coming from the Affordable Care Act?

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Gilbert Chapman
5 years ago
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1 What are you doing to prepare for the changes What are you doing to prepare for the changes coming from the Affordable Care Act?

2 The Affordable Care Act seeks to accomplish the following: Reduce the number of uninsured in America Enhance the level and quality of primary care providers to citizens Provide expanded benefits to covered individuals

3 There are not enough primary care providers to serve the needs of a society with expanded insurance coverage. Furthermore, it will be years (or generations) before the supply side becomes adequate. Today, the emergency room of the local hospital fills the void of inadequate provider access. The problem then is cost Emergency Department (ED) costs too much.

4 As a solution, many entrepreneurial efforts have taken hold. employer onsite clinics big-box stores' in-store clinics independent urgent care ( doc-in-the-box ) centers The problem? These options have increased cost with no resulting economic benefit. Example, in some cities, hospitals are actually advertising emergency room wait times on bill boards to encourage consumers to seek care there. They are doing this to capture the revenue from diagnostic testing and surgical minutes.

5 The ACA - creation of new provider care and health care financing models. Accountable Care Organizations (ACO) - which are collaborative ventures between hospitals and physicians. Provide the patients with a full-service health care continuum. Reimbursement under these arrangements is envisioned to be for the total episode of care Providers will seek to control all aspects of the patient experience (i.e., price, quality, access, satisfaction), and thus capture all aspects of the patient s needs.

6 There are multiple challenges with this evolution. The opportunity is not uniform. Highly competitive, urban markets will be early adopters. The typical hospital approach is to control rather than partner. Strategic partnership opportunities will need to be sold (so that the hospital can understand the value to them).

7 To insure the continued health and welfare of community members, and minimize the remittance of, or, reoccurrence of illness/disease process... Doctors, Urgent Cares and Hospitals can request a follow-up visit by a triage unit staffed with Expanded Practice Paramedics (Community Paramedics) Prevents 911 calls from occurring

8 ACA says little about EMS It creates significant opportunity by influencing the payment and delivery of care, which in turn allows providers such as the EMS community to assume a much different role than traditionally pursued EMS can expand its scope to care delivery that can take advantage of close geographic proximity to a community of patients To drive revenue To become more integrated into the health care system

9 1 1 safety net access for non emergent healthcare

It s the only option 37 million house calls/year 30%

9 9 1 1 safety net access for non emergent healthcare 36.6% of requests Reasons people use emergency services To see if they needed d to It s what we ve taught them to do Because their doctors tell them to It s the only option 37 million house calls/year 30% of these patients don t go with us to the hospital

10 healthy years plus 9.4 years disability Total 75.2 years years Plus 10.1 years in disability Total 78.2 years

11 ACA tipped the 1st domino New partnerships/new p opportunities Aligned incentives & risk sharing Bundled payments based on episode of care Payment based on OUTCOMES

12 Better Care Reduced Cost Right Resource Right Time Right Patient Right Outcome Right Cost

13 Transportation to alternate (non-emergent) facilities Post-discharge monitoring Disease management monitoring and assessment At home services (augment traditional in home care) Patient and community education Public health support (government programs) Participation in demonstration projects funded by the Center for Medicare and Medicaid Innovation

14 Look for Legal and political obstacles Are there state statutes that prohibit EMTs and paramedics from providing certain types of care? Do municipalities have restrictions on how publically funded staff and facilities can be used? Operational readiness What expanded services can be provided based on available expertise, or without significant additional effort? What is the staff capacity for service expansion? What systems (e.g., billing, medical records receipt and transmission) need to be put in place?

15 Operational prioritization How will core EMS responsibilities be balanced with new services being explored? Market needs assessment Community health care needs Services currently being provided through other competition (e.g. other providers positioned to offer same) Financial modeling Incremental start-up costs On-going operating costs Demand (expected utilization) Preliminary reimbursement model Profit/loss position Explore possible partnerships (e.g., hospitals, delivery system, public health, etc.)

16 Jan 23, 2013 MESA, Ariz. The Mesa Fire Department is getting some national attention for a program that started back in August. It's an idea that may be helping with overcrowded emergency rooms. For the past six months, a Mesa Fire Captain has been teamed up with a nurse practitioner to respond to low level emergencies. Mesa Fire/Medical teamed up with Mountain Vista Hospital, pairing up Fire Captain Brent Burgett and nurse practitioner Tom Morris to respond to low level emergencies.

17 EMS provider organizations explore partnerships Engage professional support to help guide the process. Assess the areas mentioned including services currently provided Partners could range from well-organized physician groups to hospitals and health care delivery systems Have an initial conversation with executives of the organizations introduce the potential of a partnership, understand the organization s strategy give an example of the value the fire department can provide.

18 Determine whether there is the potential for improved quality and lower cost using a fire department model versus the current options Assess the impact of possible public-private p partnership, the opportunity for improved efficiency and greater value may be real possibility Identify a method of reimbursement for emergency services Since the concept of global l payment is so prevalent among hospitals today, they may desire to pay for emergency services by using a flat fee versus a charge per service.

19 Assess need for services other than emergency treatment and transportation May include post-discharge patient consultation and care management services for patients with chronic conditions. The terms of the initial agreement will be important!

20 Next Steps- SUMMARY Determine need for community paramedic What should it look like? Expanded scope? Prevention? Medical Direction physician driven Education of medics Legislation/Regulation Identify contact in ACO or other agencies Build relationships Identify Reimbursement opportunities

23 National Perspective

24 Licensed/ Certified Paramedic with Additional Training Physiology, disease processes, injury and illness prevention, and medical system navigation Population Public health services to elderly, underserved, and chronic condition- primary care and social services Health Care health assessment, chronic disease monitoring, education, medical care and prescription p regime compliance, immunizations and vaccinations, laboratory specimen collection, hospital discharge follow-up care, and minor medical procedures

25 Program can provide means to free emergency response units when no actual emergency exist but still meet needs of patient walk-in clinics, mental health triage, social detox facilities, shelters and homeless services, and inhome assistance Schedule in-home evaluation of high-risk patients following hospital discharge EKG, blood glucose, pulse oximetry, venous lactate, end-tidal carbon dioxide, along with the standard vital signs, and optional blood draws

26 States with Programs in Place or Proposed Minnesota primarily for hospital or nursing home discharges (to prevent readmission)-- reimbursement Texas treat chronic /non-acute Washington (Proposed) hospital admissions/readmissions, connect with primary care North Carolina- preventative care Colorado primary care/prevention Winnipeg (Canada)- alternative transport destinations

27 Community CPR Training Program Accessing the Medical Care System Wellness Programs Targeted Prevention Strategies Fall Prevention Program Fall Prevention Program CHF, COPD, HBP, Diabetes etc. Readmissions

Community Integrated Paramedicine:

Community Integrated Paramedicine: An Emerging Model to Improve Outcomes in Rural AZ Will Humble, MPH Director, Health Policy and Evaluation The University of Arizona Center for Population Science and