A new model of healthcare has arrived in the form of mobile integrated healthcare community paramedicine (MIH-CP).
You’ve heard all the buzz about these programs and partnerships with local EMS and ambulance companies. You’ve heard about how specially-trained paramedics can visit the homes of selected residents. You’ve heard about how it’s supposed to help EMS agencies to create patient-centred, mobile resources in an out-of-hospital environment. Do MIH-CP programs live up to the hype? In today’s post, we’ll look into seven reasons that MIH-CP programs benefit everyone.
- Lowering super-utilizers
In Milwaukee, Wisconsin, a 2015 review of more than 60,000 annual 911 calls found that 7 percent, or 4288 calls, came from the same 100 people. California’s Alameda County has a list of the top 25 “frequent fliers” who call 911 regularly; in just two years, 25 people had collectively called the 911 line 4,291 times. A 2009 MedStar study found that in the Fort Worth, Texas area, 21 patients had been transported to local EDs a total of 800 times over a 12-month period, generating over $950,000 in ambulance charges and even more significant ED expenses. Most of these individuals did not have health insurance and relied on EMS and local EDs for health services. The Tucson Fire Department had been able to identify 50 individuals who accounted for more than 300 non-emergency 911 calls over a 12-month period.
This is no surprise. All EMS workers know this: super-utilizers and “frequent flyers” are prevalent everywhere across the country.
This certainly isn’t ideal. It’s a waste of EMS services, time, effort, and money, especially when most of the problems that these frequent flyers have, and this system abuse seems only to be getting worse. How can communities combat this?
The answer is not to limit people’s access to 911, of course. Instead, MIH community paramedicine is an answer. MIH-CP programs aim to solve this by attacking the underlying causes of these many 911 frequent flyers, or at least mitigate the load and give these patients the proper care. MIH-CP can improve the health and wellness of underserved populations — especially those with chronic conditions who use the ER as their primary source of healthcare. People needing mental health care can be directed to the proper facilities through proper transportation. Slowly, they’ll learn to better take care of themselves instead of using 911 as their catch-all. By helping patients in the community improve mental and physical health, the frequent flyer and super-utilizer phenomenon decreases.
- Relieve the EMS system in 911 Calls
The community paramedicine program in North Memorial, Minnesota, is seeing a decline in 911 calls after implementing an MIH-CP program. For the first half of 2018, North Memorial found no cost savings during that time period, but in the second half of 2018, the costs of patients who had received those visits declined by $1,969 per member per month.
Fort Worth, Texas, saw similar results as well. Between July 2009 and August 2011, the Texan community saw the volume of 911 calls fall by 58 percent, from an average of 342.3 monthly calls during the 6-month period before enrollment to 143.3 monthly calls afterward. Unsurprisingly, the decline in calls corresponded to a drop in wasted money; the annualized EMS transport costs for these patients decreased by over $900,000 (from $1,577,472 to $660,128) and charges falling by over $2.8 million ($4,929,600 to $2,062,899).
An EMS1 article wrote that “81 percent of [MIH-CP] programs in operation for two or more years reported success in lowering costs by reducing 911-call use and emergency department visits for defined groups of patients.”
Give the EMS and emergency room workers a break — and let them focus on the emergencies they need to focus on.
- Educate and help the under-served populations
When community paramedics can visit underserved populations, it saves time for everyone. MIH-CP programs allow paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community. Ultimately, allowing EMS workers to do this helps improve access to care, as many populations currently don’t know how to access that care. Instead, community paramedicine brings that care to them.
By focusing on medically or socially underserved populations, which are the ones who tend to have a higher risk of using emergency departments, MIH-CP programs become first responders with community health worker skills.
Healthy Hennepin, a publication managed by Minnesota’s Hennepin County Public Health Department reported the following story: “A community paramedic was on-site when an asthmatic shelter resident, who had recently been discharged from the hospital, began wheezing. ‘Normally someone would have called 911 about him,’ the paramedic remembers. ‘Instead, they called me.’ After showing the resident how to properly use his nebulizer and inhaler, his wheezing subsided. Crisis averted. Calm achieved. Costs contained.”
In a California study of MIH-CP in over five counties, patient self-assessments after receiving community paramedic visits showed several improvements: a 16% increase in their rating of overall health, 11% in their understanding of discharge instructions, 4% in their understanding of when to take medications, and 9.5% in their understanding of medication side effects.
- Provide the proper care for the caller
The point of community paramedicine is to outgrow the outdated system currently in place. Anyone working in EMS knows that the 911 calls they receive are often for non-urgent needs or those that a hospital emergency room is not equipped to handle. Research has shown that 11 to 52 percent of 911 calls aren’t from people in serious health emergencies.
Additionally, many visits are made for patients with conditions that are better treated in a primary care setting. Going to an emergency room for acute upper respiratory infections, viral infections, otitis media, and acute pharyngitis is often worse off for the patient because the emergency room is already so busy that the doctors and nurses don’t have enough time to explain the patient’s condition to them adequately, nor how to properly take care of themselves during the recovery process.
Importantly, the real underlying problems of many 911 callers, especially frequent flyers, are psychosocial problems that cannot be effectively treated in the emergency room. An emergency room doctor or surgeon cannot fix someone’s alcohol or drug dependency problem, nor can they do much to help a patient with depression. With community paramedicine programs, paramedics will be allowed to transport a person experiencing a behavioural health problem directly to a crisis care center instead of the emergency room first, which will enable patients to get the help they need much faster. Inebriated individuals can be sent to sobering centers.
Although some might argue that this could lead to the under-triaging of patients, it’s already been well established that a hefty portion of 911 calls doesn’t require emergency room treatment. It makes more sense for paramedics to transport patients to the most appropriate location for their condition instead of trying to funnel all patients through a more likely-than-not costly and crowded emergency department.
Many callers use 911 because they don’t know where else to go for healthcare-related problems. By allowing paramedics to transport them (or suggest that idea to the patient), patients can slowly learn about the available solutions to their problems.
- Reducing hospital readmissions
One specific subset of also routinely call 911 and visit the emergency room with exacerbations of chronic conditions that could be avoided with proper condition management. Community paramedics aim to help those with complex chronic conditions improve their health and wellness at home. Through home visits, community paramedics teach patients how to use and why they should use their medication. Additionally, these paramedics can assist in filling prescriptions, sorting medications, and explaining how to take them as prescribed. They can supplement information by providing counselling on hospital and clinic discharge instructions.
Community paramedics can assess the patient’s lifestyle — often the culprit of hospital readmissions, especially in those with chronic conditions — and educate them on how or why they should change certain things. This allows healthcare providers insight into a part of the patient’s life that even doctors don’t get to see and has had proven benefits in reducing the number of hospital admissions.
In a 2017 California MIH-CP study in the Alameda, Glendale, San Bernardino, Solano counties, hospital readmissions rates decreased by about 10%. Other studies have shown up to a 50% decrease in readmissions.
- Build more trust with the community
Since MIH-CP programs aim to solve everyone’s problems, having an effective MIH-CP helps people have more confidence in their EMS and network of healthcare providers in the area. By making routine visits to patients’ homes, paramedics not only help improve patients’ physical health but also feel more cared for and supported. Relations between all network healthcare providers would be improved, especially given the logistical and financial benefits for everyone involved. When people know that their community healthcare providers can provide them with the support that they need, the community inherently will learn to trust them more.
Additionally, everyone in the community will be in better shape. Emergency room doctors see fewer non-emergency cases, hospital charges decrease, urgent care centers get better access to the people who need them, and the patients get the care they need.
- It’s easier than ever to do this
The good news is that the technology is finally where it needs to be. Implementing an MIH-CP program is easier than ever because software and systems that bring entire local healthcare provider workforces together to effectively collaborate finally exist. With Julota, for example, a community’s health systems, EMS, law enforcement, social services, mental health, and all other community care organizations can benefit from more collaboration, better health, and lower overall costs. As comprehensive HIPAA-/mental health (42 CFR part 2)-/Criminal Justice Information System-compliant solution that manages secure multidirectional sharing of consented information, Julota helps patients get better and more appropriate treatments that they would otherwise lack.
Written by Kevin Amell