Now that I work independently, I have to pay a heck of a lot more for my health insurance. I miss the days when I had fully employer-sponsored insurance. The last few years I was there, I had to start paying a couple hundred a month, which still was fairly reasonable for the type of plan I had. Anyway, I think about health care a lot more now since I’m paying out the nose and also because my parents are aging fast and they’ve got more and more health issues. Here’s some interesting stuff I recently learned about some changes in the health care world.
For decades, emergency medical services (EMS) have operated on a reactive basis: someone calls for help and the necessary service providers race to aid and deliver the appropriate care. The model has worked — and continues to work — for those in a crisis and needing immediate help.
However, several trends in health care are changing the way that EMS providers are viewed and utilized in the delivery of patient care. An aging population, increases in the number of people living with chronic diseases, and provisions in the Affordable Care Act have all made it clear that EMS can provide services well beyond the traditional scope of reactive care. As a result, the concept of Mobile-Integrated Health care, or MIH, is becoming more widely accepted and adopted in health care systems around the country.
What Is Mobile-Integrated Health Care?
The most universally accepted definition of Mobile-Integrated Health care is that it is a model of care delivery that brings emergency services providers — including paramedics, EMTs, and firefighters — together with doctors, nurses, nurse practitioners, and community health providers to meet the health care needs of the community more effectively. Also known as “community paramedicine,” the MIH model of care seeks to establish a more coordinated approach to health care delivery that keeps patients out of the hospital and on the road to better health.
Among the services often included in MIH include:
- Interventions for non-emergency 911 calls. Many hospitals have a population of “frequent fliers,” i.e. patients who routinely call emergency services for non-life threatening situations. Often, these callers do so because they are having difficulty with a chronic condition or lack transportation/access to other providers. MIH allows these calls to be triaged before they arrive at the hospital.
- Post-discharge follow-up care. MIH providers visit patients recently discharged from the hospital to ensure they understand and are complying with instructions, and to identify barriers to full compliance.
- Chronic disease management. Patients living with asthma, diabetes, heart disease, and other chronic conditions can work with MIH providers to better manage and treat their disease.
- Community call centers. MIH may include a community call center that patients can call for help with medications, medical evaluations to determine the need for further care, questions about health issues, and access their primary health care providers.
The idea behind MIH is to provide care for patients in the setting where they are most comfortable — their homes — which studies show result in better outcomes, while also filling in the gaps in the health care delivery system. In the case of chronic disease patients for example, hospital readmissions often stem from poor or improper management of the disease, and a lack of appropriate medical intervention. MIH fills in the gaps between patients and doctors, ensuring that they are getting the best care, when they need it.
Changing EMS Careers
The shift from a reactive to a proactive model of care delivery means that there are also some significant changes to EMS careers. The good news is MIH creates new opportunities for EMS personnel in a number of key areas. While there will always be a need for professionals to respond to emergencies, MIH requires a new class of providers to meet the ongoing need for services. In addition, MIH models require existing EMS professionals to revise their roles. For example:
Leadership. The new health care paradigm requires leaders who are able to collaborate with multiple stakeholders and address the unique and ever-changing needs of the local population. Most MIH programs are managed by a medical director to provide clinical oversight and supervision of the EMS providers. However, there is also a need for leadership among EMS providers as well; those who have the combination of clinical and leadership skills are in high demand to help shape and manage emergent MIH programs.
Fire Service. In many markets, fire departments are called upon to handle health-related emergencies. For example, in a major city, the fire department may respond to calls about intoxicated individuals, a need for assistance lifting patients, and falls — all services that may be better managed by medical teams. Fire departments can respond to emergencies and also engage in more public health activities, including education and hazard identification.
Home Health Care. Home health care utilization is increasing dramatically as the population ages. MIH does not replace the traditional home health provider, but instead augments the scope of services available to patients and fills in the gaps. MIH providers might also work with home health care providers to provide education and support to help them provide services more effectively.
EMS Services. While the most significant change to emergency services brought about by MIH is the change from a reactive to a proactive model, there will still be a need for traditional EMS services. However, under the MIH model, “traditional” emergency services will be reserved for the true emergencies, which will be identified via more effective screening and triaging of calls. While patients who request ambulance services are still entitled to those services, in many cases, the MIH system will prevent a visit to the emergency room while still getting the patient the services that he or she needs.
One of the primary provisions of the Affordable Care Act was a reduction in hospital readmissions. Provider reimbursements are now being tied to reduced readmissions, requiring a change in how care is delivered and managed at all levels. The adoption of Mobile-Integrated Health care is just one strategy being employed in this effort, and represents the shift toward a more collaborative, more effective, health care system.
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Updated for 2017 and beyond.
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