News & Winning Strategies for EMS Leaders

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M
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EMS INSIDER MAY 2014

UNLAWFUL TO COPY WITHOUT THE EXPRESS PERMISSION OF THE PUBLISHER.

TM MAY 2014

VOLUME 41

NUMBER 5

Some of the most common questions in the development of a Mobile Integrated Healthcare (MIH) strategy relate to fnancial sustainability. Yes, it is the right thing to do for the patients and it’s necessary to meet the Institute for Healthcare Improvement’s Triple Aim (improved patient outcomes, improved population health and reduced cost of care), but without a sustainable economic model the programs are diffcult to sustain.

Thankfully, innovative economic models are fourishing. This comes as a result of healthcare fnancing changes within the Affordable Care Act (ACA) that seek to align incentives to help make the entire healthcare delivery system more fnancially sustainable. We are also seeing implementation of some long-standing, but stagnant fnance reforms.

Some of the more recognized fnance
changes—such as bundled payments,
risk-sharing arrangements, enhanced
managed Medicare and Medicaid pro-
grams and, of course, Accountable
Care Organizations (ACO)—are ways
the ACA is transforming our health-
care delivery models. However, pro-
grams such as 1115 Medicaid waivers,
managed Medicare and Medicaid, and
traditional fee-for-service models are
rapidly recognizing MIH provides a
valuable service in which they should
be investing.

This is the frst of four columns that will focus on the fnancing and economic models for MIH services that hospitals, Medicare and Medicaid, commercial insurers, integrated delivery systems, ACOs, hospice agencies and even home health agencies are funding and, more importantly, why they are funding them.

The question for this frst article: What is motivating hospitals today to work with other agencies to actually reduce the inappropriate use of their in-patient facilities?

Value-based purchasing

One of the efforts to improve qual-
ity and reduce healthcare costs in
the ACA is an initiative called value-
based purchasing (VBP). Under VBP,
• Percent of heart attack patients
given medication to avert blood
clots within 30 minutes of arrival
at the hospital
• Percent of heart attack patients
given percutaneous coronary inter-
ventions within 90 minutes of arrival
•;Percent;of;heart;failure;patients
It seems the industry is abuzz with
talk about healthcare reform and
how community paramedicine pro-
grams will help to solve the world’s
healthcare woes. While I am a pas-
sionate believer in what this future
holds for our industry, I am also
a realist and pragmatist when it