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.

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.

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 two-volume Emergency Medical Services: Clinical Practice and Systems Oversight delivers a thorough foundation upon which to succeed as an EMS medical director and prepare for the NAEMSP National EMS Medical Directors Course and Practicum. Focusing on EMS in the 'real world', the book offers specific management tools that will be useful in the reader's own local EMS system and provides contextual understanding of how EMS functions within the broader emergency care system at a state, local, and national level. The two volumes offer the core knowledge trainees will need to successfully complete their training and begin their career as EMS physicians, regardless of the EMS systems in use in their areas. A companion website rounds out the book's offerings with audio and video clips of EMS best practice in action. Readers will also benefit from the inclusion of: A thorough introduction to the history of EMS An exploration of EMS airway management, including procedures and challenges, as well as how to manage ventilation, oxygenation, and breathing in patients, including cases of respiratory distress Practical discussions of medical problems, including the challenges posed by the undifferentiated patient, altered mental status, cardiac arrest and dysrhythmias, seizures, stroke, and allergic reactions An examination of EMS systems, structure, and leadership

Integrated Care: A Guide for Effective Implementation provides a detailed, thoughtful, and experience-based guide to the complex and potentially overwhelming process of implementing an integrated care program. The advantages of integrated care from both the clinical and administrative perspectives are many, including better detection of illness, improvement in overall health outcomes, a better patient care experience, flexibility in responding to policy and financial changes, and an emphasis on return on investment. The book addresses the emerging framework of core principles for effective integrated care, reviews the most up-to-date research on implementation, and presents practice-based experience to serve as a guide. This information is useful in both traditional integration of behavioral health into general medical settings (often primary care) or integrating general medical care into a specialty mental health or substance use treatment setting. Because administrators, clinicians, policy makers, payers and others need guidance in determining what effective implementation looks like, the authors offer a three-part examination of the key components of an implementation strategy and explore the elements essential for success. The book is grounded in the authors' real-world expertise and offers readers practical, accessible information and support: Often efforts to implement an integrated care program fail because the model is more than just "plug and play." To address this misconception, the authors explore the successful implementation from every angle -- from leadership, primary care, therapist, psychiatric provider, and policy perspectives. As procedural and institutional hurdles are being overcome, codes for integrated care have been adopted. Accordingly, the book provides in-depth coverage of finance and funding models, challenges to billing, and emerging payment models. Each of the chapter authors were selected for their direct clinical experience in various integrated environments, their leadership in ushering teams through these initiatives, and/or their deep knowledge of payment and policy barriers. Impediments to the widespread implementation of evidence-based programs include payment and regulatory barriers, lack of a workforce trained in effective collaboration, and cultural differences between the worlds of primary care and behavioral health care. Integrated Care: A Guide for Effective Implementation helps health care leaders and providers overcome these obstacles to implement a successful, patient-centered integrated care program.