AMR Contributes to Successful MIH Study

Triaging calls, matching resources to patients’ needs and sending highly-skilled medics to care for patients is what American Medical Response (AMR) does well. So well, that the company is receiving praise for its contribution to the recent study proving the success of Evolution Health’s Mobile Integrated Healthcare (MIH) model.

It is the company’s ability to provide the most appropriate, timely and cost-effective care in the safest setting that healthcare industry leaders see as vital to the successful implementation of MIH.

“Our MIH model has demonstrated effectiveness in reducing hospital readmissions, medical inpatient admissions and healthcare costs, and was meaningfully powered by AMR EMS providers,” says Eric Beck, DO, MPH, EMT-P, chief executive officer for Evolution Health at Envision Healthcare.

The physician-led MIH model provides 24/7, out-of-hospital, needs based integrated post-acute care, chronic care and prevention services. The interprofessional care team consists of advanced practice providers, nurses, social workers, pharmacists, paramedics and EMTs, among others.

As the nation’s largest provider of medical transportation and community-based mobile healthcare, AMR has an arsenal of vehicles, equipment, telecommunications capabilities and clinicians it leverages to respond quickly and provide quality care.

AMR utilized those same resources to assist Evolution Health, its sister company under Envision Healthcare, in providing MIH to a Medicare Advantage Population in Florida starting in late 2015.

“This program was an absolute success,” says Bill Hall, Director of Regional Operations at AMR. Under his lead, the team at AMR worked in unison with Beck and his colleagues.

For the 90-day evaluation period in the published study, AMR performed a total of 47 encounters that included treatment for chronic obstructive pulmonary disease, diabetes, heart failure and a variety of symptoms patients experienced post-discharge. Of those visits, 34 resulted in at-home treatment and release. Twelve patients required transportation in this evaluation period to in-network hospitals and one resulted in transportation to a substance abuse rehabilitation center.

Hall said his team was well-prepared to help.

AMR’s fleet included six sport utility vehicles known as MIH vehicles—two were fully staffed 24/7. Trained MIH medics were also on ambulances to respond as interceptors.

“The operation that AMR runs with such precision and the ability of its medics to perform in-home visits and facilitate telemedicine with physicians, pharmacists and social workers truly illustrates top-of-licensure care,” says Beck.

Merlin Underwood is an MIH paramedic and the operation supervisor in Broward County. He said that through MIH, medics are true clinicians who are providing modern day, high-tech house calls: “We serve that need between lights and sirens, and waiting to get an appointment with your primary care physician. It really lets me be a true patient advocate, instead of just the ‘you call, we haul’ concept.”

Once paramedics arrive on the scene they perform a typical evaluation and then provide the appropriate treatment. Underwood emphasized that medics focus on caring for patients in their place of residence and see transportation to the ED as a last resort.

During the study, he was responsible for responding to calls and said one patient stood out because she required extra time and attention: “I wasn’t concerned about the time or getting to another call. I was there for her and her exclusively, and I could take as long as I needed.”

Part of the team’s success is due to the Medical Command Center’s clinical practice model. The center accommodated Evolution Health call takers, nurses and ambulance dispatchers, and helped streamline communications. Additionally, the technology used optimizes the utilization of resources to help make the process more efficient.

AMR’s ability to assess patients and safely deliver care in alternative settings is what makes MIH capable of reducing costs and improving the patient experience.

Results from the study, led by Beck, Daniel Castillo, MD, MBA, Brent Myers, MD, MPH, and Jonathan Mocko, Evolution’s actuary, showed that when compared to a control group, there was a 40% decrease in inpatient utilization and a 21 percent decrease in emergency department (ED) utilization. Inpatient per member per month (PMPM) costs decreased 37% , while ED PMPM costs dropped 19%.

Participants also responded well—97% said their providers were knowledgeable and 96% said they would recommend their providers to friends and family.

Underwood said that MIH is both patient and family-centered: “You’re giving families the peace of mind and security that their loved one is cared for and safe.”

Hall said that the AMR team is proud of its recent accomplishment as well as its ability to exceed patients’ needs and encourage responders to practice to their fullest potential.

Alongside Envision Healthcare’s family, he looks forward to advancing healthcare by reducing costs, enhancing the patient experience and improving population health.

“Collectively, we have a lot to offer. I feel strongly that Evolution Health, AMR and EmCare, and the whole Envision concept will be utilized to its fullest,” says Hall.

The peer-reviewed article titled, “Mobile Integrated Healthcare: Preliminary Experience and Impact Analysis with a Medicare Advantage Population,” detailing Evolution Health’s patient-centered model was recently published in the Journal of Health Economics and Outcomes Research.