Mobile integrated healthcare is a concept traditionally viewed as arising from hospital-based or private EMS services. But can fire-based MIH also become a fiscally sustainable model? More important, does it improve the health of communities?
EMS World spoke with Capt. Michael Wright, who launched an MIH program at the Milwaukee Fire Department, which has rapidly become a model for other fire-based EMS services to emulate.
EMS World: How did the idea of Milwaukee Fire Department’s MIH program originate?
Wright: I didn’t know anything about community paramedicine until I attended a conference in Arlington, Va., in 2014. After hearing Matt Zavadsky describe the concept, I called my chief right away. We have a lot of challenges in Milwaukee, and I felt this could make a major impact. The chief gave me the go-ahead and made it my full-time responsibility. I began the discovery process and had to do a great deal of research and site visits. I visited North Memorial CP [in Minnesota] and MedStar [Mobile Healthcare in Texas] and did ride-alongs with the crews. I addressed the union here and held several listening sessions with our medics.
How did you get up and running?
We sent our first group of volunteers through the University of Wisconsin-Milwaukee’s College of Nursing MIH program in 2015. Our goal in the beginning was to reach the toughest nuts to crack—the high utilizers. Soon after we launched we saw a 26% drop in our “frequent flyers,” a really drastic result. In 2016 the chief gave us an engine house, and we restarted the service in March. We started to gain partners and pick up momentum. People found us. Patients wanted help in getting their prescriptions filled, and pretty soon pharmacies wanted to partner with us. Now on every third visit a pharmacist comes along with us.
What is unique about fire-based MIH?
We’re probably one of the only programs like this in the state. Most are hospital-based or privately operated with funding and have access to patient records. As a fire department we’re detached from most of that, which can present challenges. We had to ask ourselves the best way to provide sustainability. As a fire service our staff is already “paid for” in a sense, so we “rent” them for 4 hours from an EMS to an MIH shift, then back to EMS again. This trimmed our costs per-person, per-shift. As reimbursement goes, insurance companies make the best sense for us, vs. [contracting with] hospitals. Who has the most to gain? It’s the insurance companies. We now have contracts with four payers. Several of them saw a 40% drop in expenditures on their side with launching this program.
How do you receive and discharge patients?
Traditionally we get patients from our 9-1-1 calls. It’s a consent-based process. They sign a consent form. One of the hardest things for any provider, believe it or not, is to regularly locate a patient. This population is transient. Their phones have a number of minutes, then they’re done. It’s labor-intensive, so we came up with a fixed fee. In a perfect world we get four visits in 30 days. That’s the maximum, unless we determine they need more. The first visit is two hours. It’s a physical assessment, and we’re looking for things we don’t know. By the fourth visit we’ve determined needs, who the provider is, and get them a case manager. We introduce that provider as a friend and give the patient a certificate. To close the gap, we go through any final details and deliver them to the case manager. We say, “Here’s our card. The phone number goes right to the firehouse.” Believe it or not, 85% of what we’re doing has nothing to do with medicine. It’s getting people to the right resources that are already out there.
Any closing comments for readers looking to learn more?
As a fire service, we only understand “red light.” Are you dying right now or not? There are yellow lights too—degrees of being sick. I want to enlighten the fire service that the landscape we’re standing on is changing. EMS in a lot of ways is in jeopardy with the fee-for-service model. This is a paradigm shift. As a fire department you’re already in the neighborhood. We have access to every house 24 hours a day and can enlighten the community on things like smoke detectors and fire prevention. If we wait for something to become an emergency, it’s already a fail. This is a lot of work, but it does pay off. Payers are starting to see the value in what we do.
To learn more about the Milwaukee Fire Department’s MIH program, attend Capt. Michael Wright’s session “Mobile Integrated Healthcare for Fire-Based EMS” during EMS World Expo Oct. 31 in Nashville. Visit www.emsworldexpo.com.