Knowing life matters

Acadian is one of the largest ambulance providers in the U.S. 460+ ambulances 34 Louisiana parishes 37 Texas counties 1 Mississippi county

Mobile Integrated Healthcare and Community Paramedicine are not the exactly same thing.

Where did this concept come from?

What is driving the evolution of MIH/CP?

Who are the providers? EMT AEMT Paramedic Physician LPN RN NP LPC LCSW

Integrate into existing programs Focus on high risk populations Education Disease management Crisis intervention Call center Remote patient monitoring

Call Center 24/7 access Three bi-directionally redundant centers Certified EMD call takers Emergency call roll-over to EMS communication centers MHP dispatch Provider and client notification of calls

Personal Emergency Response Remote Patient Monitoring (RPM) Instant emergency assistance RPM technology Data collected via wearable device ECG Heart rate Respiratory rate Body posture/position Activity level Data collected via wireless ancillary devices Blood pressure Blood glucose Pulse oximetry Body weight

Potential partners Hospitals Hospital systems Public health clinics Private clinics Public & private payers Other EMS agencies Law enforcement Behavioral healthcare providers Specialty care physician groups

Program implementation Initial communication Define the opportunity Establishing goals Resources Cost Reimbursement Implementation Monitor program and implement change Evaluate results

Program implementation Initial communication Often times they won’t know what they’re asking for Discuss challenges Discuss current efforts/programs Discuss opportunities or lack thereof

Program implementation Define the opportunity Population/demographics Evaluate the data Discuss capabilities Integration into existing programs/efforts

Program implementation Establishing goals Define success

Program implementation Resources Yours & theirs Personnel Equipment Technology

Program implementation Cost What is your cost?

Program implementation Reimbursement Is their a mutually beneficial reimbursement model? Fee for service Shared savings Combination

Program implementation Education PCR Receipt of referrals Referral contact Seeing patients

Program implementation Monitor program and implement change Plan to make changes

Program implementation Evaluate results Success? Expansion?

Mobile Healthcare Programs Pediatric asthma – New Orleans Sickle Cell – New Orleans Population management – New Orleans Crisis intervention – New Orleans Hospice – Dallas, San Antonio & Houston Diabetes – Lafayette Beginning soon CHF & COPD – New Orleans & Lafayette

Pediatric Asthma Program Trigger for referral = high ED utilizer Average enrollment = 59 days 90 day post-graduation hospital admission – 50% decrease 90 day post-graduation ED utilization – 59% decrease ED visit resulting in admission pre-enrollment – 38% ED visit resulting in admission post-enrollment – 100% ACT upon enrollment – 19 ACT score upon graduation – 24 Average initial peak flow – 290.5 Average peak flow upon graduation – 307.4

Hospice Program Education for high risk patients/families Crisis intervention Q1 2016 data for 80 patient contacts 91% of patients remained in the home 99% of patients remained with client Reported 3.59% revocation (12% national average) calendar year 2015

Population Management Program Trigger for referral = high ED utilization Multiple disease processes Education Crisis intervention

Challenges Reimbursement PCR Education

RBelle@acadian.com