The implementation of the Patient Portability and Affordable Care Act that began in 2012 had potentially far-reaching effects on fire-based emergency medical service (EMS) transport services. Since one of the act's regulation changes was to change from fee-for-service reimbursements to value-bundled payment to providers, the Nashville Fire Department (NFD) needed to begin evaluation of implementation of a mobile integrated healthcare program in NFD. The problem was NFD had not identified if the department could benefit from implementation of a mobile integrated healthcare program. The purpose of this applied research project is to identify if NFD and the city of Nashville could benefit from implementation of a mobile integrated healthcare program. This applied research project used the evaluative research method as the process to answer the following research questions: a) What models of mobile integrated healthcare programs exist? b) Which model of mobile integrated healthcare program would be best suited for implementation in the city of Nashville? c) What are the potential costs of implementing a mobile integrated healthcare program in the city of Nashville? d) What are the potential benefits of implementing a mobile integrated healthcare program in the city of Nashville? Procedures for this project included an analysis of EMS call volume for NFD, projected costs for the number of patients potentially eligible for the program, and projected benefits for the patients eligible for the program. Cost analysis methods were considered. Due to significant limitations discovered during research, a conclusion was inferred there would be a negligible cost increase to implement a mobile integrated healthcare program in NFD using current resources within the department. Nashville Fire Department should proceed with implementation of a mobile integrated healthcare program while conducting further analysis of the program in order to take advantage of increased revenue due to the PPACA.

The healthcare landscape in the United States is evolving rapidly but has largely ignored EMS, until recently. As the country focuses on cost containment and more appropriate methods to deliver services as a result of healthcare reform, EMS will need to undergo dramatic change to fill a new role in the healthcare system. The current traditional delivery method for EMS is financially unsustainable and will soon not be a viable option for care. EMS has a choice to make--adapt to the new environment or be left behind. A viable alternative to the current structure of EMS is Mobile Integrated Healthcare (MIH)--community-based health management that is fully integrated with the overall health system. Various programs like this have appeared across the United States, but a definitive resource that describes how to successfully implement such a program has not been available. Mobile Integrated Healthcare: Approach to Implementation fills this void by serving as a reference not only to the EMS community, but also to other medical professionals working toward implementation of a successful MIH program. Mobile Integrated Healthcare: Approach to Implementation provides a step-by-step approach for the identification of community needs, forming the appropriate partnerships, selection of staff, acquiring resources, patient identification, and overcoming hurdles to a successful program. Examples from successful programs across the country are included. The author team of Mobile Integrated Healthcare: Approach to Implementation has developed and implemented a functioning, successful program. Their experiences with community partners and other healthcare specialists provide a broad-based view of the future of EMS in the healthcare industry. Mobile Integrated Healthcare: Approach to Implementation is written by leaders in the field of EMS who are committed to guiding the successful evolution of EMS. Their approach to integration should be considered by EMS management, hospital-based social workers, and community partners such as county health authorities, homeless coalitions, and psychiatric services. The type of care EMS providers give needs to evolve with the changing landscape of healthcare. This text describes how healthcare professionals and community partners can work together to facilitate that change and define a successful MIH program.

"Background: Emergency Medical Services (EMS) and Emergency Departments (EDs) are experiencing an increase in low-acuity and high frequency patients. Treating non-emergent patients with emergency resources drives up healthcare costs, leads to delays in care for all patients, and increases strain on emergency resources. To address the increase in low-acuity and high-frequency patients within the 911 system and emergency departments, mobile integrated healthcare (MIH) has emerged as an EMS-based intervention to connect patients with community resources and reduce non-emergent transports and ED visits. This program evaluation examines the impact of nurse-social worker teams in a fire-based MIH program by measuring 911 and ED use and patient activation before and after MIH interventions.Methods: Participants were enrolled in the program evaluation by the MIH field teams. Participants were either new or existing MIH patients and enrollment occurred over a 2-month period. Participants completed the patient activation questionnaire (PAM-13) at the time of enrollment and again between 8 and 12 weeks later. The number of 911 calls, transports, and ED visits for each participant was extracted from Julota and EPIC for a period of 12 weeks prior to and after the date of enrollment. The pre and post data and PAM-13 scores were compared using Wilcoxon Signed Ranks Test of Significance. The mean pre and post PAM-13 scores were also compared to evaluate the difference. Results: 19 participants were enrolled in the study. One participant died during the follow-up period. Of the remaining 18 participants, 4 completed the second PAM-13 questionnaire. There was a statistically significant reduction in 911 calls (p=0.015), transports (p=0.021), and ED visits (p=0.006) following MIH intervention (n=19). The change in PAM-13 scores (n=4) was not significant (p=0.655). The difference in the means of the pre and post PAM-13 questionnaires was an increase of 1.75. Conclusions: MIH intervention reduced 911 calls, transports, and ED visits in this program evaluation. The effect on patient activation as measured by the PAM-13 questionnaire was not significant. Given the statistical significance in reducing use of emergency services for this small sample, a longer evaluation with more participants is needed to determine if fire-based MIH using a nurse and social worker is effective in reducing emergency resource use"--Abstract.

This thesis analyzes current fire department practices and explores how resource deployments can be modified by innovation and optimization to result in improved services to customers. Alternative response vehicles, mobile integrated healthcare, technology adoption, accreditation, and leveraging data for policy analysis are five opportunities examined in this thesis with data used from 10 fire departments, including Dayton Fire Department. The findings show that implementing alternative vehicles for responding to medical emergencies, leveraging technology, and using data for policy implementation to adopt a mobile integrated healthcare program may decrease the cost of providing services and improve response times to meet national standards. These findings may be beneficial to fire departments across the country that are experiencing budget reductions coupled with increased demand for services.

Hospital readmission is one measure of quality of care and is an area that needs to be addressed to cut health care costs. As part of the Affordable Care Act (ACA), the Center for Medicare and Medicaid Services (CMS) implemented the Hospital Readmissions Reduction Program (HRRP) to encourage hospitals to engage patients in discharge planning and improve care coordination to improve America's health care. Hospitals are financially penalized if they have excessive rates of hospital readmission using a three-year rolling period. To help meet HRRP's goal, various emergency medical services providers piloted or implemented mobile integrated health (MIH) models. There are several challenges for MIH, but the primary hurdle is health insurance reimbursement, particularly CMS reimbursement. Donabedian's Quality of Care Framework was used as the model to conceptualize MIH-CP and its impact on HRRP. A literature search was conducted using key terms, and inclusion and exclusion criteria yielded 10 HRRP articles and two reimbursement articles for review. Source materials from various government agencies and private entities were reviewed for background and additional information. California started developing its MIH programs in 2014 using pilot projects. The state had five pilot projects designed to evaluate MIH's safety and efficacy in reducing hospital readmissions. An evaluation of the California and three pilot projects in other states showed that they effectively reduced hospital readmissions with significant cost savings to Medicare and Medicaid. Analyses of four MIH-CP programs implemented across the nation showed similar findings. A review of reimbursement of MIH-CP services outside of pilot projects showed that several states allow MIH-CP providers to bill Medicaid and commercial insurance plans. Policymakers should evaluate the feasibility of implementing an MIH model in their jurisdiction and explore reimbursement mechanisms for MIH-CP services to be sustainable.