As mobile integrated health (MIH) grows as a profession, teams across the country examine the best business model for them. Many teams operate under their local EMS or ambulance services, while others operate within a physician group or hospital. Because MIH services are carefully tailored to community needs, it makes sense to choose a business model that fits easily into the community.
Hospital-based MIH teams can access a range of services and resources from the larger health system, providing them with opportunities for care. Larry Shots, NRP, CP-C, works as part of an MIH team through Daviess Community Hospital in Washington, Indiana. Daviess Community Hospital is a small, rural hospital that serves a culturally diverse population. Because the hospital operates the local EMS service, the MIH program stems from the hospital.
Within a little over a year, the program has experienced tremendous growth, with support and buy-in at the highest levels of the hospital. It began as an effort to reduce 30-day readmissions. Today the program encompasses three care areas: chronic care management, perinatal care, and peer recovery. Larry heads up the chronic care management side, and he has no shortage of tasks. He provides everything from discharge follow-up to lab draws to wound care to appointment transportation and so much more.
Success through community connections
The key to the program’s success is close partnerships with the community. Larry has a relationship with about 20 primary care physicians, half of which are affiliated with the health system, and he regularly meets with local councils focused on seniors or other vulnerable community members.
He facilitates care with the PCPs daily, performing labs and helping carry out the doctors’ care plans.
“I sit one-on-one with the PCP to discuss patient care and findings,” he said. “I’m often the eyes and ears of the physician. I share patient questions back with the doctors and explain the doctor’s game plan with the patients.”
An important service he’s able to offer thanks to the hospital integration is medication reconciliation. Many patients he sees are on multiple prescriptions given by multiple doctors. The pharmacies don’t always catch drug–drug interactions. He compares changes in prescriptions to what patients are actually taking and follows up with the PCP.
“I will do a med rec and report back to the PCP, who will talk to the other physicians or contact the pharmacy,” he said. Larry has a wealth of knowledge to tap into as needed through his connection and tenure with the hospital.
“What I love about this small, rural hospital is I’ve shadowed everybody before we started our program; I know who I can reach out to,” he said. “We have an open-door policy with the EMS director, the CEO and the CFO. I can explain how I want to build the program, and they support me.”
Working through funding challenges
Funding remains a challenge as with all MIH teams. The program at Daviess is primarily grant funded, although they have found ways to bill for some services. There’s a learning curve to the billing process, ensuring you meet all the requirements and bill on time.
For example, Larry said billing for transitional care management requires three parts within a set time to make one charge. The team must be diligent about following up and ensuring patients have the appointments necessary to complete the charge.
Results from the program are starting to come in. The program is well-received in the community, and the team’s hard work has been reflected in HCAHPS scores. Larry follows up with patients after discharge to make sure they understand their instructions, and this education aspect has contributed to higher patient satisfaction.
Larry said the team continues to look for ways to bill and increase funding, as well as keeping an eye on legislation going on at the state level.
Integrating with a health system is one potential model for MIH teams, whether you’re in a small or large service area. Hospitals offer access to services and expertise that may not be available through other models. Close coordination and clear communication are key to getting and maintaining buy-in at the highest levels of the organization.