Mobile Integrated Healthcare: Addressing the Myths Behind the Medicine

Healthcare is a notoriously slow industry when it comes to changing how things are done and the adoption of the latest technology innovations despite their potential impact on both patient outcomes and the bottom line. The same can be imparted for healthcare’s reimbursement structures that remain both antiquated and counterintuitive when it comes to paying providers for services delivered and ultimately reinforcing proactive medicine and health strategies. That said, the everything old is new again philosophy that is more commonly applied to fashion trends is also relevant here when we talk about the healthcare delivery model known as mobile integrated healthcare (MIH) which has had a bit of a full circle moment in recent years.

Remember when doctor house calls were the norm? A provider came to your house, assessed your condition, treated you and then left? MIH is the next iteration of that long since passed care delivery model offering a provision of in home (and out of hospital) healthcare services typically delivered by highly trained paramedics or other healthcare specialists. 

The use of paramedics to treat patients in the out of hospital setting first came to be in 1993 as a result of a governmental demonstration project in Red River, New Mexico. During this time, teams were trained in clinic medicine and responsible for managing patients in essentially a healthcare resource desert leveraging telemedicine and other technologies to deliver care that would otherwise not be available. While the program was a success clinically, funding was a challenge as there were (and still are) no significant payer reimbursement models for MIH. 

It is promising that more recently, insurers, risk-based organizations, including health systems, and other entities have started to recognize the true value of MIH and how the model can be used to better manage patients in the home urgent care or hospital at home setting, with better outcomes, significant cost savings and higher patient satisfaction results. For those still learning about the MIH model we address four of the most common myths related to the offering to assist in better understanding what is truly possible today. 

Myth #1 EMTs and paramedics are not qualified to care for patients with urgent, non-emergent medical issues not requiring transport to a hospital.

Fact: While it’s true that EMTs and paramedics are trained to save lives in any variety of emergencies, the majority of calls that EMS address do not typically involve critically injured or sick patients. Whether it be a patient suffering a behavioral health crisis, a child with a sprained ankle on a soccer field, or an elderly patient reaching out because they’ve had a productive cough for a week, EMS professionals respond, assess, treat, and transport patients for definitive care. In successful MIH programs, these EMS professionals, many of which have years of clinical experience, receive extensive training and education that helps them strengthen their assessment skills, differential diagnoses formulation, and the way they present cases to physicians, nurse practitioners and physician assistants through telemedicine that allow for real-time collaboration on the best course of  treatment. That treatment is then initiated on-site without delay.

Myth 2: There are very few patients who can be safely managed at home,

Fact: Ask any emergency physician what types of patients fill their waiting rooms, and you’ll see that lower acuity minor issues clog emergency departments’ (ED) with patients that could safely be managed at a primary care physician’s office or even an urgent care. Unfortunately, access to these outpatient resources can be a challenge as well as time intensive. Solutions such as MIH, which offers comprehensive care delivery in the home, is a medically efficacious alternative. Take a patient with sinus related symptoms. They can’t get in to see their primary for a week, but they’ve had sinusitis before and are familiar with the symptoms. Urgent care is an option, but childcare or even simple lack of transportation make travel difficult and thus delays treatment. The ability for a MIH paramedic provider to come to the home, equipped with technology-driven tools, medications, and procedures who can perform an assessment, consult with a physician, and implement a treatment plan right then and there provides more timely treatment, lower cost or appreciated cost savings, and a very happy, and healthier patient. 

Myth 3: Patients would rather be seen by a physician in the hospital as opposed to being treated in their home.

Fact: In reality, patients are most interested in timely access to care with competent treatment. Whether that’s done in the ED, the primary care physician’s office, or their own living room, first and foremost the patient just wants to get better, and if than can happen in an expedited manner and in a comfortable environment versus a six-hour ED wait, MIH starts to look mighty appealing. 

Myth 4: Treating patients in the home is more expensive than in the urgent care or ED.

Fact: The most expensive part of any hospital visit is the cost of labor. Essentially, when you go to the ED and are billed for that visit, the largest portion of that bill takes into account the physicians, nurses, technicians, janitors, financial billing folks, essentially anyone working to keep the hospital lights on. During an MIH visit the patient pays for the paramedic, the physician consultation, and any equipment that is used as well as medications, lab processing fees, etc. It may sound economically daunting at first, but this cost is traditionally well below (by at least $1500) an ED visit and often less than the patient’s co-pay. What is promising is that insurers are finally starting to embrace the MIH model, as they are essentially at risk for every member and focused on reducing costs while not impacting quality. The ability to manage a patient out of hospital in a timelier manner, with reduced fees is a definitive cost saving strategy and one that we can expected will definitely be appealing to health plans in the future. 

With the introduction, or in the case of MIH, re-emergence, of new ways to deliver care more efficiently and effectively, an element of initial speculation is to be expected. We believe that the model is at a critical inflection point as a more general understanding and appreciation for the advanced clinical outcomes and cost savings that can be achieved through care in the home are being fully realized. Addressing the true feasibility and falsehoods of MIH head-on is a step in the right direction.