At the American Ambulance Association’s annual conference in Las Vegas, Nev., JEMS board member Jonathan Washko, MBA, NREMT-P, AEMD, presented a session that recounted his work with the Academy of International Mobile Healthcare Integration (AIMHI). In the session, titled Establishing Performance Metrics that Prove Value, Washko identified AIMHI as a group of “like-minded” organizations with the following high performance design features:
- Sole providers
- Externally accountable
- Use full cost accounting
- Control center operations
- Revenue maximization
- Flexible production strategy
- Use system status management
He noted that the mission of AIMHI is to lead the transformation of EMS to mobile integrated healthcare. He added that the involved systems are transitioning their systems to high-value EMS organizations, from what have traditionally been high-performance EMS organizations.
He posed the following questions to the attendees:
Why focus on value? Value is what you get versus what you give up.
Healthcare Value = Quality/Cost
Who do we need to prove value to? Understand the healthcare value chain.
- Upstream = Patients and care takers; payers; anyone who could refer business
- Laterally = EMS agencies, public safety agencies, competitors & regulators
- Downstream = All of healthcare, outbound referrals, patients
What do they consider valuable?
- Primary care: Wellness, preventative, patient education, risk assessments
- Pre-hospital: 9-1-1 as an access point into healthcare; care navigation, alternative destinations
- Acute/hospital: We take a lot of patients in, and we take a lot of patients out of their hospital, transport appropriateness screening, transitions of care, throughput and length of stay, patient experience
- Post-Acute: On/off hours PCP extender, home health extender role, in-home risk abatement
He discussed EMS’ Existing “Invaluable” Value Proposition
- We have been focusing on scarcity management of dollars
- We are not seen as healthcare providers, but, rather, as suppliers/a transportation commodity
- We have never focused on getting a seat at the table as an integrated healthcare partner
- We have to shift to value-based care versus fee-for-service providers
Wahsko stated that we put a lot of emphasis on response times, but for too long we have placed too much reliance on response time. Data now shows that response times are not as important as we have thought in the past.
Traditionally, high-performance systems have been focused on data and operations, so that is a good platform to move to other value-based perspectives going forward. We look at lost unit hours and other parameters that are light years ahead of some parts of healthcare.
He also said that our healthcare system is broken and unsustainable. The reasons for this are:
- It is not patient-centered
- We work in silos
- We built a fee-for-service system
In contrast, the new healthcare value proposition is based on:
- Using economic/payment reform to transform delivery systems
- The Triple Aim Initiatives
- Being great at improving things like:
o Population health
o Patient satisfaction
o Clinical outcomes
o Employee engagement and satisfaction
o Transparent disclosure
o Operational effectiveness and efficiency
o Patient and employee safety, and
o Improved financial outcomes
How do we improve/prove our value?
- Good data—you cannot improve what you cannot measure
- Have good measurement systems
- Make sure what we are doing is effective and efficient
- Is it reliable and reproducible?
- Is it like by those involved?
- Is it safe?
- Is it affordable?
The most important advice Washko left with the audience was that in order to understand what value EMS brings to the table, we must “follow the money.” Understanding the perspective of the audience you are working with and how they get paid is essential. This helps us understand their value needs, and EMS must align its value proposition to their needs, not ours.
About Jonathan Washko
Jonathan Washko is responsible for oversight and accountability for the Emergency Medical Services program for Northwell Health’s Center for EMS with 700+ employees, 135K+ annual call volume and a 60M+ budget, serving all 5 boroughs of New York City and all of Long Island (Nassau and Suffolk). His program includes the largest voluntary hospital participation in the NYC 9-1-1 FDNY EMS system, largest regional critical care based hospital transportation network, private and municipal emergency response programs, the region’s only dedicated air medical program (SkyHealth), regional training programs, state of the art PSAP / Command and Control Center, substantial special events program and a highly effective revenue collection department.