EMS 3.0 Transformation Summit: Jumping on the MIH-CP Bandwagon

In his presentation “The Incubator for Innovation and Transformation” at NAEMT’s EMS 3.0 Transformation Summit in Arlington, VA, Daniel Felton, director of State Government Relations of Philips Healthcare, discussed how agencies can determine if a mobile integrated healthcare and community paramedicine program (MIH-CP) is a viable option for their communities.

Philips Healthcare plays an important role in the EMS industry as a seller of providers’ routinely used devices such as AEDs and prescription monitoring systems. Felton’s involvement in this arena sparked his interest in the growing field of MIH-CP. He began studying state-level trends of MIH-CP programs being implemented in the United States, and learned that 2015 was a pivotal year in the way laws started changing to allow for MIH-CP. Between 2011 and 2014, only one law was passed each year accommodating for MIH-CP. Then, in 2015, 10 laws were enacted, followed by 8 in 2016, 7 in 2017, and more than 10 are currently pending for 2018.

Legislation is a key element in the establishment of these programs since certain state policies can prohibit or limit their capabilities. In total, 45 MIH-CP bills in 20 states and Washington, D.C. were considered between 2015 and 2016, and 44 bills in 21 states were considered in 2017 and 2018. Felton provided an overview of several states included in this movement—in California, successful pilot CP programs set the stage for legislators to get the ball rolling on a bill (now in progress) that would enable permanent CP programs. Florida is looking at nonemergency alternative treatment options for EMTs to employ, while Hawaii is planning to initiate a three-year CP pilot program to test the waters. As Maryland studies data on MIH before deciding on enacting a law accommodating for it, Minnesota is seeking creative ways to implement CP to serve various areas in need, such as opioid addiction treatment arrangements and other alternative health care delivery systems.

There are a variety of policies to consider when implementing an MIH-CP framework into a community’s healthcare system. Who will provide medical direction? How will your state define what a community paramedic is and how will one obtain licensure? Can your state define MIH-CP in a way that makes it coincide with current state protocols? These questions, along with topics like provider and patient liability, data collection, and funding, must be taken into consideration.

But still, the overarching challenge is legislation: are there existing laws or regulations that prohibit an MIH-CP program? If so, they will likely need to be amended in order to accommodate for your state’s scope of practice. Felton says that proof reports “give legislators comfort in knowing the issue is bonafide, it’s real, and there’s data to back it up.”

The public also wants to see evidence that MIH-CP is a worthwhile endeavor, as the added support will help drive legislation forward. Of course, it’s important to devise a sustainable strategy for funding before bringing a proposal to the table. Some EMS programs are eating the costs of their MIH-CP programs, some are receiving Medicaid reimbursements while others have acquired state and federal grants. Know what your agency is capable of handling financially and determine how you can fill the gaps.

Ultimately, however, you want your legislators and elected officials to understand the benefits of MIH-CP for the end user. They’re “relying on you to educate them” on why this is a necessary pursuit for your community, says Felton.

“If you’re not sitting at the table, you might end up on the table,” Felton says, emphasizing the importance of getting involved and knowing your “enemies”—those who simply have differing opinions (or have yet to establish one)—so you can present your case effectively with an understanding of their perspective.

For more data on MIH-CP trends in the United States, check out NAEMT’s national survey document.