Administration and Leadership, EMS Insider

A Safe Harbor in Tumultuous Times: Navigating the Changing Healthcare Waters

This month marks the first of a new bi-monthly series that JEMS has graciously offered me to write that I am calling EMSOLOGY – The Art and Science of EMS.  The aim of this series is to share the wealth of knowledge and wisdom I have been privileged to garner in the 30+ years of my EMS career working with countless EMS agencies at both the bottom and top of their games from around the U.S. and other countries. 

This series will cover a variety of topics, along with the sharing of best practices I have learned from other amazing people in the EMS industry, along with commentary on important topics, in a succinct and hopefully enlightening approach, encompassing an easy and quick read of about 800-1000 words.  

A Broken System

Our healthcare system is broken, financially unsustainable and must be fixed.  The U.S. has one of the most expensive per capita healthcare systems in the world, yet our life expectancy is average to below average.  Many factors play into this, but one thing is certain: just because something costs more doesn’t mean it’s better. 

We have some of the best physicians and medicine in the world, yet our outcomes in many areas (life expectancy being just one measure of this) fall short.  This is because our delivery system is broken and care is provided in an uncoordinated and episodic nature, not because we have bad medicine, dumb providers or lack in the latest technology or pharmaceuticals.

President Obama’s attempt to overhaul healthcare under the original ACA was essentially in two parts.  Part 1 addressed how we obtain and pay for health insurance and created the state health insurance exchanges.  Part 2 addressed how to reform the delivery system through changing how healthcare is paid for by shifting away from fee for service payment systems and moving to Alternative Payment Models (APM), Value Based Purchasing (VBP) and Risk based reimbursement schemes, with the intent of incentivizing new behaviors, drive innovation and responsibly disrupt our traditional episodic systems of care. 

Thus far, President Trump’s repeal and replace policies are attempting to adjust Part 1 of the ACA, namely how we obtain and pay for health insurance, but there’s been little discussion or focus about Part 2, and here’s where I believe there is some stability in our trajectory, or a place I believe EMS leaders should point their ship towards for safe harbor during these tumultuous times. 

The way we get health insurance may change, (personally I believe we should have a single payer system with a privatized delivery model like Japan), and we must reform the delivery system. This takes reimbursement restructuring so that we’re rewarded and incentivized for providing appropriate integrated care, not episodic uncoordinated care.

An Integrated System of Care

For many of the top performing EMS agencies and leaders I am honored to interact and sit alongside with in my various industry roles (including the agency I work with in NY), we have been collectively figuring out the next evolution of EMS (what NAEMT is calling EMS 3.0 and AIMHI calls High Value EMS).  What does this mean? Really, it means we are figuring out how EMS can provide significant value as part of a future integrated system of care.  

Some call this Mobile Integrated Healthcare (MIH) or Community Paramedicine (CP).  These are test beds for what I believe EMS will become as part of a fully integrated healthcare system.  Imagine being able to do the right thing for our patients every time.  Imagine helping someone get the appropriate care they need at the appropriate place.  Imagine having the ability to break the cycle of our repetitive patients (frequent flyers, frequent faces, etc.), imagine treating people at home without convincing them they’re going to die unless we transport them to the ED and finally imagine getting paid for all this great work! 

This is happening now in many communities across the U.S. and the results so far are significant in all the important measures of success (improved health, improved satisfaction and lower costs – what healthcare and the Institute for Healthcare Improvement calls the Triple Aim).           

If you are waiting to point your EMS ship in this direction because of uncertainty, fear, years of tradition unencumbered by progress or simply don’t know how to navigate, I compel you to learn more, get involved and course correct your ship soon.  This disruption is still very early in the Diffusion of Innovation Curve, but to sit and wait for mass adoption could find you without a chair when the music stops or without a mooring in the safe harbor when you arrive late.  

Though there’s still much to learn about how EMS can provide additional value in an integrated system of care–and by no means should you dive head first into this very complicated game without proper due diligence–it’s very clear to me that early adopters can gain first mover market advantage and have a chance to survive what’s sure to be the next wave of consolidation, regionalization and downsizing that integrated care disruption will ultimately bring us in the long term (more on this in another article).

To learn more about how you can integrate your EMS system into a coordinated healthcare system, look to NAEMT and AIMHI on the web for resources as well as follow me on Twitter @EMSOLOGY or @JonathanWashko for quick 140 character insights and links to other resources.  Also, will be live soon for additional resources on this and other important EMS topics.