEDIC

Future of Emergency Care: Emergency Medical Services at the Crossroads (Institute of Medicine Report) 2003  Coordination  Regionalization  Accountability EMS Agenda of the Future 1996

Emergency Medical Services of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring

This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care providers and public health and public safety agencies. It will improve community health and result in more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net.

The Institute of Medicine (IOM) estimates that $750 billion—30% of the U.S. annual health care budget—is wasted on unnecessary services Barriers to patient access, fragmentation of acute and chronic care, ineffective management of chronic illness, and complex, outdated reimbursement processes leave patients, clinicians and payors frustrated at historic levels.

Renewed focus on bringing healthcare to the patient, specifically by delivering care outside of traditional settings, has underscored the need for realignment of financial incentives and reimbursement policy

Patients are routinely referred to hospital emergency departments (EDs) by their healthcare providers, outside of normal business hours, despite the common knowledge that the ED is an imprecise match to their needs.

Mobile Integrated Healthcare Practice (MIHP)is intended to serve a range of patients in the out-of-hospital setting by providing 24/7 needs-based at-home integrated acute care, chronic care and prevention services.

Focus on patient-centered navigation and offer transparent population-specific care by integrating existing infrastructure and resources, bringing care to patients through technology, communications, and health information exchange Define its operations through population- based needs assessment and tools

Leverage multiple strategic partnerships operating under physician medical oversight Improve access to care and health equity through 24-hour care availability

Deliver evidence based practice using multidisciplinary and inter-professional teams in which providers utilize the full scope of their individual practices and support healthcare delivery innovation

Cataloging of provider competencies and scopes of practice Medical oversight, both in program design and in daily operation Population needs and community health assessment

Strategic partnerships with stakeholders, engaging a spectrum of healthcare providers including, but not limited to: physicians, advanced practice nurses, physician assistants, nurses, emergency medical services personnel, social workers, pharmacists, clinical and social care coordinators, community health workers, community paramedics, therapists, and dieticians

Patient access through patient-centered mobile infrastructure Coordinating communications, including biometric data

Telepresence technology, connecting patients to resources, and permitting consultation between in-home providers and those directing care Capacity for patient navigation Transportation and mobility

Shared/Integrated health record Financial sustainability Quality/outcomes performance measurement

MIHP framework is structured to provide patient-centered care, with every effort made to ensure patients receive the right care, by the right provider, at the right place, in the right time and at the right cost.

When you’ve seen one community paramedic program, you’ve seen one community paramedic program

Decrease overall health care costs Eliminate health disparities Proper referrals to primary care physicians, home health organizations and other community resources Decreased misuse of emergency departments

Improved patient outcomes Better collaboration with community partners Help to prevent serious health issues/avoid the emergency in the first place Less expensive to prevent than to treat

Proactive vs. reactive EMS care Avenue for patient education Decreased non-essential ambulance transports Decreased hospital readmissions

1. Increase positive patient health outcomes and overall patient experience. 2. Decrease overall patient/healthcare provider costs. 3. Provider/Physician Driven.

Will accomplish these goals through the following activities : 1. Identify and fill gaps in community health services by connecting resources for underserved populations 2. Identify frequent users of Emergency Medical Services (EMS) and Emergency Departments (ED) and develop proactive patient management programs to meet their needs

3. Develop quality initiatives, financial incentives, and safe options for EMS to treat without transport and treat and transport to alternative destination programs 4. Provide in home follow up care to patients after hospital or ED care including but not limited to: assessments, vaccinations, laboratory services, diagnostic monitoring, medication reconciliation, wound care, disease and injury education, and fall prevention.

5. Electronically communicate patient needs with medical home primary care providers and the health care system to optimize patient care and effectively measure and analyze the program benefits

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Task force of EMS Providers and Stakeholders has been formed Needs Assessment Set Standards for Education and Credentialing

The MIHP approach differs from existing out of hospital care programs in its synchronized multi-provider patient-driven partnerships, defined by local needs and resources. It responds to the growing evidence that “single- provider/single agency” care models will not optimize expertise for patient results, will be too limited in capacity, and are unlikely to be financially sustainable.