Bringing primary-care physicians in touch with the local EMS is enabling team-based care in Washington. In turn, they can reduce unnecessary utilization of the ED.
The emerging era of team-based care makes for somewhat strange bedfellows. Or at least bedfellows who normally wouldn't be in close contact with each other.
Take the case of Northwest Physicians Network, an independent physician association (IPA) serving thousands of Medicaid enrollees in the Pierce county region of Washington. Three years ago, the president of the IPA met with representatives from the state's paramedicine workgroup to talk about high utilizers of the healthcare system. These are patients who call 911 half a dozen times over the course of a few months, sometimes even more. This process can be time consuming and costly, especially if they end up going to the emergency department for an unnecessary reason.
From this initial meeting, a collaboration between the Northwest Physicians Network and West Pierce Fire and Rescue, out of University Place, Wash., emerged. The two sides agreed to work together and reduce unnecessary utilization of 911 services as well as visits to the ED.
"When the EMS has patients who are high utilizers, they refer them over to Northwest Physicians Network and if it is one of our patients, they are referred to [a case manager]. If they belong to another healthcare system, we refer them over to that healthcare system and they hopefully provide case management services," says Melissa Haney, Community Partnership and Behavioral Integration Manager at Northwest Physicians Network. The two sides use tech to connect with each other and share pertinent data on the patient.
In Pierce County, Haney says there is a significant problem with high utilization of 911 services as well as the ED. She says many patients face multiple physical and mental health issues, and getting them to engage in the system is an absolute must. "The patients [who tend to be high utilizers] tend to be vulnerable, they tend to be isolated. They have very little family support available to them. Many of them are elders who are isolated and need an increased amount of care or people with behavioral health issues," she says.
In many cases, these patients require multiple physicians, specialists, and providers. Bringing those teams together leads to more comprehensive care. By connecting the patient's with a care manager as soon as they call 911, it can happen in a more efficient manner, Haney says.
From the perspective of West Pierce Fire and Rescue's EMS Battalion Chief, Bill Barber, the collaboration helps his team better manage its workload and lessen its burden. They've also become more proficient at documenting these patients in the field, allowing them to get the right information over to the Northwest Physicians Network team.
The collaboration has spread its wings, having started with patients who are diabetics and suffered falls. It now includes most high utilizers and there are plans to include other aspects of the healthcare system, including insurance systems.
Barber says if practices and medical groups are looking to start a similar collaboration with their local EMS group, he recommends starting with a defined patient population like this one. "Be careful not to bite off more than you can chew," he says. Haney recommends having a point person and ensuring they get mental health utilizers involved.
"They are really high utilizers almost all have significant mental health issues," she says.