November 22, 2017

These patients used to call 911. Now, they get in-home care instead.

Daily Briefing

    To keep vulnerable patients out of the hospital, hospitals and insurers are turning to so-called "mobile integrated health," which involves first responders providing care for patients at home, Leah Samuel reports for STAT News.

    Mobile Health Clinics: Improve access to care for the underserved

    Background

    Samuel reports that first responders often take elderly, chronically ill patients to the ED for even seemingly minor illness—a potentially inefficient use of resources that is one of several factors behind the rise of mobile integrated health. Further, laws in many places—such as Massachusetts—require a hospital trip for 911 calls, Samuel reports.

    Under mobile integrated health initiative, patients are given an alternative number to call during certain hours of operation. First responders are permitted to provide certain care services in the patient's house. By preventing unnecessary hospital visits, mobile integrated health programs can save insurers money, reduce the risk of hospital-acquired infections, and provide a less stressful experience for patients, according to Samuel.

    Mobile integrated health in action

    More than 100 mobile integrated health efforts are up and running around the United States, Samuel reports, including several in Massachusetts, where the Department of Public Health has waived certain rules for EMS providers for two Boston-area mobile integrated health efforts.

    One of the programs, Commonwealth Care Alliance (CCA), launched in 2014 and works with individuals in the Boston area who qualify for both Medicare and Medicaid—or "dual eligibles." According to a MedPAC report, dual eligibles in 2012 made up 18% of the Medicare population but accounted for 31% of spending—in part because of their frequent ED trips.

    Patients interested in participating receive a refrigerator magnet with a number to call in case of medical emergency between 6 p.m. and 1 a.m. Individuals who call the program consult with an NP, who coordinates a care response with CCA contractor, EasCare Ambulance Service.

    According to Samuel, patients who call during the program's hours of operations are usually seen at home by a first responder within an hour, while those who call at other times are scheduled for a visit during the evening shift. When an EMT arrives at a patient's house, he or she records vitals and the patient's symptoms, consults with a physician over the phone, and then—if appropriate—provides basic care services, such as administering medical tests, setting up an IV, or providing medicine. The program's vehicles do not include stretchers, so if the EMT decides the patient requires emergency care, he or she will call for an ambulance.

    Another mobile integrated health program, SmartCare Community Paramedics (SCP), was also created under the DPH waiver. SCP works with Beth Israel Deaconess Medical Center patients with severe health problems that put them at high risk for repeated hospitalizations.

    A promising trend—but limited evidence

    While there is interest in expanding mobile integrated health programs, their efficacy hasn't been studied much, Samuel reports.

    For instance, CCA surveyed 275 program participants who received mobile care services through July 2017 and found that 84% were able to avoid all ED use over that time period. According to a 2016 study coauthored by CCA, avoided ED visits save between $800 and $3,600 per patient compared with the cost of similar care in a hospital setting.

    Stephen Dorner—an emergency medicine physician at Massachusetts General Hospital who co-authored a 2016 journal article on mobile integrated health programs, and who consults with CCA—said, "We're able to anecdotally note that there is a benefit, but we need to measure how beneficial these programs really are."

    He added, "We know that it saved money when people avoided going to the hospital. But we're talking about avoiding something that it's hard to predict in the first place. There hasn’t been a full-scale, retrospective analysis" (Samuel, STAT News, 11/17).

    Mobile Health Clinics: Improve access to care for the underserved

    More than 50% of uninsured non-elderly patients lack a usual source of health care, and 25% of low-income patients miss or reschedule appointments because they lack transportation.

    This research report provides best practice models for employing a mobile clinic to improve access to care for vulnerable populations, including detail on national mobile health clinic trends.

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