Alameda County: An Example of Mobile Integrated Healthcare in Action

In this article, we’ll look at an example of mobile integrated healthcare in action: Alameda City, CA. While there’s a place for talking about mobile integrated healthcare in abstract terms, sometimes you need to get up close and ask the following questions: What’s really going on? And how is this working out there in the real world?

Those are the questions we’ll pose as we examine Alameda County/City’s mobile integrated healthcare-community paramedicine programs (known as their CARES program). We’ll look at the programs they offer, the goals they have, and the results they’ve seen. By the end of this guide, you’ll have a more comprehensive picture of what MIH-CP is and how it varies in form.

First, we’ll look at some Alameda County demographics. Then, we’ll talk about the problems their patients were facing and how they worked to overcome them. Finally, we’ll go over some measurable results.

Example of Mobile integrated Healthcare: Alameda County CA Overview

To understand the Alameda Fire Department’s approach, we need to know more about the program. As you’ll often hear, Mobile Integrated Healthcare is highly specific and variable depending on the area. That’s why it’s critical to understand the area before assessing the success of a program (or whether the same sort of program will work for your area).

Regardless, even when you know the program won’t apply fully to your area, setting, or demographics, there is still something to learn by studying the example of others. With that, let’s go over several topics we’ll explore as we work to understand Alameda County’s MIH program.

Here’s what we will cover:

  • Getting to Know Alameda County
  • The problems they were facing
  • What they did do to overcome
  • The features of the MIH program
  • What was the result

Now, we’ll have a closer look at these components.

Integrated Healthcare in Action: An Overview of Alameda County (And City)

Alameda City lies within Alameda County, California. This island city is nestled in the bay area near San Francisco. The city of Alameda has a population of about 80,000. This is where the Alameda Fire Department has initiated the community paramedicine program.

In a more urban area, there will be many struggles facing patients and the public health system. A few common problems might be homelessness, substance abuse, and behavior and mental health struggles. Of course, it depends on the healthcare system, but even in urban environments, there can be significant struggles in patient access and care coordination.

Let’s look at the specific struggles Alameda chose to address, and then we’ll talk about how they initiated the program.

The Struggles Facing Alameda (Needs Assessment)

If you’re familiar with the steps to starting a community paramedic program, you’ve probably heard about a needs assessment. The needs assessment helps uncover the areas of greatest need so that programs know where they are directing their resources to be worthwhile.

In Alameda’s case, there were likely many problems they could have thrown their resources toward, but they decided on the issue of behavior and mental health. Why? Here’s a little bit about the problems they were facing.

With an uptick in behavioral and mental health calls, there were negative dispositions for patients. Many patients weren’t receiving care at the proper facilities, and there was an increase in police encounters with mental health patients. Also, many patients were being transported to the ER as a default instead of receiving definitive care.

Let’s talk about the program that Alameda put in place.  

The Program Pathway Alameda Chose

Alameda has stated that 25% of all their EMS calls revolve around patients having a psychiatric condition. With these numbers on the table, it’s not hard to understand why they opted for a program that seeks to help these patients.

Ultimately, the Alameda EMS service formed the ACT or Alameda Care Team. The goal was to reduce the strain of mental health and behavioral calls on police departments and to improve the outcomes of those struggling with psychiatric ailments. Let’s talk a little about how they did this.

The Features of the Program

The ACT operates on a 24-hour basis. The team is staffed with a paramedic trained to assess and stabilize behavioral health incidents. This team is in operation seven days a week.

This specialized response team will be dispatched to calls meeting the pre-established behavioral emergency criteria. This way, the program allows other ambulances (police officers, first responders, etc.) to respond to other emergencies. After responding to the person in need, the behavioral paramedic is trained and authorized to place the patient on an involuntary hold (with communication with medical direction).

As you might have guessed, the program doesn’t operate in isolation. On top of the other programs the Alameda Fire Department has employed, this program works in partnership with Alameda Family Services (AFS). The ACT program makes the initial connection with the patient, and if applicable, the person is then provided a consultation with AFS.

With this system, the person experiencing a behavioral or mental health crisis can have their immediate needs met, as well as a plan for their long-term goals.

This program has proved successful. In the next section, we’ll look at some numbers and stats. Finally, we’ll review several points other providers can learn from Alameda.

The Results of the Alameda Program

What was the result after implementing a new system? Let’s look at a few key metrics that have helped prove the success of this program. We list three metrics that this program measured. We’ll review each of them and discuss their meaning and why they made such a positive impact.

Patients transported to the emergency room: Before the ACT program was initiated, 80% of patient encounters ended up with the patient being transported to the emergency room. This high volume of patients at the ER can often overwhelm hospital staff. Not only that, but the emergency department is not always the optimal location for a patient experiencing a behavioral or mental health episode.

After the ACT program was initiated, only 10% of patients were transported to the ER. This is a considerable reduction and demonstrates that the program was doing something right. But if the patients weren’t going to the emergency department, where were they going?

Patients who were not transported: Before the start of the ACT program, only 10% percent of patients were not transported anywhere. After initiating the ACT program, 74% of patients weren’t transported. What do these numbers indicate?

Well, they could mean several things; however, given the number of patients who were transported to the ER (before the ACT program), it probably means that after the start of the program, people had more resources available to them. In short, they didn’t need to be transported because a specially trained crew could address their needs without transport.

Psychiatric Facilities and Alternative Destinations: After the program’s initiation, there was a drop in the number of patients transported to psychiatric facilities and an increase in the number of patients transported to alternative destinations.

Overall, the program appears to have completed two key goals of any mobile integrated health program: first, the ACT program delivered better patient care. Second, the program freed other community resources to do their jobs better.

For a more comprehensive look at numbers and graphs, check out this article detailing the City of Alameda Program.

What Programs Can Learn from this Example of Mobile Integrated Healthcare

Let’s review a few things Alameda has done exceptionally well with their ACT program. Of course, some people are likely working very hard behind the scenes to complete tasks that we cannot see.

However, there are several things they appear to have done right:

  • Performing a needs assessment: the Alameda team looked at their present landscape and made a concerted effort when they initiated the ACT program. They knew what they needed, and they made a plan.
  • Stayed malleable: The Alameda area has had several community paramedic programs that address all sorts of issues. While we’re unaware whether they were all a success, it is admirable that they were willing to try multiple ideas.

All right, now let’s go over a few final thoughts.

Conclusion: Alameda, CA as an Example of Mobile Integrated Healthcare

The Alameda Fire Department found and addressed an issue with careful planning and strong execution. The ACT program is an excellent and successful example of community paramedicine. The partnerships forged with this program have made the health systems more robust and the citizens healthier.

Contact Julota to uncover how their interoperable software can help your MIH-CP program form stronger community connections, store better data, and improve patient care.