2nd Mobile Integrated Healthcare Summit Focuses on Contracts and How Providers Will Get Paid

A year ago, mobile integrated healthcare was still something EMS providers and the agencies they work for largely just talked about. Now, with the second Mobile Integrated Healthcare (MIH) Summit, held in conjunction with EMS World Expo in Nashville, TN, on Nov. 12, wrapping up, it’s increasingly apparent that the talk is shifting more and more toward action.

During the second Summit, MIH experts from across the United States gathered to discuss the ground-level challenges of implementing a community paramedic program; case management and patient assessment for mobile healthcare/community paramedics; MIH contracting; and the economic sustainability of EMS and MIH.

Because MIH is such a “new” concept for many in- and outside of healthcare, those discussions focused on contracts and sustainable funding models were particularly well received.

Among the questions asked of panelists was how MIH contracts differ from traditional ambulance contracts. For starters, you have to get payers used to paramedics doing different things than just transport. Then you also need to decide how your EMS agency is going to get paid for the MIH services it provides.

Asbel Montes, vice president, government relations & reimbursement for Acadian Ambulance, said Acadian looked at using a capitated, or a per member per month model, based on a Monday–Friday, 8–5 schedule. Acadian is also seeking out managed care individuals, and has moved to a fee-for-service model with pediatric asthma patients. “As you’re working through contract negotiations and management, you have to be very fluid and see what works for your customer,” Montes advised. “There are no one-size-fits-all models, but you also have to remember you can’t do it for free.”

Matt Zavadsky, public affairs director at MedStar Mobile Healthcare, the exclusive emergency and non-emergency EMS/MIH provider for Fort Worth and 14 other cities in North Texas, said MedStar started with a similar fee per patient contact per hour model, but has since switched to enrollment fees for the patients it sees as part of its MIH program. “Whatever price you think you want to charge for this, ask for at least twice that amount,” Zavadsky stated bluntly. “We’ve found out patients are often willing to pay two to three times what it actually costs to provide the services. Just ask what the patient is willing to pay” to find out how much you should charge.

Panelists also pointed to the importance of the specific clauses included in the contract. Data was cited as something that sounds minor and can easily be written off, but it was stressed that EMS/MIH providers need to retain access to the data they generate from the service provided. “We had a contract when we first started that allowed our partner to retain all the data,” one panelist explained. “As a result they have all my data, and the data is what you need to take to other customers to sell this.”

Another contract issue addressed was exclusivity, but not how one might think. Rather than the EMS/MIH provider asking to be the only such provider their healthcare partner will work with to provide these services, Zavadsky said a couple of MedStar’s early partners asked for exclusivity with them. “They wanted to be the only home health provider, only hospital system, etc. that we worked with,” he explained. But, eventually, EMS/MIH providers are going to want to partner with all of the healthcare providers in their area to maximize the earning potential of their MIH program.

The biggest take away from the day’s sessions was that EMS/MIH agencies should listen to what everyone in the room was saying but ultimately they needed to build their MIH programs in a way that worked specifically for their agency and their service area. If that meant starting slow, with a very limited MIH program and scope of practice to avoid getting in over their heads, then so be it. That sentiment was summed up best by Brian LaCroix, president of Allina Health–Emergency Medical Services in St. Paul, MN, who also serves on the boards of the North Central EMS Institute and the National EMS Management Association. “We tried to be everything to everybody,” he said, “and that was a mistake.”