Five Questions With: Pat Songer, Ready Responders

Ready Responders hopes to redefine house call with EMS providers and nurses helping patients who don’t have a medical emergency but still want to be evaluated for nonemergency complaints. With the use of telehealth to access a 24/7 network of physicians, the Louisiana-based organization will assess and then refer patients to the next appropriate point of care, whether it be a pharmacy to get a prescription, a trip to urgent care, a primary care physician, or a follow-up home visit. Ready Responders facilitates the use of alternative transportation to get patients to these locations.

Launched on June 25, 2018 in New Orleans, the company has secured funding for its patient visits from Louisiana’s Medicaid system through UnitedHealthcare, Aetna, and Louisiana Healthcare Connections. Ready Responders also sees UnitedHealthcare’s commercial members. Currently residents can reach Ready Responders directly at 504/321-4444, via 2-1-1, or with an app. Ready Responders developed a proprietary smartphone app that allows for skill-based routing so the appropriate-level provider may be quickly directed to the patient’s location. 

The company is currently working on partnerships with 9-1-1 systems to respond to low-acuity calls alongside EMS units. Ready Responders believes municipalities will see the value of reducing the financial burden on their residents by providing them with options for more appropriate and less expensive care. Addressing the needs of the patient without ambulance transport to a hospital emergency department also preserves EMS resources and should help improve response times to high-acuity medical emergencies.

Pat Songer, senior vice president of operations, joined the company on May 7. EMS World asked him about the new venture.
 
EMS World: You’ve been operational for about eight weeks now; what initial challenges are you having, and what are you focusing on at the start?

Songer: The greatest overall challenge is changing the commonly held views of how patients access healthcare in the United States. The use of 9-1-1 and hospital emergency departments as access points to the medical system has become the default for some patients’ healthcare needs. The challenge is how to create a message that appropriately directs patients to an access point for nonemergency healthcare concerns without placing them at risk. But New Orleans residents are seeing more and more of Ready Responders, whether it be through geotargeted digital marketing, branded brochures stacked in waiting rooms, or a visit from a Ready Responders team member during a farmers’ market or after church services. 

As the word spreads we’ve seen numerous success stories with our patients. One of our diabetic community care patients, for instance, was regularly testing 300–400 mg/dL fasting blood glucose. When asked about her diet, she told her Ready Responders medic that the summers were very hot and she would drink lots of Gatorade. The medic educated the client on her chronic disease process, how sugar affects people with diabetes, and the importance of tracking glucose levels. By her next visit her glucose was tracking around 120–140 mg/dL over the week, and she was feeling much lighter on her feet. Our patient-driven interactions in the comfort of their homes have yielded so many positive outcomes just like this. This patient is part of a growing cohort who have significantly reduced their usage of 9-1-1 and the emergency department.
 
Many MIH-CP services struggle to find funding. Can you describe the negotiations you had with the health plans and how Ready Responders was able to secure Medicaid funds from the state?
 
To make Ready Responders’ vision sustainable, the cofounders knew they had to have insurance companies fund the services we offer. Because Ready Responders’ services are designed to increase patient access to healthcare to prevent the unnecessary utilization of emergency services and departments while also improving health outcomes and reducing costs, they’re deemed a “value-added benefit and service” by the Louisiana Department of Health. This allowed flexibility in contracting with the payers. Leading up to that determination, hundreds of hours were spent on the road traveling back and forth between New Orleans and Baton Rouge, and a great number of trees were sacrificed to present our company model based on data-driven best practices across the country. Our founders and executive team, with backgrounds in entrepreneurship, public health, business, and law, were able to help payers understand the value and savings Ready Responders provides for the community.
 
Ready Responders providers are currently being summoned by patients with nonurgent medical problems via 2-1-1, and you are visiting heavy utilizers of 9-1-1. How else will you provide care to patients in the community?

We are working to integrate with municipal 9-1-1 systems to respond as a partner in the healthcare system to navigate nonemergent patients. Our handling patients who do not require transport by an ambulance will increase readiness among 9-1-1 providers. Similar programs have seen dramatic reductions in medically unnecessary emergency room transports and visits, decreased times for ambulances to go back into service, increased patient satisfaction, significant cost savings throughout the healthcare system, and improved hospital and EMS provider satisfaction.

We are also working with hospital partners to address overutilization of emergency departments as well as high readmission rates via our MIH programming (a treat-and-refer hotline), community care program (a weekly health education and monitoring visit to superutilizers), and other means. Finally we are planning on providing in-home flu shots and treatment, which is also backed by our payers. 

Ready Responders sounds like a good part-time job for an EMS provider. What are your onboarding and training plans for your providers, and how will you conduct quality improvement?

It is a good part-time job! In fact, our part-time position is unique in that, like other gig economy jobs, medics can go on- and off-call as they please, even if only for an hour at a time. In sum, Ready Responders is a physician’s group that employs EMTs and paramedics to provide healthcare services and response. Our onboarding, credentialing, and quality improvement measures mirror those of a typical high-performance EMS system. The one exception is that all providers go through a robust training based around a typical community paramedicine curriculum, along with a course on patient navigation.
 
Can you talk through a typical call scenario from start to finish?
 
Treat and refer—Patients currently access Ready Responders’ treat-and-refer program via our direct number, 2-1-1, or our commercial app. Our communication center appropriately triages the call. A warm handoff to the local 9-1-1 system is conducted for patients triaged as emergent. Patients eligible for services are entered into Ready Responders’ CAD system and assigned to the nearest medic via proprietary technology connecting to our medic-facing smartphone app. The medic responds to the call, facilitates a telehealth consultation with an advanced-practice provider (doctor or nurse practitioner), and provides navigation, along with identifying transportation solutions, if needed, to the recommended next point of care. Ready Responders has improved care coordination with providers to enable patients’ same-day and next-day appointments with primary care medical homes. Working together as a team, we are making it easier for residents to access the right care at the right time.
 
Community care—Ready Responders’ community care program is a healthy-lifestyle behavioral-education program designed specifically for individuals who struggle to manage health conditions and lack access to necessary resources. The program’s premise is that equipping patients with the appropriate tools, resources, and support will help them effectively manage their health conditions, thereby reducing the overutilization of emergency services. Patient referrals are typically provided by health plans and community healthcare partners. Enrolled patients are assisted in identifying and meeting health goals by utilizing guidelines based on the social determinants of health. Patients are ultimately connected to primary care providers, applicable social services, and transportation as needed to facilitate reaching long-term health goals. The typical patient will be enrolled up to three months and complete approximately 15 home visits, graduating when they meet criteria set by Ready Responders’ physicians and the health plans.