1. DALLAS FIRE-RESCUE DEPARTMENT MOBILE COMMUNITY HEALTHCARE PROGRAM Norman Seals, Assistant Chief Emergency Medical Service Bureau Dallas Fire-Rescue Department

2. Dallas Fire-Rescue 1,887 uniformed personnel 58 stations – 57 engines – 21 trucks – 40 front line Rescues, 3 Peak Demand Robust all-hazards capability 380 square miles, 1.2 million population In excess of 200,000 EMS calls per year Fire-based EMS system that occasionally fights fires 2

3. What is Mobile Integrated Healthcare? Proactive versus Reactive Scheduled versus unscheduled Case management versus incident management Integrated care – bridges the gap between patients and service providers Cost avoidance/ revenue generating The best solution to an age-old problem for EMS 3

4. Mobile Community Healthcare Program (MCHP): Overview Phase I officially started March 2014 Proactive service delivery model Identifies high utilizers of the system and seeks to reduce their dependence on the 911 system 120+ unique patients seen to date Intensive case management process that involves a network of community organizations all working for the good of each individual patient 4

5. Cost/Call Avoidance 1 year pre-enrollment: 2,870 calls – 1,103 transports x $1,578 = $1,740,534 – 1,767 non-transports x $835 = $1,475,445 – Total service cost: $3,215,979 During enrollment: 995 calls – 439 transports x $1,578 = $692,742 – 556 non-transports x $835 = $464,260 – Total service cost: $1,157,002 Post graduation: 510 calls – 81 transports x $1,578 = $127,818 – 428 non-transports x $835 = $357,380 – Total service cost: $485,198 Cost avoidance of $2,730,781 (82%) Call avoidance of 2,360 5

6. Mobile Community Healthcare Program: Overview Phase II involves contracts with area hospitals MCHP provides services to hospital program patients: – Accountable Care Organization (ACO)/Managed Care Program patients – Readmission avoidance – High utilization patients – Many possibilities A great deal of interest in this program has been shown by our area hospital partners As of October 2015 have entered into three contracts with two area hospitals that total in excess of $700,000 per year 6

7. Children’s Hospital One part of larger program Working to reduce recidivism for high-risk pediatric asthma patients Involved additional program specific training for paramedics Education, home evaluation, treatment as needed Starting slow, gradually building Treatment algorithm jointly developed 7

8. UTSW – NAIP Network Access Improvement Program Managed care for approximately 20,000 in the City of Dallas All Amerigroup patients Risk stratification profiling Goal is to reduce healthcare spending Patients who meet identified criteria are referred to DFR MCHP 8

9. UTSW – Clements Hospital ED High frequency patients from the ED Best contract to-date Most appropriate referrals Great coordination with hospital social workers Their high frequency patients are not our high frequency patients 9

10. Phase II results Very early data Total enrolled patients - 3 contracts: 48 911 call reduction: 43 total 1 year prior to 3 in 5 months ED visits reduction: 127 total 1 year prior to 25 in 5 months Cautions about the data 10

11. Contracts – Lessons Learned Don’t expect the legal process to go quickly Don’t expect the operational process to move quickly either Persistence and coordination will be required The end results are worth the effort Study what other systems are doing and determine how to make things work in your environment Learn how to speak hospital administrator – it’s a whole new language! 11

12. Future Increase number of contracts 300-400 visits per week by next year Data management solution $1.9m revenue expected FY17 Increase staffing of team – 1 Lieutenant and 5 medics now – Will add 7 more by end of year Eventually will be its own division Hope to add social service worker, mental health and substance abuse components 12

13. QUESTIONS? 13