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Mobile Integrated Healthcare Part 1: Strategic Planning for Rapid Implementation
Beginning this month, EMS World launches a yearlong series that will provide readers with a road map for developing mobile integrated healthcare programs. This series will address the following topics:
- Data metrics and strategic goals;
- Collaborations with home healthcare;
- Updates on CMS Innovation Grants;
- Accreditation of MIH programs;
- Profile of the MIH Summit at EMS on the Hill Day;
- Payer perspectives for MIH services;
- Choosing MIH practitioners candidates;
- Education and training of MIH practitioners;
- MIH programs in rural settings;
- International models of MIH.
This month we look at strategic planning for rapid MIH implementation.
The Challenge
Healthcare stakeholders such as hospitals, physicians, payers, home health agencies and hospice agencies are quickly learning the impact that EMS-based MIH programs can have on patient outcomes and the cost of care. While that is great news, it is also scary. In some instances they may want an MIH program faster than you can comfortably implement one. What would you do if one of your local healthcare stakeholders called you today, said they’d heard about EMS-MIH and wanted to meet with you next week to get a program started? What gaps would you fill? What’s the right delivery model? What education will the providers need? What data metrics should you track to demonstrate the value of the program? This article walks you through the steps necessary to strategically plan and rapidly deploy an MIH program for your community.
It’s Tuesday morning. You’re sifting through the field operations schedule, trying to fill those last openings for Saturday night, when your phone rings. It’s Liz Harris, the CFO of Mercy Medical Center, the largest hospital in your service area. Liz explains she just received the hospital’s 2015 readmission penalty notice, and it’s increased from 0.51% last year to 1.89% this year. She recalls that last year you met with them to discuss readmission prevention programs, but at that time the payments they were getting for the admissions were higher than the penalties being assessed. With the change in the penalty this year, the reverse is now true, and the hospital wants to start a program with you as quickly as possible. Liz invites you to a breakfast meeting tomorrow with her, the chief executive officer, chief medical officer, chief experience officer, chief nursing officer and vice president of care coordination. As your palms start to sweat, you accept the invitation, thank her for her call and hang up. Game on!
You’ve attended the MIH Summit at EMS World Expo, read every MIH column in EMS World and even read the Jones & Bartlett text, Mobile Integrated Healthcare: An Approach to Implementation. So you must be ready, right?
Your strategy for the meeting is crucial. As a savvy leader, you start assembling your innovation and integration team and invite them to a working lunch. The team includes your medical director, operations manager, communications manager, human resources manager, IT manager, clinical manager, compliance officer and billing manager. During lunch you work to frame out the questions you’ll need to work through with the Mercy team in the morning:
- What’s the problem Mercy would like to solve?
- Can EMS provide the right solution?
- What is the delivery model?
- Who all needs to be involved and committed?
- What training will be necessary for practitioners?
- Who will do the training?
- How will information be shared?
- What is the economic model?
- What does success look like, and how will it be measured?
You agree to recommend to Mercy the use of a rapid implementation strategic plan using the “driver diagram” methodology (see Figure 1) recommended by the Center for Medicare & Medicaid Innovation.1 A driver diagram depicts the relationship between the aim (the goal or objective of the program), the primary drivers that contribute directly to achieving it (the factors or components of a system that influence achievement of the aim) and the secondary drivers necessary to achieve the primary drivers.
Clearly defining an aim and its drivers enables the team to have a shared view of the theory of change in a system because it represents the team members’ current theories of cause and effect—what changes will likely cause the desired effects. It sets the stage for defining the “how” elements of a project—the specific changes or interventions that will lead to the desired outcome.
The Meeting
The next day your team is enthusiastically welcomed into Mercy’s c-suite. During breakfast the Mercy team offers preliminary answers to the key questions your innovation team developed. They want to reduce 30-day CHF readmissions by a quarter. Together you come up with the strategic plan shown in Table 1.
All agree that in order to meet the strategy, several joint Mercy/EMS task forces (Table 2) will need to be formed. The goal is implementation within 90 days.
With this plan you are well on your way toward a rapid implementation strategy. You agree to have weekly program implementation conference calls and face-to-face meetings every three weeks. During these meetings the task force leaders will report progress and everyone will help with accountability. The executive task force will work through thorny issues such as HIPAA compliance, health IT integration and contracting. The cardiology and EMS medical control leaders will meet with their constituents and get various protocols approved and contact processes resolved. The finance task force will assist with financing asset acquisition and setting up the billing process. The CMS Quality Innovation Network (QIN) participants on the clinical task force will offer assistance in developing the quality improvement and patient safety reporting processes and facilitate the reporting of outcomes to the state Medicaid office and CMS Innovation Center.
Because you are a well-connected EMS leader and have kept abreast of the MIH movement, you also decide it’s time to “phone a friend.” There are several industry thought leaders knowledgeable on this topic who have developed and implemented MIH programs, and you pick one to call. They are very helpful and offer to host the chairs of your task forces in a visit to see their programs in action, offer insight into the dos and don’ts of program implementation, and offer technical and strategic consulting help. The task force chairs are excited about the opportunity and select a date for the visit.
By working collaboratively with all the internal and external stakeholders, you successfully launch your program 90 days after the first call from Liz. This is an amazing feat by any measure. You recall reading in the Jones & Bartlett book about organizational readiness and community needs assessments, and you reopen the book to those chapters. A smile comes to your face as you reread the section describing that, in some cases, the need comes to you faster than you thought, and you should to be ready to move quickly.
“Yeah, I get that."
References
1. https://innovation.cms.gov/files/x/hciatwoaimsdrvrs.pdf.
3. https://theconversationproject.org/.
Matt Zavadsky, MS-HSA, EMT, is the 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. MedStar provides advanced life support ambulance service to 421 square miles and more than 880,000 residents and responds to over 117,000 emergency calls a year with a fleet of 54 ambulances. MedStar is a high performance Emergency Medical Services (HPEMS) system, providing advanced clinical care with high economic efficiency. Matt has help guide the implementation of several innovative programs with healthcare partners that have transformed MedStar fully as a Mobile Integrated Healthcare provider, including high utilizer, CHF readmission reduction, observational admission reduction, hospice revocation avoidance and 9-1-1 nurse triage programs.
