The Fall 2023 Mobile Integrated Health Summit, hosted by the National Association of Mobile Integrated Health Professionals and conducted as an EMS World Expo preconference in New Orleans buzzed with the charge of change in the air, though I suspect that it may have been detectable by those who were looking for it. Once noticed, it was both unmistakable and thrilling.
The shift was to power past the desire to support a community paramedicine program, and toward a willingness to take the steps needed to sustain and grow one. It was to recognize that a novel, impactful line of business takes effort to build—but surely “the juice will be worth the squeeze.” Not just in terms of clinical impact – which must itself be proven by numbers, not merely by anecdotes – but also in terms of compensation, professional advancement, and a crack in the phalanx of America’s modern healthcare system through which Mobile Medicine has a chance to charge and at last take its rightful place at the center.
There were talks of opioid addiction, mental and behavioral health, and I brought up the need to protect children with special health needs—who, if medicine does its thing, will have a chance to become adults with special health needs. There were sessions about the fundamentals of contracting (Christopher Kelly); coding so that insurance companies know how to pay for services rendered (Maggie Adams); using grants to kick-start programs but not sustain them (Suzanne Ailwine’s team); and the machinations of partnering because Mobile Medicine is a full contact group sport (Carlie Coward-Dodson and Ashley Nelson). New York’s Steve Kroll channeled Tip O’Neill, former U.S. Speaker of the House of Representatives, by reminding us—as my friend Lisa Suennen, a famed healthcare IT investor, has also said—“you only get what you ask for.”
As I’ve been known to do, I sought to break expectations in the way that only a Silicon Valley technologist can: “Move fast and break things” is a popular saying in my professional neighborhood. While Mobile Medical software can rarely be accused of breakneck speed, movement is unmistakable—the Fire Service is about to find out what it feels like for a mountain to move sideways, as NERIS renders NFIRS obsolete—and long-held misconceptions justify recalibration. Who would have anticipated that the most successful CP/MIH programs could be shut down for being too successful at relocating patients to optimal care…just not in a hospital room? Because CP/MIH has been around for a while now, more MIH summit attendees could reference programs where agencies overstayed their welcome by too effectively taking money out of hospitals’ mouths (so to speak).
Once upon a time, a CP/MIH program’s focus was to attend to patient’s clinical needs as well as their Social Determinants of Health, without ever detouring through the emergency department. Now there is an emerging recognition that hospitals need revenue—and even readmitted patients provide some; at the same time, some care facilities are more pressed than others by external forces like nurse shortages.
Therefore, aspiring CP/MIH programs must look more deeply at the numbers—which means they need the numbers, and in many communities, those numbers don’t exist in any one place; they exist in several. Hence, the emergence of the “co-responder” model aggregating Fire, EMS, public health, public safety, social work, and more. For the first time that I can recall, an entire session at the EMS World Expo (not specifically the MIH Summit) looked at the overlap between Mobile Medicine and hospice. Like giving Mobile Medical professionals access to end-of-life medical orders (i.e., POLST forms), facilitating crosstalk among the many groups that work to ease patients’ burden in palliative care is so obvious that it’s impossible to unhear. (Isn’t that a wonderful thing? We’re learning and can’t revert to the way we were).
I’m describing something magical that doesn’t happen nearly enough: the discovery that we are together in a foxhole, considering community-level quandaries that impact every care provider serving a patient who is in crisis, whether due to polychronic manageable disease, or the lurking shadow of acute mental illness. Fire, EMS, police, social work, nursing care, and even the folks whose software builds the economic models—we need one another in order to solve big problems, and to avoid continually reinventing the wheel. But that also means that we are experiencing stress together—including the strain of loss, as Dr. Mike Daily of Albany Medical Center pointed out to me—and while we need to let humans feel, there is comfort in recognizing that we’re not alone. Knowing that misery needs company is how we at last end the stigma.
After each of my talks, audience members said they had never considered that readmission avoidance was a dead-end model for driving community paramedicine to the promised land of longevity. One leader confessed that “I scared him by turning all that he thought he knew on its head.” My reply: “I hope together we can turn that fear into hope for long-term solutions.”
We’ll hear about their wins and challenges during future confabs, but solutions are forthcoming. In the meantime—while innovations in technology, medicine, and business are being conceived, crafted, tested, and tweaked—the 2023 MIH Summit at EMS World Expo showed that better is happening. There is no endpoint; better health and better access are perpetual targets (let’s leave “lower cost” aside for now because it may be a red herring). Right now, we get to live our brand: clinical health challenges lead to social determinants that in turn lead to clinical health challenges. Breaking the cycle calls for “integrated” approaches that force strange bedfellows to acknowledge they’re not so different after all.
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Brave New Interoperable World: Part 2: The Liberation (At Last!) of Healthcare Data
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