Health systems and payers are forging partnerships with paramedics and other community health providers in mobile integrated health programs that bring home-based care to high-risk, high-expense patients.
The growing value of healthcare in the home is creating some interesting new partnerships for health systems and redefining the house call.
Sometimes called mobile integrated health (MIH) or community paramedicine, these programs give health systems and payers an opportunity to address gaps in care and reduce ER traffic by sending specially trained paramedics to the homes of selected patients—most often those identified as high-risk or who often call 911 or their doctor. Hospitals or health plans can partner with local fire or EMS departments to offer the service, train their own paramedics or contract with a vendor.
"It allows us to create an integrated system of care," says Patrick Mobley, president of Bright HealthCare, a six-year-old payer operating in 14 states, which launched a partnership in 2021 with MedArrive, a San Francisco-based startup offering MIH services. "We were looking for an in-home solution that provides more proactive care."
While each program is unique, most begin with a provider or payer identifying a population in need of home-based care – most often high-risk patients with chronic care needs who aren't following doctor's orders at home or so-called "frequent flyers," who often call 911 for non-urgent care needs and treat the ER as their primary care provider.
Once that population has been identified, a plan is drafted to send specially trained paramedics and/or home health aides to the home. These providers can perform primary care services and wellness checks, coordinate more specialized care, screen for social determinants of health, even just sit down and chat for a while with someone who's lonely.
"We're the glue between the patient, the provider and the payer," says Dan Trigub, who co-founded MedArrive in 2020. "Healthcare is a lot more than just acute care treatment. The continuity of care is absolutely critical."
Critics of these programs say the cost outweighs the benefits, and the challenge does lie in identifying the ROI and proving sustainability. Aside from patient engagement and improved health and wellness, payers and providers are balancing the cost of these programs against expenses tied to hospital and ED visits, as well as reduced hospitalizations.
In a 2021 study published in the Journal of the American Medical Association (JAMA), researchers at Canada's McMaster University analyzed some 1,740 calls by an MIH program operated by Niagara EMS (NEMS) of Ontario in 2018, and found the program reduced ED transports by roughly 50% (compared to emergency transports in 2016 and 2017) and slashed the mean total cost per 1,000 calls from roughly $297,000 to about $122,000.
"This economic evaluation’s findings suggest that MIH delivered by NEMS was associated with reduced ED transport and saved substantial savings of EMS staff time and resources compared with ambulance for the matched emergency calls," the study concluded. "This service model could be a promising and viable solution to meeting urgent healthcare needs in the community, while substantially improving the use of scarce health care resources."
California-based payer Molina Healthcare launched an MIH service earlier this year in Texas, also partnering with MedArrive.
"The mobile integrated health program will provide more efficient in-home care to members by bridging the gap between the hospital and primary care services, assisting in authorizations, ensuring medication reconciliation, and identifying social disparities that may affect care," Chris Coffey, plan president for Molina Healthcare of Texas, said in an e-mail to HealthLeaders. "Molina members currently have access to services that provide referral to in-home healthcare services; this program goes the extra mile in offering Molina members special after-hour access to Mobile Integrative Health (MIH) caregivers."
Coffey says the program helps Molina by reducing and preventing unnecessary ED visits and hospitalizations and ensuring that resources are directed to members who need them the most. It also allows members to be treated in the comfort of their own home, rather than travelling to a doctor or hospital.
Eventually, he says, the program will expand to other states, and could be broadened to address other populations, such as the elderly, and offer such services as remote patient monitoring, behavioral health and substance abuse care, and hospice care.
"The business model can be used for implementation of a variety of change management projects," Coffey says. "Mobile integrated health services are meant to challenge current systems that underserve populations, specifically elderly patients, and can be used to close quality gaps, provide non-emergency in-home assessments, vaccinations, education, and overall care."
In New York, the Arc of Rensselaer County, a residential support program for people with developmental disabilities, has launched an MIH service to give its target population access to primary care services at home. The organization is partnering with UCM Digital Health, which offers "a digital front door platform with a 24/7 emergency medicine treat, triage, and navigation telehealth service."
Don Mullin, the Arc's CEO, notes that the 150 or so patients they serve "have the same healthcare issues that we have," yet a trip to the doctor's office, clinic or hospital is much more challenging.
"We would be paying [ambulance or EMS services] to bring them to the ER, where they might spend five or six hours, and then they'd bring them back, and Medicaid would be charged for the entire visit," he says. "This reduces a lot of that time and effort and stress. We can see $300,000 a year in Medicaid savings alone."
In addition, he says, "a lot of the individuals we support have high anxiety. Going out into the community is a real challenge for them. And a phone call [with a doctor] isn't always great for folks who can't always communicate that way."
Mullin says the service, which sees about 150-175 visits a year, is coordinated with each patient's primary care provider.
"We've probably reduced primary care visits as well," he says. "That's another savings we haven't considered just yet. These savings are coming out of different pockets."
“Mobile integrated health services are meant to challenge current systems that underserve populations, specifically elderly patients, and can be used to close quality gaps, provide non-emergency in-home assessments, vaccinations, education, and overall care.”
— Chris Coffey, plan president, Molina Healthcare of Texas.
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.
Health systems and payers are looking for ways to improve healthcare access and outcomes for high-risk patients who spend a lot of time in the doctor's office or hospital, such as those who call 911 often for non-emergency issues.
Mobile integrated health (MIH) and community paramedicine programs create pathways to send specially-trained paramedics to the patient's home for primary care services and wellness checks.
These programs aim to reduce unnecessary and expensive ER transports and hospitalizations while improving health and wellness and long-term clinical outcomes.