News & Updates

Tucked within the Trump administration’s 2018 HHS budget is a proposal that could be easy to miss. A short sentence repeated a few times throughout the budget calls for the Agency for Healthcare Research and Quality to be consolidated into the National Institutes of Health.

Health policy experts say that may be a step in the right direction for AHRQ—if done right. Turning the agency into a separate institute under the NIH’s umbrella could elevate AHRQ’s importance and strengthen its mission.

But that positive outcome can only happen if AHRQ and NIH receive the appropriate resources and support, experts say.

“Its critical AHRQ would have the same recognition as other key entities at the NIH,” said Dr. Andrew Bindman, the former director of the agency from May 2016 to January 2017.

As an independent agency housed at the HHS, AHRQ has faced frequent budget cuts and harsh criticism from congressional leaders who question its importance. Moving to the NIH might change that, Bindman said. AHRQ could benefit from NIH’s bipartisan support and a robust budget roughly seven times larger than its own.

NIH “might in fact create more of a safe and stable home for AHRQ,” he added.

But NIH is facing its own budgetary hurdles. Trump’s budget also proposed cutting $5.8 billion—or 18%—from the institutes’ budget for 2018. Those cuts have garnered significant backlash and Congress quickly boosted NIH’s funding by $2 billion for the last five months of this fiscal year.

Bindman said he anticipates AHRQ’s budget would grow at a “rate that parallels the work that goes on at the NIH as a whole.”

NIH Director Dr. Francis Collins didn’t say Thursday at a hearing with lawmakers on the Hill whether or not AHRQ would fit well at the institute, but he did say if it were to merge with the NIH, “We would figure out how to make the best of that circumstance.”

Collins also noted that AHRQ’s research is “complementary” to some of NIH’s quality and safety research.

AHRQ often follows up on NIH findings to test their implications on safety and quality. Bindman said that relationship would only improve if AHRQ was part of NIH.

AHRQ could also re-emphasize its important and unique patient safety research work at its proposed new home, Bindman said, and advocates should push for more funding since errors related to patient safety are one of the leading causes of mortality in the U.S., he added.

AHRQ can be forgotten in its current state under the HHS’ vast umbrella, according to Francois de Brantes, vice president and director of the Center for Payment Innovation at the Altarum Institute. “They might not get lost at the NIH,” he said.

But there are still differences that could hurt AHRQ, according to Dr. Richard Kronick, former director of AHRQ from 2013 to 2016. AHRQ focuses on health services research, whereas NIH largely focuses on biomedical research.

“Maintaining AHRQ’s razorlike focus on improving quality and safety could get more difficult over time” at the NIH, Kronick said.

In order to ensure AHRQ doesn’t get “lost” in the vast work that goes on at the NIH, Bindman said it’s crucial AHRQ is a distinct entity at the institute. The Trump administration proposed to keep AHRQ’s identity by creating the National Institute for Research on Safety and Quality to replace AHRQ.

If AHRQ is within the NIH, it could become the unified voice on priorities for health services research, Bindman said. He suggested the agency make a yearly address to Congress that lays out the priorities for health services research for that year. “AHRQ needs to be the home for health services research activity,” he said.

Innovations could help produce a more efficient and effective healthcare delivery system but only if the industry creates conditions that allow new models to thrive and clear a pathway to spread and scale reforms.

That’s the underlying message of a new report, “Accelerating Innovation in Health Care: Five Game-Changing Ideas to Clear the Way, by the Aspen Institute’s Health Innovation Project. The report is the result of off the record discussions with dozens of executives from Fortune 500 companies, provider organizations, and insurance companies; and leading innovators, researchers and academics.

In order to drive reforms, “the most pressing task at hand is to create fertile ground in which the seeds of innovation can grow, especially by stimulating market demand for change,” according to the report announcement.

The report explores five “game changers” to create conditions in which new models for delivering healthcare can thrive.

These big ideas suggest the industry:

End fee-for-service reimbursement by 2025
If healthcare continues to be reimbursed based on how much service is provided, there is no sustainable incentive to apply innovation to diminish volume and lower healthcare costs, according to the report. Its replacement—a new universal reimbursement model, designed collaboratively by payers and patient advocates— would pay for patient and community outcomes, not for services provided. This model would create incentives for new innovations to keep patients healthy and remove waste from the healthcare system.

Cut out the middle man and create direct-to-consumer insurance products.
A tighter alignment between what patients value about care and the financial goals of their providers would push providers to respond to consumer needs or risk losing market share. A direct-to-consumer marketplace would allow patients to opt into a relationship with a particular provider group. Employers could still contribute to the cost of this insurance model for their employees, but they would no longer be able to influence its design as middlemen, the report noted.

Share healthcare savings with consumers and communities.
Along with rewarding providers for good outcomes, new payment models must be structured to also reward the patients and communities who achieve them. A shared savings model would allow patients to earn money for managing their medical or health conditions. Although some employers offer wellness plans, the report said this concept could be applied on a larger scale. As an example, the report said the federal government could calculate how much Medicare, Medicaid and other taxpayer-funded programs would save over the next 30 years if blood pressure readings were controlled to a certain level among the population in a particular city. To save that money, the city would receive federal funds to promote blood-pressure-lowering goals through local policies and at all levels of the community, including schools, workplaces, and public spaces. Continued funding would be contingent on measurable progress, the report suggested.

Empower consumers with their own data.
Although the industry has an extraordinary amount of health data from electronic health records, insurance claims and clinical trials, the report noted that most patients make healthcare decisions based on the advice of one doctor. But if patients had greater access to aggregated data, supported by artificial intelligence and analytics, in order to make decisions about their care, it would revolutionize the industry and create a new demand for innovation, according to the report.

Develop a common return on investment (ROI) calculator.
It would be easier to adopt innovations if the industry had a universal ROI calculator that would provide information about likely outcomes and costs, taking into account short-term savings, long-term impacts and cost-sector benefits, according to the report. New research and outcomes should feed into the calculation as well. “Although individual entities, such as the Innovation Center of the Centers for Medicare and Medicaid, have encouraged ROI calculations for specific payment reform proposals,” the report said, “an industry-wide approach would accelerate innovation exponentially.”

HARRISBURG, Pa. (WHTM) – The state House this week approved legislation that would require insurance companies to reimburse ambulance companies when patients receive medical care but are not transported to a hospital.

Rep. Steve Barrar (R-Chester/Delaware) said his proposal, House Bill 1013, would allow for reimbursement as long as the ambulance was dispatched by a county 911 center.

Barrar said the current practice where EMS agencies can only be reimbursed if they transport the patient is a significant contributor to the financial challenges facing ambulance companies. He said many ambulance companies are facing pending closures.

He said with advancements in emergency medical services, EMS crews can treat and stabilize patients to the point where a trip to the hospital in an ambulance isn’t necessary. Such emergency calls include drug overdoses that are reversed with Narcan.

The bill is awaiting consideration in the Senate.

Link to the Bill language  http://www.legis.state.pa.us/cfdocs/billInfo/billInfo.cfm?sYear=2017&sInd=0&body=H&type=B&bn=1013

Among sweeping changes underway in U.S. healthcare is a brighter spotlight on patients’ transitions from hospital to home. What can be done to reduce readmissions during these vulnerable periods and possibly save billions of dollars in the process? Increasingly, an answer lies with mobile integrated teams of providers, often led by paramedics, who take healthcare right into patients’ homes.

If David Glendenning, EMT-P, had any doubts about the mission of the community paramedic program he helped organize in Wilmington, N.C., with New Hanover Regional Medical Center (NHRMC), they were dispelled four years ago, when he entered the apartment of his first patient, a man with congestive heart failure. “The thing I remember most is where he had stored his injectable medications,” he says. “Instead of putting them in the refrigerator as directed, the patient had stored them in the freezer. They were frozen solid.”

Glendenning is part of a growing wave of paramedics, advanced practice nurses, physician assistants, pharmacists and other community health workers who are traveling to newly discharged patients’ homes to provide 24/7, non-emergency care. Often working as part of emergency medical services (EMS) systems, their task is not just to deliver point-of-care treatment—thus taking the pressure off of overloaded 911 systems—but to educate and steer patients to other services and professionals they might need. The goal is to keep these high-risk individuals, many with chronic cardiovascular disorders, from returning short-term to the hospital. Pivotal to that effort are the observations these feet-on-the-street professionals make (for example, a box of pepperoni pizza on a patient’s kitchen counter) and the questions they ask (“How are you doing with your medications?”).

“We provide a unique service that helps to fill in the gaps for patients,” says Glendenning, education and outreach support officer for NHRMC-EMS. “We’re not just paramedics, but part of a comprehensive team of case managers, pharmacists and others who provide services the patient may be eligible for but not aware of.” Among the first programs of its type, the North Carolina initiative also has a solid track record. As shown in the figure at right, during a six-month period in 2014, the 30-day readmission rate for the 76 patients who were part of the program was 9.2 percent, compared to 22.2 percent for the parent hospital. The number of readmitted patients with congestive heart failure: zero.

Community paramedics also have a geographic and socioeconomic rationale. According to the Centers for Disease Control and Prevention, in 2017, 15 percent of Americans lived in rural and remote areas. Yet, only 11 percent of the nation’s physicians practice there and rural physician shortages have been documented for 85 years (Virtual Mentor 2011;13[5]:304-9). Mobile integrated programs help address that imbalance by providing an effective at-home alternative for patients who are released from acute care but afterwards have little or no access to check-ups, monitoring and prevention programs. The same principle applies to patients who are discharged to homes in economically distressed neighborhoods—even though they may live only 10 or 15 minutes from the hospital.

Economics as the driver
What’s stoking interest in the home care model is, in a word, economics. With MACRA and bundled payment models rewriting the healthcare rulebook, providers realize they need to broaden their focus from episodic to continuum of care. And no area comes into their crosshairs faster than the slippery period from hospital to home. Here, patients are at their most vulnerable as they grapple with complex and changing care regimens, particularly with medications. Up to two-thirds of hospital readmissions have been traced to nonadherence and adverse side effects of drugs (Ann Intern Med 2003;138[3]:161-7).

A recent study of an insurer-initiated care transition program based on medication reconciliation for high-risk patients led by pharmacists via home visits and telephone consultation found that people in the intervention group were 50 percent less likely to be readmitted within 30 days of discharge than those in the control group. For cardiovascular patients, the risk of readmission was 5.3 percent compared to 9.2 percent for the control group. What’s more, the study reported that the pharmacist-driven program saved two dollars for every one spent (Health Aff [Millwood] 2016;35[7]:1222-9).

“MACRA requires us to stay interested in our patients,” says Jason Stopyra, MD, assistant professor of emergency medicine at Wake Forest Baptist Medical Center, and medical director for the Randolph County, N.C., Department of Emergency Services. “It means we’ll have to form partnerships with all our patients and develop approaches for even the most difficult ones,” adding, “Decision-makers will come to realize that putting money into preventive strategies will far outweigh any penalties.”

Concierge approach to patient care
North Texas Specialty Physicians (NTSP), an independent practice association serving Fort Worth and surrounding counties, acted decisively in 2010 to minimize the bundled risk it bears for healthcare utilization by its 60,000 Medicare Advantage members. NTSP contracted with MedStar Mobile Healthcare to reduce emergency department visits and unnecessary hospital admissions through visits by MedStar’s specially trained medics and case managers to the homes of patients enrolled in the program. During these visits, medics become aware of the patients’ disease management and coping skills, frame of mind and support networks. Should an individual become short of breath at 2 a.m., the same medic may be asked to intervene with medication at the home, thus preventing a trip to the hospital.

“We think of it as a concierge approach to chronically ill patients,” says S. David Lloyd, MD, MBA, medical director for Silverback Care Management, the care management division of NTSP. “And one of the reasons the program is so successful is that we partner with paramedics, who have the kind of credibility which [other providers] going into patient homes might not.” In 2016, 75 percent of the program’s 45 members had no hospital admissions within 30 days of enrollment, he says.

The number of mobile integrated healthcare programs has grown from four in 2009 to 260 today, according to Matt Zavadsky, director of public affairs for MedStar and president-elect of the National Association of Emergency Medical Technicians. For traditionalists like Medicare, which continues to cover only ambulance transport to the hospital, Zavadsky points to Agency for Healthcare Research and Quality data and offers this advice: “If you would pay us to keep people out of the hospital, not only would you get better outcomes, but you would save a ton of money by avoiding the average $10,500 expense of admitting each patient.”

Original article can be accessed here.

The 1,400 federally qualified health centers across the U.S. are an essential source of primary-care services for approximately 24.3 million low-income individuals. Yet they are limited by a volume-based reimbursement model that prevents them from participating in outcomes-based care approaches.

Medicaid pays the centers a flat rate. Called the prospective payment system, the model ensures these centers are paid a fixed amount for each patient visit. The system was enacted in 2000 to help federally qualified health centers struggling to stay afloat with mediocre Medicaid payments.

But this model is anchored by in-person visits—even for minor ailments such as blood pressure checks—raking up Medicaid spending, limiting services and draining the providers who work at the safety-net centers.

These shortcomings have encouraged a growing number of states to consider establishing alternative payment models that enable such centers to expand services paid for by Medicaid. Federal law allows states to establish alternative payment models for its qualified health centers as long as the revenue is equal to the prospective payment model. About six states—California, Colorado, Minnesota, New York, Oregon and Washington—have created reimbursement models that pay centers for value-based services such as at-home visits, transportation services and telehealth.

But shifting to a new payer model comes with challenges that include financial risks and difficulty accessing appropriate resources, especially necessary data. It can also be difficult to adapt to a new way of doing business.

“If you are on a visit-based model for decades and you change to another model that’s hard,” said Craig Hostetler, executive director of the Oregon Primary Care Association. “Change doesn’t happen overnight so a big part of our work is supporting each other.”

The Oregon Primary Care Association works with federally qualified health centers and the state to roll out and oversee the program, called the Alternative Payment and Advanced Care Model.

Of the six states, Oregon is the farthest along in its push to value-based care for the centers. It began a pilot program with three centers in 2013. Washington plans to begin its pilot initiative July 1. The other states are still in the planning and implementation phases.

The push for states to engage in these value-based payment models has been partly influenced by Medicaid expansion under the Affordable Care Act, argues Sara Rosenbaum, a professor of health policy at George Washington University in Washington, D.C. States that expanded Medicaid saw a large increase in the number of beneficiaries seeking care at federally qualified health centers. In 2015, 55% of qualified health center patients in expansion states were Medicaid beneficiaries, compared with 34% of health center patients in states that didn’t expand the program.

“The weaknesses of (the volume-based) model are magnified in Medicaid expansion,” Rosenbaum said. “There is a lot of pent-up demand for newly insured people who were getting limited care before.”

All six of the states looking to reform their health centers with new value-based payment models expanded Medicaid.

This heightened demand for services pressures providers who already experience burnout at these community centers, Rosenbaum said. Because the health center reimbursement model is visit-based, providers must see an exorbitant number of patients per day, even for minor conditions that can be treated over the phone or through telehealth.

“Like any encounter-based model, it can be subject to over-utilization,” Rosenbaum added.

For Oregon, the visit-based model was no longer sustainable. Of the 400,000 people treated at the state’s 200 qualified health centers, about 60% are insured by Medicaid. A federal match program that allowed the centers to engage in transitional-care services such as partnerships with community organizations ran out at the end of 2013. This forced the centers to cope with a strictly fee-for-service model that strained doctors and drained funds.

“The big motivation was to get these FQHCs financially viable,” said Jamal Furqan, program manager for federally qualified health centers at the Oregon Health Authority.

The new model allows participating centers to engage in value-based payments without losing out on reimbursement dollars. The model uses a capitated per member, per month payment system. The centers generate a list of patients who have had a visit in the last 18 months and determine the fixed rate for that patient’s care based on their usage history. This allows the center to provide services that were previously nonbillable in the prospective payment system without losing out on revenue.

The Oregon Primary Care Association has worked with the 13 centers participating in the program and the state to determine what the previously nonbillable services should be. They’ve gone through several modifications but can include offering cooking classes, transportation services and appointments via telephone.

“Addressing social determinants of health is a big piece of this,” said Hostetler at the Oregon Primary Care Association. “We have built a learning community that includes collecting data and testing interventions.”

Data collection has been a challenge, however, Hostetler said. “Capturing the work the centers do under the capitated system is difficult.”

The state has been working with the electronic health record vendor Ochin and the centers to integrate various other value-based approaches with patient data. This will allow the centers to not only easily track their previously nonbillable services but also whether or not the interventions are working.

Because of the analytics-focused approach of the model, the centers must use EHRs in order to participate. They also must have stable finances. There are budgetary safeguards a center has to make about a year before it switches to the APM model to account for any losses.

“They need to not be risk-averse,” Furqan said.

The centers also need to be eager to innovate. The model requires them to think about innovative ways to engage their patient populations and to reduce costs, Furqan added.

Cost savings from the new model have already been reported. A 2016 study from researchers at Portland State University found the program saved the Oregon health system $240 million over two years.

“We are seeing that FQHCs are able to address the needs of the communities,” Furqan said.

Starting next month, Anthem Blue Cross Blue Shield of Georgia will no longer cover emergency department services it determines are unnecessary for members with individual plans.

The insurer said the policy aims to steer patients with nonemergent symptoms to see a primary care physician, urgent care provider or use its LiveHealth telehealth app to limit costly ED visits. If a BCBS of Georgia policyholder receives care for nonemergent symptoms, a medical director will use the prudent layperson standard to deem whether the service is necessary.

Jeff Fusile, president of BCBS of Georgia, told WABE, “The cost of care’s been going up so much faster than people’s earnings. We have got to find a better way to do some of this stuff, taking some of that unnecessary spending out of the system.”

The policy does not include referrals from a physician to the ED for nonemergent services, nonemergent services provided to children under age 14, instances when an urgent care clinic is more than 15 miles away and when care is administered on Sundays and major holidays.

“We’re not trying to steer people away from the emergency room if they have a serious condition,” Debbie Diamond, director of publications for BCBS of Georgia, told Becker’s Hospital Review. “If a member is having chest pain that they think is a heart attack, they should still go to the emergency department.”

Ms. Diamond said similar policies have been enacted at Anthem-affiliated plans in Missouri, Kentucky and Virginia. Missouri said it would reinforce the program June 1 and Kentucky enacted the policy in 2015.

Donald Palmisano, president of the Medical Association of Georgia, told WABE the policy disproportionately affects the elderly, rural residents and children over the age of 14. He added physicians are concerned the policy places “the patient, who doesn’t have the clinical background, to determine whether their condition is of an emergency nature.”

Original article can be accessed here.

ALBUQUERQUE, N.M. — Getting the people who overuse emergency services under control has been an uphill battle, but one major health insurer has been teaming with metro area emergency medical services agencies for over a year to put a dent in the numbers of ER visits by some of its Medicaid members.

During that time, a handful of Albuquerque paramedics have been making house calls through a program designed to reduce hospital readmission rates while helping discharged patients stay on the road to good health.

It seems to be working.

The Community Paramedicine initiative, launched in January 2016 by Blue Cross Blue Shield of New Mexico, has moved from pilot program status to an ongoing service helping more than 1,100 Medicaid members, mostly in the Albuquerque area. The insurer saw an almost 62 percent drop in emergency room visits and a 63 percent decrease in ambulance use by frequent flyers, many of whom live alone, have a limited support network, lack transportation or have a housing situation that’s in flux.

Community paramedics from Albuquerque Ambulance and American Medical Response go into the patients’ homes to check on their overall health issues as well as factors like safety precautions and nutrition, said Kerry Clear, Blue Cross’s manager of community social services and coordinator of the program. Blue Cross estimates that the program in its first year saved $1.7 million that would have been spent in the ER.

The insurer is in contract talks with ambulance and fire agencies to expand the program to other New Mexico communities.

Reducing visits to the ER by what the Centers for Medicare and Medicaid Services calls “super utilizers,” typically defined as those who use 911 or visit hospital emergency departments four or five times a year, starts early.

Five nurses employed by Blue Cross assess Medicaid enrollees slated for discharge from a hospital and who may be at high risk for readmission. That includes people being treated for chronic illnesses like congestive health failure, pulmonary disease, asthma, diabetes as well as those recovering from hip replacements.

The assessments may trigger a referral to the paramedic services in the Blue Cross Blue Shield program.

The paramedics are dedicated to the program and do not respond to 911 calls, said Clear.

Shelley Kleinfeld, a paramedic for AMR, visits 10 to 12 patients a week, coaching and educating and taking vitals. She helps clients manage their medications, ensures they are properly using medical equipment and devices, coordinates appointments with primary care providers and looks to see if there is enough food in the house.

If she encounters a minor health issue, she’ll transport patients with conditions like flu or minor wounds to clinics or urgent care centers rather than to the ER.

Kleinfeld said she likes seeing her career shift “from emergency response to proactive response.” She said community paramedicine is healthcare on a grass roots level, which she prefers. “It’s nice to interact with someone other than from the back of an ambulance.”

Original article can be accessed here.

Next to human capital, community trust is one of the most valuable assets for an EMS agency. Building your agency’s community trust takes a concentrated effort and a specific strategy. Richmond Ambulance Authority and MedStar Mobile Healthcare are two examples of AIMHI member agencies that have developed robust community relations. Here are our top 10 strategies to help you build community trust.

1. Deliver Rock-Solid Service

All the PR in the world will not help you if you routinely have service failures. While response times (the historical service benchmark used by most communities) have been proven to have minimal to no impact on patient outcomes, they do have a customer experience impact. Response times that are exceptionally long are typically the source of complaints and even news articles. For example, you can meet or exceed a 90% fractile response time standard and be “late” to 10% of the calls. However, if one of those 10% is a 19-minute response time to an injured child in a public place, it’s likely to cause enough angst to prompt a phone call to an elected official, or your local “I-Team” reporter. In Fort Worth, MedStar has focused on minimizing extended response times by geographically positing units in parts of our service area that are hard to reach, which arguably goes against the standard practice of high-performance EMS of dynamically posting units to cover predicted call volume. This practice has essentially reduced MedStar’s response time complaints to zero.

2. Know Your Community

All politics are local. Knowing the landscape is essential to building community trust. What are the healthcare needs of the community? What are the key organizations to join and support? Are the cell phone numbers of the hospital CEOs, nursing directors, city council members, local important non-profit directors and the assignment desks of your local media outlets programmed into your phone? Do you belong to the local chambers of commerce, send representatives from your organization to your local leadership programs? This type of community involvement and volunteerism keeps you aware of things happening in the community that you or your organization could support. More important, this involvement helps build relationships with local leaders whom you can partner with for community benefit.

3. Create a Community Advisory Board

CLICK HERE FOR MORE INFORMATION
Following the advice above, invite local leaders to become part of a community advisory board for your organization. This group could periodically meet at your facility to learn what’s happening with your agency. You can also seek their advice and counsel about ways your agency can partner with the community. MedStar started a CAB several years ago comprised of representatives from local hospitals, chambers of commerce, homeless services agencies, Salvation Army, Meals on Wheels, interfaith council, Area Agency on Aging, United Way, Red Cross and other similar organizations. The agency typically hosts a breakfast meeting twice a year, and through these meetings, learns about things the agency can do for the homeless and homebound, elderly residents of our community.

4. Conduct an EMS Citizen’s Academy

Many police and fire agencies conduct citizen’s academies designed to educate residents about the rigors, challenges and benefits of their agencies. If you are a stand-alone EMS agency (i.e., not part of a police or fire department), you can host and conduct an EMS academy for your residents. Some of the things participants can learn are the structure and governance of your EMS system and how you deploy resources. They can also learn CPR and first aid, try to start IVs and do intubations, go on ride-alongs with ambulances and sit with your communications team plugged into the phone console listening to 9-1-1 calls. The Richmond Ambulance Authority (RAA) partners with its police department to provide “EMS Night,” when the attendees get a hands-only CPR class and an understanding of how emergency medical response works. The EMS night can be delivered in English or Spanish, depending on the audience. In addition, RAA also operates an annual youth academy.

5. Be Accessible for the Media

We’ve heard from many EMS leaders that they have a difficult relationship with their local media. While writing press releases, conducting media interviews and allowing the media to do ride-alongs can be nerve-wracking, the media can be a powerful partner in your community relations strategy. News always happens. Knowing what and how to let your local media outlets know about breaking news can be invaluable. It is always important to keep patient-protected information HIPAA-compliant. There are general newsworthy events you can communicate to your local media. Equally important is your availability for requests for media information. The best way is to have a 24/7 public information officer with a well-known phone number and e-mail address for the media to reach.
Another way to be a good media partner is to have a list of media ideas handy. It is not unusual for a reporter to call on slow news days and ask if there is anything they can report on as their deadline approaches. Ideas to keep on hand include new equipment, interesting call types, seasonal stories such as heat- or cold-related emergencies, or even human interest stories about EMS agency team members.
6. Leverage the Power of Social Media

One of the most powerful tools in your communications arsenal is social media. Twitter, Facebook and Instagram are effective platforms to share information about your agency. The key is followers, and you develop them by posting timely, relevant and useful information your local community members find valuable. Examples could include health and safety tips, healthcare-related items of interest, or just fun facts. MedStar recently used social media to conduct an AED scavenger hunt during National Heart Month. Local media participated with announcements and information on how to report found AED locations using Instagram, Facebook and Twitter. This resulted in the locating of over 100 AEDs and dramatically increased the number of MedStar followers.

7. Host Community Benefit Events

By combining your community relations, social media and traditional media prowess, you can host blood drives, blood pressure screenings and other community benefit events. MedStar recently hosted a bone marrow registry drive at its facility. Local media supported the event by broadcasting the date, time and location leading up to the event. MedStar employees and community members came to the event in support of the effort. Media outlets then reported the results from the event. RAA hosts a “big push” campaign to teach hands-only CPR—anytime, anywhere and in any language. RAA discovered that the most successful way to train many citizens is to take CPR on the road and deliver it to churches, youth groups, community organizations and the biggest travelling event of the year—National Night Out. The visibility that participation brings is worth every minute spent.

8. Share Outcome Dashboards
The healthcare system is moving from volume to value. EMS needs to prepare for that by finding outcome metrics that are meaningful and reportable. One of the first performance-based outcome metrics hospitals were accountable for was patient experience. If you are not tracking patient satisfaction scores, start now! If you are, publish the reports on your website and through social media. You should even build an e-mail distribution list of local stakeholders so you can share the reports electronically. In addition to patient experience reports, you can track and publish meaningful outcomes the community will understand, such as cardiac arrest survival, scene times for trauma patients and even spikes in certain types of calls.

9. Publish Annual Reports

Annual reports, both in person and in print, can be powerful tools. They summarize pertinent and notable achievements by your agency over the past year. Printed reports can include fun facts, photos of your team members in action or doing community benefit events, and other contributions throughout the year. Include comments from patients that you glean from patient experience surveys, or thank-you notes from patients and families. A good time of year to provide in-person reports is during National EMS Week. You can request a proclamation for your area’s governmental agencies, and at the meeting you will be presented with the proclamation and can give an annual update about your agency.

10. Host EMS-Themed Birthday Parties

Who doesn’t like a good party, especially if it’s unique and educational? Parents can be very competitive when it comes to finding memorable birthday parties for their kids, so why not consider a “Junior Paramedic Party”? Imagine an ambulance with safety clowns, coloring books with safety information, toy stethoscopes and even junior paramedic badge stickers. Kids can learn important safety and first aid information while being entertained by the safety clowns. The parents will get gold stars from their kids and other parents for an innovative and fun way to celebrate birthdays!

Sweeping Up the Media
Have you ever wondered why TV news stations in your local area seem to field big stories, high investigative drama and heart-wrenching tales at certain times of the year? The timing of most of these releases is far from accidental as TV stations, while syndicated to major networks, are franchised out to media management companies and their viewer ratings are hugely important to them. To measure how well a TV and news station is doing, certain periods of the year are designated as the “sweeps.” During this time, audience viewing figures are determined using the Nielsen audience measurement system. Information collection devices are placed in selected homes and viewing habits are measured.

Against this backdrop, stations plan sweeps campaigns and work in the preceding months to prepare their stories before “teasing” them—giving snippets of the story to increase viewer interest and subsequent ratings. To be on the right side of a sweeps story, follow all the advice offered in the main article and work with your local stations to provide a great story that helps both them and you. Reuniting crews with a cardiac arrest survivor attracts attention and attests to the professionalism and credibility of your organization. For a harder hit, facilitate a ride-along for reporters and attach a number of GoPro-type cameras to a vehicle to record how other road users interact with a vehicle responding with lights and sirens. Sweeps dates for the next 12 months:

June 29–July 26, 2017
October 26–November 22, 2017
February 1–February 28, 2018
April 26–May 23, 2018
The Word on the Street

Five years ago at the Richmond Ambulance Authority, a staff welfare meeting raised the issue of improving internal communications, as staff felt they weren’t fully informed about what was occurring in the organization. As a result, for the following week, the RAA team undertook to publish one piece of news a day. The format was simple, two paragraphs and a few photos contained in a PowerPoint slide that was then printed and published at eight locations around the RAA headquarters. The PR team realized that there was so much to share that the project continued beyond that first week.

With RAA’s eventual expansion into social media via Twitter, Facebook and LinkedIn, WOTS became a cornerstone of not only its internal communication strategy, but external as well. The daily news has attracted readers and followers from all over the world. The successful format of two paragraphs and photos has not changed, although the challenge for the contributors and WOTS editor is to be succinct.

Staff are encouraged to submit stories and ideas to WOTS. To assist them, an e-mail address was created to allow them to send in (non-HIPAA) photos of their daily activities to supply fresh images for both WOTS and other RAA-related reports and presentations. Over time, the keen photographic eye of some staff has resulted in their work being used in various publications.

Original article can be accessed here.

Since 1997, Spectrum Health in Grand Rapids, Mich., has provided community-based care through its Healthier Communities initiative. Developed through the merger of two previous programs, Core Health was added in 2008 to provide in-home education on general wellness, including weight and stress control, for patients with early-stage chronic conditions, such as diabetes, heart failure and chronic obstructive pulmonary disease.

Eventually, it became evident that Core Health, as originally designed, was not serving some of the communities’ neediest members, those with more advanced disease, some of whom also had cognitive and behavioral challenges that made it difficult to benefit from the home-education curriculum.

“We realized that, wow, we’re saying, ‘No’ to a cohort of people who don’t have anywhere else to go,” says Core Health Program Supervisor Bethany Swartz.

Accommodating advanced disease
“We were challenged to shift the program to be able to serve those folks who were a little more clinically complex, a sicker population, those not so much in early-disease state,” Swartz says, “and also those who cognitively didn’t have the same capacity for learning and might have behavioral health issues that impede their ability to focus on their health first.”

Like its predecessors, Core Health employs community health workers, or CHWs, who make home visits to at-risk populations in Spectrum’s Grand Rapids and Greenville, Mich., markets. The program has been instrumental in improving patient health and reducing hospitalizations and emergency department visits among its participants.

Core Health tailored its services to the needs of its clients by adding a bilingual, licensed social worker and behavioral health screens for depression and anxiety. Core Health staff also developed a health risk assessment to better identify how social factors, such as housing, transportation, finances, food access, education, immigration status and relationship status, affect a client’s health.

The original Core Health curriculum was modified to reflect clients’ cognitive abilities and pace of learning. As in the original program, the Core Health curriculum includes lessons on healthful eating, stress management and portion control. However, the order and topics are determined by client goals and not by a pre-designed curriculum, Swartz says.

While the original was a yearlong program, in its new iteration, there is no defined timetable. The program is deemed successful when clients demonstrate necessary self-care management skills.

“We changed how we define success,” Swartz says.

How it works
Core Health is staffed by six CHWs, three full-time-equivalent registered nurses who function as care managers, and a full-time licensed social worker, in addition to Swartz. The CHWs visit three to four clients in their homes each day, spending about an hour with each, Swartz says, which allows them to see each of its approximately 300 clients about once a month.

During the visit, the CHW monitors the client’s condition and helps to set goals, such as eating healthier foods or exercising more.

In addition, a care manager performs medication reconciliation with each client about every three months.

The CHWs maintain contact with a client’s care manager and primary care physician. For example, if a client’s blood pressure is higher than a certain level or blood sugars are too high or too low, the CHW will call either the care manager or the PCP for further instruction. “Our ultimate goal is to get the client to a place where they’re using their primary care doctor to make their health decisions,” Swartz says.

The CHW also documents the visit as part of the client’s care plan in Spectrum’s electronic health record, which is then routed to a Core Health care manager, who must approve the plan within 24 hours after it’s sent.

CHWs are selected for their ability to relate to community members. They are intimately familiar with the barriers and struggles of the target population, says Mark Lubberts, R.N., manager of community health education for Spectrum Health’s Healthier Communities outreach program. “You’re not looking for the person with the master’s degree in public education,” he says. “You want somebody who has lived the life of many of our clients.”

Once selected, CHWs undergo rigorous training in a certification program developed jointly by Spectrum Health’s Healthier Communities and the Grand Rapids Community College to provide the Michigan Community Health Worker Alliance standardized curriculum. Upon completion, the student will receive a certificate from GRCC. To become certified for the Core Health program, CHWs are tested in eight competencies, including advocacy and outreach; community and personal strategies; legal and ethical responsibilities; teaching and capacity building; communication skills and cultural competencies; coordination, documentation and reporting; healthy lifestyles; and mental health. The eight-week onboard training includes classroom work, scenario precepting, job shadowing and peer mentoring, after which CHWs understand the nature of diabetes, heart failure and COPD, as well as the resources to manage them.

Newly minted CHWs also undergo Spectrum’s systems, department and program orientations.

Swartz notes that CHWs are being used more frequently by hospitals these days, and that it has become a coveted career in the region. Often, there are more applicants than job openings. “I think that is in part due to the training and certification and the amount of attention that this position is getting at local, state and national levels,” she says.

Outcomes to date
In 2016, Core Health had the following results in client engagement, and health and cost efficiency:
Success for the client is measured using a patient activation measure, or PAM, score, which assesss a client’s competence and readiness to manage his or her condition and engagement with primary care. In 2016, 70 percent of clients had a mean increase in their PAM scores of 26 percent. The client satisfaction rate was 97 percent.
Objective measures of patient health indicate an improvement as well; more than 52 percent of diabetes clients decreased their A1c levels by an average of 17.2 percent during the period they participated in Core Health.
Clients reduced the number of hospital stays and visits to the ED, which dramatically reduced Spectrum’s costs to care for these patients.

Lessons learned
The major takeaway, Swartz says, is the extent to which factors other than physical health affect the client’s ability to manage a chronic condition. “Looking back at the original design of Core Health, the behavioral and social health needs of our clients were probably underestimated,” she says.

Core Health staff have come to appreciate the complexity of chronic conditions, especially for the program’s target clientele. The acuity level of the clients’ conditions and the number of community members who were not receiving appropriate care services were unexpected, Swartz says.

Modeling the program around the client’s needs and capabilities is also much more productive than trying to mold clients into a certain approach, she says. This means that work with the clients is more intense, but often not as long.

“Our caseloads might be smaller, but we’re discharging clients more successfully at a faster rate, so we can open that slot to somebody new,” Swartz says.

Next steps
One future objective is to incorporate technology into home visits. Swartz perceives a great need for pharmacy services, especially medication reconciliation for clients who are seeing providers from multiple health systems. Managing medication prescribed from non-Spectrum providers is often challenging, she says.

The solution most likely involves virtual visits, Swartz says. Spectrum has a new online platform called MedNow that enables patient visits with a primary care physician or advanced practice provider via online access. Pharmacy visits might one day be offered through MedNow, as well. Virtual nurse visits would allow care managers to “visit” more patients, expanding the effective client base of the program.

Whatever the approach, the goal is to keep evolving. “I think we can get creative,” Swartz says.

“This has been an incredibly exciting program over the years,” says Lubberts.

“It has impacted a lot of outcomes,” Swartz says, “but still the most impactful elements within this program were the times when I would receive phone messages from clients describing how a community health worker made all the difference in their lives.”

Original article  can be accessed here.

For people living in cities, the constant sight of red lights and sound of sirens can be taxing. Their omnipresence can be particularly frustrating given that around 80 percent of calls to 911 aren’t actual emergencies.

To cut back on these expensive and often unnecessary trips to the hospital, cities are revamping their emergency services programs. Houston, a sprawling metropolis made up of more than 2 million people, is leading the charge.

A fire truck in Houston

In 2014, the city launched a telemedicine service that has reduced 80 percent of the number of unnecessary emergency visits. The program is called ETHAN, which stands for Emergency TeleHealth and Navigation. It works like this: When paramedics arrive at the scene of an emergency and realize a patient doesn’t need to be rushed to a hospital, they use a tablet to video chat with a specialist. For instance, a patient can chat with a nurse to get a prescription refilled or get an appointment scheduled on the spot with their primary care doctor for joint pain.

Michael Gonzalez, ETHAN’s program director, says the program is approaching its 10,000th patient encounter and has prevented 6,000 unnecessary ER transports. The average teleconference visit clocks in at about seven minutes, and the cost of treating a patient virtually is around $220 — substantially less than the $2,200 it costs to transport someone to the ER.

As a result, Houston’s use of telemedicine in emergency services is catching on. Gonzalez says he’s had about 300 teleconferences with health agencies from around the world since ETHAN launched. A handful of American cities are also about to launch their own EMS telemedicine programs similar to Houston’s.

“It’s very clear to us that telemedicine has a place in EMS,” says Vince Robbins, president of the National EMS Management Association. “It depends on the agency, and how effective it would be for them, but it’s a good technology and can have good value.”

This is Houston’s third effort in a decade trying to modernize emergency services. In the first iteration in the early 2000s, the city went with a hotline, where chronic 911 users could call and chat with a nurse. The problem, however, was getting someone who normally calls 911 to dial a whole new number.

“It was like fitting a square peg in a round hole,” says Gonzalez.

Houston then created a computer-based algorithm to triage patients. Once paramedics arrived at a scene and again realized it wasn’t an emergency, they would connect a patient with a paramedic at headquarters. But it turned into a headache for paramedics: It was time-consuming and often required immediate transport to a hospital anyway.

While Houston’s latest approach to redirecting people away from the ER is novel, Robbins says there are other ways to use telemedicine that can make emergency care better for everyone.

A couple of localities — including Minneapolis and Berks County, Pa. — use telemedicine to treat stroke victims en route to the hospital. These programs can shave 20 minutes off of a patient’s treatment time once at a hospital, which is important because “in a stroke, time is of the essence,” says Robbins. “If you can intervene early enough, you can even reverse the symptoms.”

The goal behind these efforts is not only to reduce the number of “frequent fliers” — those who repeatedly show up at the ER — but also to reduce the overall number of “red lights and sirens” that residents have to deal with on a daily, sometimes hourly, basis.

“There’s a public expectation when you call 911 that you want an immediate response, so we as an industry need to re-educate the public,” says Robbins. “We need to let people know that there is strong medical literature that shows there are some instances where your condition is not going to get any worse, and we have time to better help you.”

Original article can be accessed here.