Bringing the Doc to the Home
By: EMSWORLD/ Stephanie Noriea, Esq; Jared Oscarson, NRP, FSCPE
Charlie, a Medicaid recipient, visited the emergency department 17 times in one year for back pain and hypertension. Why? Because the only way he knew to access the healthcare system was through an ambulance ride and visit with an ER physician. Then he connected with Ready Responders, a new healthcare company based in New Orleans.
Over three months Charlie visited regularly with a designated responder from the organization at his apartment, local hangout, and the community dominos table to discuss and navigate his barriers to care. Facilitated by his responder, Charlie increased his PCP visits, improved his medication compliance, and received education on diet and exercise and help obtaining transportation. Ultimately Charlie graduated from Ready Responders with a big smile on his face after a dentist appointment facilitated by his responder wherein he was approved and fitted for new dentures. Since his first meeting with Ready Responders a year ago, Charlie has only been to the emergency room once.
Over the past decade, mobile integrated healthcare (MIH), community paramedicine (CP), and similar innovations have been a driving focus for EMS across the country. Costs keep mounting, and many patients utilize emergency departments as their primary healthcare access. Healthcare systems have shifted their focus to address the needs of patients internally, creating mechanisms to navigate them more efficiently and head off problems before they grow. Innovation is a top priority for cost savings, improved patient care and outcomes, and streamlining process and workflow.
This evolving approach to care for low-acuity, nonemergent patients has created gaps that are being filled by companies like Ready Responders. Identifying a patient need, Ready Responders utilizes a workforce consisting of EMTs and paramedics dispatched to the home of the patient through a proprietary Uberlike app to facilitate a telehealth visit with a physician, nurse practitioner, or behavioral health specialist. This provider treats the patient much like a traditional urgent care would or conducts an intense patient-centered clinical and care system navigation program, depending on the patient’s needs.
Bringing the Physician to the Home
Imagine needing to seek medical care and knowing you must work, pick up the kids, and make dinner before you get there. What if you don’t have transportation? Do you know where the closet open provider is? Ready Responders provides a mobile urgent care service that brings the provider into the patient’s home, work, or any other location at any time and quickly.
That telehealth connection is a point of distinction from many other MIH-style approaches. Ready Responders developed an app that allows patients to register and request services with real-time tracking of the responder, including a picture and their credentials. Patients come to Ready Responders in several ways, including self-call, nurse advice line referral from hospitals and payers, and after-hours clinic referrals from physicians, social workers, and community partners.
Upon arrival the responder evaluates the patient and conducts a physical exam, checking heart and lung sounds, pulse oximetry, blood pressure, and blood glucose. They facilitate and assist with a video evaluation by a qualified provider within the Ready Responders network. The physician will examine the patient in real time, offer a diagnosis, and can prescribe medications to be filled at the nearest pharmacy for the patient to pick up.
After the physician interaction, the responder works to help the patient understand appropriate utilization of the healthcare system and gather information on their social determinants to assist in navigating additional social and physical health resources.
Ready Responders’ initial vision was to partner with EMS agencies to handle appropriate low-acuity 9-1-1 calls through quick response made possible through its app. These partnerships, the company envisioned, would allow EMS and fire assets to remain ready and available for calls that were truly emergent and not billable as medically necessary. At the same time the team realized that a quick, one-visit response was insufficient to navigate superutilizers of the emergency system or those recently discharged from the hospital to the appropriate level of care; thus they developed technology and clinical programs to improve those patients’ care access and navigation.
This vision has been reignited with the announcement of the ET3 (Emergency Triage, Treat, and Transport) Medicare model. Now Ready Responders is poised to partner with EMS agencies across the country to provide and facilitate a telehealth component to their home-care programs.
Developing this kind of community care program was no easy task. So many MIH programs exist and have results that impact segmented groups of superutilizers and specific diagnoses. How could we build a program to care for patients who are medically and socially complex? The goal is to care for people, not diseases or diagnoses.
How do you balance care and economics? As the program develops, risk segmenting has proven effective for enrolling patients in the appropriate program to change behaviors, improve numbers of healthy days, address social needs, and find long-term solutions for patients’ physical health, mental health, and social needs.
Patients are enrolled in one of several programs. The options range from 1–15 visits, depending on utilization segment and progress in the program. In between visits the responder will maintain communication with the patient to ensure compliance. The program length can be shortened or extended based on the judgment of the responder and patient care team.
Ready Responders’ program starts on the first visit with a responder listening to the patient’s story and allowing them to prioritize their social and clinical needs. The responders’ objective here is to begin building trust and a relationship that supports cooperation and collaboration to accomplish the mutually agreed-upon goals and care plans. The first goal of the program is to establish or re-establish the patient’s relationship with a primary care physician.
During subsequent visits the responder encourages, coaches, and assists the patient with continuing to pursue these goals. The goals and priorities may change during the course of the program as social and medical needs are resolved through resource navigation and access. This may in turn uncover additional or unrecognized needs not identified during the initial visit. The patient will have the same continued support to address new needs in the same manner. This allows the patient to remain involved in their care plan and driving their own success.
After a patient successfully meets the goals of the program, they graduate. Ready Responders then follows the patient for up to one year to ensure they stay on course. A house call program for nonemergent complaints continues to be available for the patient post-graduation.
Sustainability and Relationships
The success and ability to grow of companies like Ready Responders requires participating hospital and payer partners in each community, as these funding streams are essential to developing sustainable and viable programs.
Overall, Ready Responders has had exceptional results with its payer and hospital partners. The project appears scalable and replicable in markets across the country. The excitement for such programs from partners remains unprecedented.
Sidebar: A New Career Path
Providers in EMS often look for new and innovative career opportunities. Many factors drive this, including compassion fatigue, burnout, and general mental and physical well-being. The reality of working long hours on shifts and the physical and emotional toll required of EMS providers can become daunting. Providers may leave the profession to pursue education, financial gain, or seek a new adventure.
Ready Responders and companies like it can offer EMS providers opportunities in innovative and nontraditional roles. Their providers respond quickly (the average response time in the New Orleans area is 12 minutes) but can stay with their patient and provide patient-centered care without the pressure to turn around quickly and return to service.
MIH work requires a particular type of provider who is looking for the next evolution in both their career and their passion for patient care. It’s not a job for everyone—it requires the provider to be able to navigate complex medical patients, community resources, social services, and have an incredible amount of dedication and patience.
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