That early remark from keynote speaker Capt. Michael Wright helped set the stage for the fifth annual ImageTrend Connect conference, which officially began Wednesday in St. Paul, Minn.
Wright, who heads the Milwaukee Fire Department’s mobile integrated healthcare program, was referring specifically to the resurgence of vaccine-preventable disease like measles but expanded on the point with numerous examples from his own department.
Leaders of MIH-type programs can do a lot to shape downstream costs, he said. Within his MIH program, for example, Wright’s team can offer nonurgent patients who need hospital services a range of transport options, from self-transport in a personal vehicle to BLS or ALS ambulance rides or even a flight.
Guiding patients’ health efforts effectively, though, requires a broad range of data from a full set of community partners. That’s still a relatively new approach for many fire-based services, and many are playing catchup.
Wright described several local initiatives that leverage data to provide more appropriate care. Two dealt with the opioid crisis: a Wisconsin prescription drug monitoring program that tracks controlled-substance scripts in the state, and MORI, the Milwaukee Overdose Response Initiative. MORI takes EMS run data, combines it with dispatch data to help identify and locate users at risk, and ties in data from law enforcement, hospitals, and other sources to paint fuller portraits of patients and determine communitywide pictures and patterns.
The department’s MORI outreach team—two community paramedics and two peer-support counselors, reformed addicts themselves—intervene, initially and most importantly with lifesaving measures. The ultimate goal is treatment, Wright noted, but you can’t get someone to rehab if they’re dead, so mitigating life threats comes first.
Milwaukee County had 356 overdose deaths last year, but probably 10-15 times as many overdoses that weren’t lethal. Nationally, the opioid crisis accounted for some $600 trillion in total costs in 2018. Besides keeping vulnerable people alive, better management of those who abuse can obviously have enormous financial implications.
With Wisconsin law prohibiting transport to alternative destinations, the team struck a deal with Lyft to take appropriate patients to nonhospital facilities. When you combine new resources and use them in a logical sequence, Wright said, bigger things can be accomplished.
Sometimes that happens in surprising ways. One patient, finally ready to quit, turned his fentanyl over to the department's team. Unsure what to do with it, they secured it in a sharps container. This led to a search for better alternatives and the discovery of special drug-disposal bags that facilitate such situations.
MFD providers also engaged with patients through the Coverdell Stroke Program, following up with those recently released from hospitals. Wright and company had the AHA’s “Get With the Guidelines” treatment recommendations replicated within ImageTrend’s platform for easier application with these patients.
Finally Wright described a postdischarge evaluation program. Team members visit referred patients first in their hospital or healthcare facility, again within 36 hours of discharge, a third time seven days later, and a fourth time if necessary, all to ensure their compliance with medications and discharge instructions, monitor overall health, and troubleshoot any problems before they grow.
He concluded with an overview of the social determinants of health, those nonmedical factors that can impact the health and wellness of vulnerable citizens. Things like housing, money, personal safety, and transportation all can have spillover effects. One patient, for instance, was a man in his late 20s stuck at home caring for a sick uncle. He’d never driven or even ridden a bicycle or bus, but he called 9-1-1 regularly—as it turned out, just to get out of the house. MFD providers ended up helping him learn to use the city bus.
In a second talk later, Wright emphasized two recent realizations the program helped prompt: One, emergency workers don’t fix patients. You may resuscitate a cardiac arrest victim and help that patient toward neurologically intact discharge, but if they return home and resume the poor diet and other bad habits that contributed to their heart woes, you’ve bought them time but not a solution. And two, EDs can’t cure chronic illnesses; they can only manage symptoms. The goal of MIH and community paramedic programs is to interrupt such cycles by addressing unmet needs.
The MFD MIH program has arrangements with four payers, Wright added in his second talk, and data is necessary to help convince them. Learn the available programs, he counseled; study your population; secure all levels of buy-in; find partners with complementary missions; focus on outcomes; and be able to measure success.