MIH-Consortium

Kellie Burnam, Community Health Manager, Schertz EMS

Brandon Kludt, EMS Chief, Canyon Lake Fire/EMS

Chris Velasquez, MIH Coordinator, San Antonio Fire Department

Richard Britz, MIH Paramedic, HIS Centre (Bulverde/Spring Branch EMS)

Objectives

•Defining Mobile Integrated Healthcare

•STRAC MIH Consortium

•Current MembersStaffing Projects Overview

•Vision for the Future

•Q&A

Not Sustainable!Most expensive route to most expensive care

Current EMS Model

Healthcare Expenditures

• 2016 – 17.9% of Gross Domestic Product, almost $3.5 Trillion

• 2026 - Expected to rise to $5.7 Trillion

•Medicare – 7.4% per year

•Medicaid – 5.8% per year

Growth in Major Healthcare Payers

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Medicare Medicaid

Triple Aim

Improve Patient

Experience

Improve Health of Populations

Reduce per Capital Cost of

Healthcare

Institute for Healthcare Improvement

Patient has a medical complaint or injury

Patient calls 911

EMS transports the patient to the ER

Patient is treated

Patient is discharged

High UtilizerPatient Cycle

Patient has a medical complaint or injury

Patient calls 911

EMS transports the patient to the ER

Patient is treated

Patient is discharged

Continuity of Care

• Primary Care

• Follow-up care

• Referral to specialists

Resources

• Home health

• Therapy

• Access to medications

• Financial constraints

Education

• Disease and medications

• Nutrition and

physical activity

• Safety

• Healthcare system

What prevents patients from getting better?

“the provision of healthcare using patient-centered, mobile resources in

the out-of-hospital environment.”-NAEMT

PATIENT NAVIGATION

Mobile Integrated Healthcare (MIH)

Mobile Integrated Healthcare (MIH)

•Reach

•Teach

•Educate

•Assess

Low ProfileResponse Vehicles

Can address: ✓System High UtilizersOverutilization of the 911 system

Overutilization of Emergency Department

✓Hospice Revocation

✓Hospital Re-Admissions

✓At-Risk Populations

✓Address social determinants of health

Mobile Integrated Healthcare (MIH)

Mobile Integrated Healthcare (MIH)

Why EMS?

Trusted resource in the Community

Tied into 911

Trained to recognize emergencies and immediate life threats

Comfortable in less than favorable conditions

Delegated Practice (Texas)

24/7 availability

Fully mobile

Flexibility in projects

STRAC MIH Consortium

Regional approach to MIH

“One-stop shop” for organizations seeking MIH services✓One contract to negotiate

✓One process

✓One point of contact to correct issues

✓One coverage map, made up of multiple MIH teams

Mobile Integrated Healthcare Consortium• Utilizing agreements and relationships already in place• Minimize the financial impacts of high-utilizers and chronic care patients • Maintain a high standard of care for patients with these complex conditions• Improve the healthcare system through cost-containment• Decompress over-crowded emergency departments throughout the region

• Encourage all EMS providers in the region to be members• Membership is voluntary• Member Agencies participate as appropriate for their community• Comprehensive regional membership accomplishes continuity of care

* Member Agencies must be the municipal or contracted 911/Emergency Medical Service provider for the jurisdiction they serve under the MIH Program. As such, the Membership Application must be signed/recognized by the governmental authority having jurisdiction.

Patient Care Referral

CommunityBased Care

Local EMS Involvement

Continuity of Care

Patient FocusImproved

Health

Consortium Responsibilities:(Backbone Organization)

Simplify & streamline:✓ Contract Process✓ Data Collection (input & output)✓ Information Sharing✓ Quality Improvement✓ Regulatory Compliance

STRAC MIH Consortium

MIH Chief level meetings

Special project meetings

Data Management

STRAC MIH Consortium

• Open to all STRAC Agencies that are 911 providers

• Conforms to Consortium Charter

• Must have an Inter-Local Agreement (ILA) in place between STRAC & 911 provider regarding MIH• Umbrella (over-arching) agreement to do MIH work• Project-specific agreements

• If choosing to participate in a project, must be able to meet all contractual requirements

STRAC MIH Consortium

HIS Centre Community Health(contracted by BSB Fire & EMS)

2016-2017 Highlights:

• 1003 -Patients Fall Risk, Healthcare Navigation, High Utilizer

• Wellness on Wheels (WOW) -Collaborative mobile shot clinic for community & schools

• Outreach - 414 box fans distributed; medical supplies to Bulembu Swaiziland

2018 Initiatives:

Continue current programs

Focus on senior homelessness (collaborative

project to build homes)

Richard Britz, Director of Community Health

Brandon Kludt, Division Chief of EMS

Gregory Eckert, MIH Paramedic

M – F (8am-5pm)

MIH Services:• High Utilizer Program • Fall Prevention and Home Safety Surveys • Humana Immunizations• EMS Personnel Referrals• Community Education• Community Health Screenings

Canyon Lake Fire / EMS MIH

TOTAL MIH Contacts (6 Month Pilot) 32

Average Age 70

Minimum Age 11

Maximum Age 95

Female Patients 14

Male Patients 17

Average # of Calls for Service Pre 1st MIH 5.9

Average # of Calls for Service Post 1st MIH 1

TOTAL MIH Contacts (Jan– Dec 2017) 101

Average Age 74

Minimum Age 11

Maximum Age 99

Female Patients 28

Male Patients 27

Average # of Calls for Service Pre 1st MIH 5.8

Average # of Calls for Service Post 1st MIH 1.2

• 79.3% reduction in 9-1-1 calls for service for patients that MIH intervened• 18 patients were seen during the Pilot Program (15 have transitioned

out)• 41 new patients after the Pilot Program (3 carried over from Pilot

Program)

*This data excludes patients seen during the monthly health screenings

Canyon Lake Fire / EMS MIH

Canyon Lake Fire / EMS MIHProjected cost savings (call abatement)

• Based on the average of 5.8 9-1-1 calls for service per patient pre MIH intervention, it can be assumed that a cumulative total of 319 9-1-1 calls for service would have been made by the 55 patients involved in the MIH Program.

• Based on the average of 1.2 9-1-1 calls for service (79.3% reduction) per patient post MIH intervention, it can be assumed that a cumulative total of 253 9-1-1 calls for service were avoided by the district.

• Based on the previous financial analysis and an assumption that 60% of EMS calls for service result in ED transport, the district observed a savings of $145,811.49 as a result of MIH intervention.

• October 2014 – pilot program began with High Volume Utilizers

• May 2016 – 7 MIH Paramedics• 4 (24 Hr Shift) MIH Paramedics• 3 (40 Hr/week) MIH Paramedics• 1 Lieutenant/MIH Coordinator

• Over 12,000 MIH Contacts since 2014• Approximately 400 internal referrals from Fire in 2017

San Antonio FD/EMS MIH

Past/Current Projects:• System High Utilizers

• 2,345 high volume utilizer participants• 59% reduction in call volume

• Pediatric Asthma NAIP Grant• 75 patients participated in program• Reduced ED visits, EMS calls, Hospital Admissions• Increased med compliance & PCP visits

• Hospice• 96% effective in stopping unnecessary transports

to the ED

• Haven for Hope Project• Opioid Crisis Task Force

City of Schertz EMS MIH

• Kellie Burnam, Community Health Manager

• Tyler Bowker, MIH Paramedic

• M – F (8am-5pm) & 24/7 On-call MIH Paramedic

• Program began in 2013

• Began MIH-Consortium with SAFD & Canyon Lake FD

City of Schertz EMS MIHPast/Current Projects:• System High Utilizers

• 40 patients participated since program began• Fall prevention, safety assessments

• Humana Immunizations Program• Flu vaccines covered for all Humana cities in service area

• Pediatric Asthma NAIP Grant• 15 patients participated in program• Reduced ED visits, EMS calls, Hospital Admissions• Increased med compliance & PCP visits

• Hospice• 96% effective in stopping unnecessary transports to the ED

• MIH Coordinator • Currently providing project coordination for the entire

Consortium

Add members to the Consortium

Negotiate larger contracts to sustain programs

National Model for regional approach to MIH

STRAC MIH Consortium:Future State

For more information:

Kellie Burnam

kburnam@Schertz.com

210-619-1430