There is big money to be made in Mobile Medicine. Gargantuan money, in fact. Billions of dollars in the United States alone. Looking around the world, the opportunities are even greater, and the ROI stands to be even higher. Yet so many lament Mobile Medicine’s economic stagnation despite access to more revenue sources than perhaps at any time besides the COVID-19 public health emergency. Something is keeping America’s Mobile Medical services from capturing the dollars they deserve. Why the tunnel vision?
Why, in a room of Mobile Medical leaders during the 2023 NAMIHP MIH Summit and EMS World Expo, had fewer than a half-dozen agency leaders sought public revenue sources beyond the Center for Medicare & Medicaid Services (CMS) and FEMA’s various grant programs?
Why did only one hand go up when I asked about DOT’s Safe Streets & Roadways for All (SS4A) program, a multi-year, multi-billion-dollar effort for which Mobile Medical services are not only eligible, but supremely positioned and have been specifically targeted for outreach by NHTSA?
When a MIH leader asked online: “If oil goes to $150 a barrel, is your MIH and EMS program ready for this budget adjustment?” why did not one answer, “Yes, and this is how we are hedging in our organization against the price of oil and gas, so that we make money when it’s down, and we make money when it’s up? After all, logistics—including fuel—is our business!”
Think Differently
John Mather, my former business school professor, was fond of emphasizing that the key to powering through is often to “shift the frame.” Or as Steve Jobs suggested to “Think Differently.” Others already are. One company that runs a large, dispersed community paramedicine-like program, has raised over $330 million. Another company that pioneered hospital-at-home and has team members actively engaged with MIH associations, has raised over a quarter of a billion dollars’ worth of investment. Even a nationwide electronics store has recently leaped into the fray via a subsidiary.
No need to take my word for the size of the Mobile Medical market: if it weren’t an overlooked gold mine, it wouldn’t be attracting major technology companies (one of whom implemented a community paramedicine-type program). And don’t forget ride haling apps are getting into the industry too. And as controversial as it is has become and despite legal challenges that have battered its stock, another mobile medical services and transportation company still has a market capitalization of $582.24 million.
There is no lack of ways to make a buck in Mobile Medicine—but doing so isn’t easy. It’s even more difficult if one only wants to do the same old same old. Then again, what business is “easy”? Is one root of our profession’s financial ills a cognitive dissonance—that that those who have been so focused on running toward crises can’t stomach the idea that their calling is also a company?
True, it is risky to take funding announcements at face value because when a company is private, only insiders know the details of the arrangement. Yet it’s clear that even as major companies are paying—a lot—to break into Mobile Medicine, Mobile Medical agencies themselves are decrying their lack of money. News programs are decrying their lack of money. Legislation is starting to drip-drip-drop more public funding, but sustainability remains an ever-present caustic fog.
Something Seems Amiss
How can there be gobs of money for companies doing Mobile Medical work—but not for Mobile Medical agencies themselves to do the work?
- Mobile Medical agencies want (and need) the cash that is drawing into our profession—yet they are not the ones receiving it? Stepping outside our bubble, it’s not clear that this is an ambulance problem, but rather, a “truthiness” problem. Three health apps have raised millions of dollars (ranging from $56 million to $250 million by investors.
- Yet the Public Safety Answering Points (PSAPs) that these three companies serve are struggling to hire and stay open. What happens when one’s company goes off and raises capital but said company’s clients are going out of business or lack free cash to spend? The situation seems reminiscent of the transition from NFIRS to NERIS on the fire side of our profession: what happens when a technical architecture goes obsolete but all of one’s products are built on that foundation? This is to say nothing of organizations that swath themselves in the raiment of emergency service readiness without having anything to do with response: SOS, featured at the 2023 HLTH summit (I wrote about last year’s event here) makes a digital vending machine to dispense…toiletries.
Falling into the Trap
Many American Mobile Medical professionals fall into the trap of believing that politics are the root of all challenges (put down the social media…it’ll be better for your mental health). They pine for the life of the paramedics of the Commonwealth countries like Canada and Australia. They think a seamless nationwide healthcare system is all it takes, that the maple leaves are greener over yonder. But one of Australia’s largest ambulance services is still fully paper-based in 2023—and has taken over a year to try to meet its aspiration of digitizing and interoperating with its regional hospital system. Does that sound familiar? Meanwhile, London’s ambulance “wall times” exceed even California’s: “Ambulance response times in England were the worst on record across all major categories in December, while people waiting 12 hours or more…reached an all-time high.”
I often listen to podcasts as I walk the neighborhood, and when I do, I stop to take notes that tend to germinate into JEMS columns. Against the backdrop of the HLTH 2023 summit, I stumbled upon a podcast featuring renowned investor Hemant Tejana.
His discussion centered on the power of holding a mission at the center of one’s daily work, and while his firm’s “mission [is] to invest in positive, powerful change, at the end of the day, founders are those agents of change. And the change that they create is building these enduring companies that are focused on improving society, focused on creating both purpose and profit with their work, supporting their purpose.”
I could not help noticing that Tejana’s statement maps onto the world in which you and I operate: “So if you go back to our mission, to invest in positive, powerful change, at the end of the day, and (Mobile Medical professionals) are those agents of change. And the change that they create is building these enduring (communities) that are focused on improving (health), focused on creating both purpose and (sustainability) with their work, supporting their purpose.”
Correcting the Record
But therein lay Tejana’s one error, so let us correct the record: “We have no viable healthcare system for inner cities and rural America, and we have to fix that. And so when we think about, OK, this goes back to my long-term enduring mindset. In 30 to 50 years, what should the system look like? It needs to be a system of health assurance. Proactive, affordable, accessible.”
Sure you do: Mobile Medicine is that “viable healthcare system for inner cities and rural America.” Indeed, it is often the healthcare system for those spaces and the folks who live there. It doesn’t get the credit because it is being drowned out by those who are telling the story about the bonkers sums of cash that they have raised, or technologies that they might put into the world…someday. Mobile Medical professionals aren’t fighting fire with fire because they stories they are telling are not of achievement and the projection of success; they are crying “desiccation!” and beginning for life rafts.
This fits the profession’s M.O. because Mobile Medical professionals are reluctant heroes. The most fundamental truth of business is “you only get what you ask for,” as Lisa Suennen, my friend and a renowned healthcare investor, taught me. Just ask Kaiser’s nurses: If you ask for eleven dollars per hour, you won’t get twenty-two. If you want twenty-two, ask for twenty-two, then, reasonably, be set to compromise at eighteen. But first know your value. Do you know your value?
Among the names that I cited above are some companies that deliver little quantifiable value—their clients have gone on-record as saying so—yet they spin yarns and mesmerize with possibilities while delivering fairy dust. Still, they get the investments while those who are doing—you!—get a pat on the back. Perhaps Mobile Medicine should take more bows because even those who are watching so often do not realize what it is that you do. It’s past time to tell them.
More from the Author
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A ‘Thank You’ to Governments (On Behalf of CP/MIH Programs That Deserve to Get Paid)
