Health systems and payers are building partnerships with paramedics and other community health care providers in mobile integrated health programs that provide home care to high-risk, high-cost patients.
The growing value of home health care is creating some interesting new partnerships for health systems and redefining the home visit.
Sometimes called mobile integrated health (MIH) or community paramedics, these programs give health systems and payers the ability to close gaps in care and reduce ED traffic by sending specially trained paramedics to the homes of select patients—most often those who identified as high-risk or who frequently call 911 or their doctor. Hospitals or health plans may partner with local fire or emergency departments to offer the service, train their own paramedics, or contract with a provider.
“It allows us to create an integrated system of care,” said Patrick Mobley, president of Bright HealthCare, a six-year payer operating in 14 states that launched a partnership in 2021 with MedArrive, a San Francisco-based startup offering MIH services. “We were looking for a home-based solution that provides more proactive care.”
Although each program is unique, most begin with a provider or payer who identifies a population in need of home care—most often high-risk patients with chronic care needs who do not follow physician orders at home or so-called “frequent travelers” , who frequently call 911 for non-emergency needs and view the emergency department as their primary provider of care.
Once this population is identified, a plan is made to send specially trained paramedics and/or home health aides to the home. These providers can provide primary care and health checks, coordinate more specialized care, check for social determinants of health, even just sit and talk for a while with someone who is lonely.
“We are the bridge between the patient, the provider and the payer,” says Dan Trigub, who co-founded MedArrive in 2020. “Healthcare is much more than just acute care treatment. Continuity of care is absolutely critical.”
Critics of these programs say the costs outweigh the benefits and that the challenge is really in identifying the return on investment and proving sustainability. In addition to patient engagement and improved health and well-being, payers and providers balance the costs of these programs against the costs associated with hospital and emergency room visits and reduced hospitalizations.
In a 2021 study published in the Journal of the American Medical Association (JAMA), researchers from Canada’s McMaster University analyzed about 1,740 calls from an MIH program run by Niagara EMS (NEMS) in Ontario in 2018 and found that the program reduced ED transports by approximately 50% (compared to emergency transports in 2016 and 2017) and reduced the average total cost per 1,000 calls from approximately $297,000 to approximately $122,000.
“Findings from this economic evaluation suggest that NEMS-delivered MIH was associated with reduced EMS transports and resulted in significant savings in EMS personnel time and resources compared to ambulance for matched emergency calls,” the study concluded. “This service model could be a promising and viable solution to meet urgent community health needs while significantly 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 effective home care to members by bridging the gap between hospital and primary care, supporting authorizations, ensuring medication reconciliation and identifying social disparities that may impact care,” Chris Coffey , plan president of Molina Healthcare of Texas, said in an email to HealthLeaders. “Molina members currently have access to services that provide referrals to home health services; this program goes the extra mile by offering Molina members special after-hours 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 the members who need them most. It also allows members to be treated in the comfort of their own home instead of traveling to a doctor or hospital.
Eventually, he says, the program will expand to other states and could be expanded to include other populations, such as the elderly, and offer such services as remote patient monitoring, behavioral health care and substance abuse and hospice care.
“The business model can be used to implement a variety of change management projects,” says Coffey. “Mobile integrated health services are designed to challenge current systems that underserve populations, especially older patients, and can be used to address quality gaps, provide non-urgent home assessments, vaccinations, education and holistic care.”
In New York, the Arc of Rensselaer County, a residential support program for people with developmental disabilities, launched an MIH service to give its target group access to primary care services at home. The organization has partnered with UCM Digital Health, which offers a “digital gateway platform with 24/7 emergency medical care, triage and navigational telehealth service.”
Don Mullin, Arc’s CEO, notes that the 150 or so patients they serve “have the same health issues we do,” but traveling to the doctor’s office, clinic or hospital is much more of a challenge.
“We were going to pay [ambulance or EMS services] take them to the emergency room where they might spend five or six hours, then they’ll bring them back and Medicaid will be billed for the entire visit,” he says. “It cuts out a lot of that time and effort and stress. We could see $300,000 a year in Medicaid savings alone.”
Also, he says, “many of the people we support have high levels of anxiety. Going out into the community is a real challenge for them. And a phone call [with a doctor] it’s not always great for people who can’t always communicate that way.”
Mullin says the service, which has 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 yet. These savings come from different pockets.”
Erik Wiklund is the innovation and technology editor for HealthLeaders.