Transcript COMMUNITY PARAMEDIC MOBILE INTERGATED HEALTH CARE

Partners in Healthcare- Filling unmet
needs with untapped resources
Donna G Tidwell, MS, RN, Paramedic
Director Office of Emergency Medical Services
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illness, and complex, outdated reimbursement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 populationbased 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
Gap analysis of health needs
68%
Community assessment
66%
Other CP programs
Other healthcare stakeholders
30%
20%
Other 7%
Combat repeat users
1%
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 “singleprovider/single agency” care models will not
optimize expertise for patient results, will be
too limited in capacity, and are unlikely to be
financially sustainable.