Emergency Medical Services (EMS) traditionally focuses on rapid response and transport for acute emergencies, operating primarily as a reactive model. Mobile Integrated Healthcare (MIH) expands this role beyond emergency transportation to deliver person-centered care outside of the hospital. MIH leverages existing mobile resources to address gaps in the healthcare system that often lead to unnecessary emergency calls.
Defining Mobile Integrated Healthcare
Mobile Integrated Healthcare is an organizational framework that integrates EMS agencies with other healthcare providers, including primary care physicians, hospitals, and public health organizations. This collaboration provides comprehensive, coordinated care in the patient’s home or community setting. MIH utilizes the existing EMS infrastructure, such as vehicles, communication networks, and personnel, to address non-emergency health needs. By connecting patients with the most appropriate level of care, MIH aims to streamline services and provide higher quality, cost-effective medical interventions.
The Role of Community Paramedicine
Community Paramedicine (CP) is the service delivery model operating under the MIH framework, utilizing specialized personnel to execute the strategy. A Community Paramedic is an EMS professional, typically an EMT or paramedic, who completes additional training beyond the traditional emergency scope. This specialized training focuses on areas like chronic disease management, public health principles, and the social determinants of health.
These professionals function as members of a patient’s medical team, often supervised by a physician or advanced practice provider. Their expanded role allows them to perform comprehensive health assessments, provide education, and coordinate care in non-emergency settings. They also connect patients to social services.
Essential Services Provided by MIH Programs
MIH programs deliver a range of services designed to bridge healthcare gaps and reduce reliance on emergency services.
Post-Discharge Follow-up
Community Paramedics visit patients shortly after a hospital stay. These in-home visits ensure patients understand discharge instructions, take medications correctly, and have a safe living environment. This significantly reduces the risk of hospital readmission for conditions like Congestive Heart Failure (CHF) or Chronic Obstructive Pulmonary Disease (COPD).
Chronic Disease Management
Providers offer regular monitoring and education for patients with ongoing conditions such as diabetes or hypertension. The Community Paramedic may perform procedures like blood draws, check vital signs, and help patients adjust to new treatment plans, often facilitating interactive telemedicine consultations with a physician. This personalized in-home care supports medication compliance and helps patients recognize early warning signs of disease exacerbation.
Mental Health and Substance Abuse Referrals
MIH programs play a role in Mental Health and Substance Abuse Referrals by connecting patients with appropriate community resources. If EMS is called for a behavioral health crisis, the MIH team can evaluate the patient on-site and facilitate a direct transfer to a treatment facility or connect them with social work services, rather than defaulting to the emergency department.
Wellness and Preventive Care
Wellness and Preventive Care are integrated, with services including administering vaccinations, conducting health screenings, and providing injury prevention education, such as fall risk assessments in the home.
Systemic Impact and Future Direction
MIH interventions lead to a significant decrease in unnecessary Emergency Department (ED) utilization and a reduction in 911 calls from frequent users. Some programs have reported a reduction of approximately 50% in ED transports for enrolled patients. This reduction in non-emergent use allows traditional EMS units to remain available for true emergencies, improving community safety.
By focusing on preventative care and patient education, MIH programs improve patient adherence to treatment plans and decrease costly hospital readmission rates.
The future trajectory of MIH centers on establishing sustainable funding and regulatory models. Historically, EMS reimbursement has been tied only to patient transport, creating a barrier to financial stability for non-transport services. Ongoing policy discussions and pilot programs, including some through the Centers for Medicare and Medicaid Services (CMS), are exploring ways to reimburse EMS agencies for treatment provided on the scene or for transport to alternative, non-hospital destinations. Expanding these value-based payment models is necessary for MIH programs to become a fully integrated and sustainable component of the healthcare system.