Michigan Pathways Partnership Eases Demand on EMS

Sometimes a few people can have a major impact on the healthcare system. Take Michigan’s Saginaw County as an example: In 2012, one patient was transported to an emergency department by local EMS provider Mobile Medical Response (MMR) 42 times. Twenty-four patients in total were transported more than 20 times each in the same county, resulting in a total of more than $462,000 in ambulance charges. Meanwhile, in Michigan’s Muskegon County, a woman with epilepsy was being transported by EMS to emergency every day for 30 consecutive days due to repeated seizures.

In a bid to address these patients’ needs while trying to reduce their use of ambulance services, the two counties above, Ingham County, and the EMS providers in these jurisdictions jointly decided to take part in the Michigan Pathways to Better Health program. A Michigan Public Health Institute program funded by a $14 million three-year award from the Centers for Medicare and Medicaid Services, Michigan Pathways to Better Health employs community health workers (CHWs) who meet with at-risk patients and connect them to the community-based health and social services they need. In doing so, the program helps reduce these individuals’ reliance on EMS responders and transportation for help, saving government money while meeting or even improving the at-risk patients’ overall health.

“Using this ‘Pathways Community HUB’ model, our goal is to decrease hospitalizations and emergency department visits by identified at-risk patients by improving their adherence to therapy, access to primary care and increasingly using preventive care and support services,” says Barb Glassheim, project manager of Saginaw Pathways to Better Health. Over the award’s three-year period (2013–16), the three project sites/HUBs hired, trained and deployed 75 CHWs.

EMS’ Role: A Saginaw County Snapshot

To get a better sense of how EMS helps make Pathways to Better Health succeed, consider Saginaw County’s experience.

MMR is a private, nonprofit ambulance service that provides basic, advanced and critical care transportation services to 15 counties in mid and northern Michigan. It has over 110 ambulances and 600-plus staff, and is expected to respond to over 135,000 service requests in 2016.

MMR’s formal participation in Saginaw Pathways to Better Health began in the fall of 2013, when a list of the agency’s high utilizers was provided to the Pathways program.

This list required a degree of drilling down to compile. “The initial criteria were based on five or more transports, emergent responses, and the destination being just two of our local hospitals,” explains Steve Myers, MMR’s director of patient access. “This yielded 1,000-plus patients, so it was clear the criteria needed to be tightened. We modified the query to include patients transported over 20 times in a year; this yielded 24 patients who had accounted for over 650 transports.”

Once Saginaw Pathways staff had sorted out which high utilizers were best suited to CHW support, MMR hired their own patient access nurse (PAN), to whom MMR’s EMS technicians would refer high utilizers. “This nurse had an extensive background in home healthcare and integrated into this process easily,” says Myers. “Representing a trusted community resource like MMR, the nurse was extremely successful enrolling patients via outreach with phone calls. Our nurse was able to enroll 48 out of 50 patients in the Pathways program in just one week.”

To further leverage their PAN’s medical capabilities, MMR also made this nurse’s services available to patients needing help and guidance outside of the Pathways footprint. For example, a patient was identified in MMR’s far northern service area who had called 9-1-1 27 times over a six-week period. “The patient suffered from MS and was utilizing his deceased father’s DME (durable medical equipment),” Myers says. “Many of these responses ended up being a lift assist only, since the patient was falling while transitioning in and out of his father’s wheelchair.”

The response under the Pathways project: “The patient access nurse contacted the patient’s primary care physician, who had no idea this was going on,” says Myers. “The patient received physical therapy and appropriate DME, and the calls for assistance ceased.”

Similar positive results have been achieved by Saginaw’s Pathways program in general. “For the patients enrolled by the nurse, MMR saw a decrease of 153 transports in a six-month pre- and post-enrollment period in the Pathways program,” says Myers. “Our road staff is now in tune with identifying patient issues and challenges beyond the call for medical assistance.”

Conclusion

The Pathways to Better Health program has shown that connecting EMS with an available CHW can result in improved healthcare for at-risk patients that is appropriate, cost-effective and capable of easing the demand on local EMS services and emergency rooms. As such, it is a useful response to the issue of high utilizers.   

“Our experience with the Pathways program proved to be very successful not only for our high utilizers but for the community as a whole,” says Myers. “It raises the question as to the true ‘medical’ support provided by a community paramedic versus the need for socioeconomic guidance and navigation. Patients who are being transported 20-plus times in a 6–8-month period appear to need help with multiple issues that are not necessarily medical in nature.”

For more information about Saginaw Pathways to Better Health, go to www.saginawhub.org/web/. For information about Michigan Pathways to Better Health, go to www.mphi.org/projects/michigan-pathways-to-better-health/.

James Careless is a freelance writer with extensive experience covering computer technologies.