As the EMS provider for more than 1 million people in the greater Fort Worth area, MedStar sees the use of the 9-1-1 system for medical and trauma conditions that, for the patient’s benefit, could best be addressed by a response other than an ambulance trip to an emergency department. In 2008, 21 individual patients were transported to area emergency rooms more than 2,000 times by MedStar, resulting in $962,429 in ambulance charges (not including the charges from the hospital emergency departments). Majority of these bills are uncollected. Many people are using EMS as a health care safety net.

In July 2009, MedStar implemented the Mobile Integrated Healthcare Program that identified high system users and developed individual care plans for each of those patients.

As part of that care plan, the enrolled patient receives regularly scheduled home visits by one of our Mobile Healthcare Providers. During those home visits, the paramedic provides a medical assessment, ensures the patient is taking their prescribed medications and is following up with their primary care provider. They also provide some often much-needed social interaction for these patients.

That humble beginning has led to the development and implementation of several programs all centered on Patient Navigation and Mobile Integrated Healthcare:

High Utilizer Group (“HUG”) Program

Patients who use 9-1-1 15 or more times in 90 days, or who are referred into the program by ED or payer case managers due to high ED utilization, are enrolled. MedStar’s Mobile Healthcare Providers (MHPs) conduct regular home visits, evaluate Social Determinants of Health, connect the patients to available resources and teach the patients how to better manage their own healthcare. Typical enrollment is 30-90 days. Since October 2013, 820 patients with 2 years of utilization data available (1 year pre and 1 year post enrollment) have reduced ambulance transports to the emergency department by 48.4%  It also has prevented 5,545 ED visits in this patient population. This reduction has saved $15 million in healthcare expenditures for ambulance and ED admissions ($18,297 per enrolled patient).

Readmission Avoidance

Patients at risk for a 30-day readmission are referred to MedStar by the patient’s Case Manager or PCP. MedStar conducts a series of home visits to educate the patient and family on appropriate care management and loops the patient to their PCP. If the patient needs intervention, the MedStar MHP may coordinate in-home diuresis or other treatments with the patient’s PCP, along with a follow-up PCP appointment. Since October 2013, 684 patients who had a prior 30-day readmission AND the referring agency felt would have a 30-day readmission have been referred into the program. The enrolled population had a 49.2% readmission rate versus the expected 100% readmission rate.

Episodic Care Coordination

MedStar works with numerous healthcare partners with special populations to help navigate patients to the most appropriate source of care for their medical needs. Sometimes this is during a 911 call, while at other times it’s a home visit requested by the partner agency. These partners include hospitals, health insurers, home health and hospice agencies, care management organizations, accountable care organizations and other partners.  Through December 2023, of the 6,054 911 and urgent care responses to these enrolled patients, only 4,179 (69.0%) of the calls resulted in the patient being transported to an emergency department.

Patient Perception of Health Status

Patients enrolled in MedStar’s MIH programs are provided with a questionnaire to assess their perception of their health status upon enrollment in the program, and then upon graduation from the enrollment. These scores are then compared to assess how the patient’s perception of their health status has changed as a result of the enrollment.  The chart below depicts the EuroQol score or the change in the patient’s perception of their health status.

The success of these programs would not be possible if it were not for our myriad of community partnership who have formed a unique collaborative to support enrolled patients with services and resources that contribute to their success!

The American Journal of Emergency Medicine published a study about MedStar’s MIH program.

Click here to review the peer-reviewed study.

The goal of the Mobile Healthcare Program is to meet the Institute for Healthcare Improvement’s Triple Aim:
– Improve patient outcomes, including their experience of care
– Improve the health of the population
– Reduce Costs