Mobile Integrated Health – Community Paramedicine Program Launches to Advance Healthcare in West Baltimore

The University of Maryland Medical Center, the City of Baltimore and Baltimore City Fire Department, and the University of Maryland, Baltimore have partnered to launch a new healthcare delivery model for selected areas of Baltimore City, .

This innovative community-based program will support the health of individuals through a comprehensive, free, multidisciplinary care model for patients which provides care outside the hospital setting, and which is designed to reduce health disparities, decrease emergency department visits, and prevent hospital readmissions. The 2-year pilot program is serving zip codes 21216, 21217, 21223, 21229, 21201 and 21230. The first patients enrolled May 15, 2018.

Mobile Integrated Healthcare is patient centered and incorporates a holistic approach focused on the improvement of patient outcomes,” said Mohan Suntha, MD, MBA, president and chief executive officer of the University of Maryland Medical Center. Our goal is to meet the health care needs of our community members and to improve health disparities for West Baltimore residents."

Mobile Integrated Healthcare is a community-based, cost-effective health care solution designed to provide effective and efficient care to patients outside of the hospital. Paramedics and nurses with advanced training are able to function outside traditional emergency response and transport roles, and instead assist in maintaining individuals’ health at their homes while also providing convenient, unscheduled care access. This program has been successfully implemented in areas across the country and has improved healthcare access for underserved populations and reduced costs. 

Social and economic factors, weaknesses in primary care infrastructure, and lack of access to treatment for chronic conditions contribute to a high rate of potentially avoidable health care utilization and emergency medical service (EMS) responses in West Baltimore. More than 80% of Baltimore City Fire Department (BCFD) 911 responses are for EMS incidents, presenting a significant strain to the system. Further, it is estimated nationally that 15% of persons transported to emergency rooms could be treated safely in non-urgent settings. This statistic is likely higher in West Baltimore given the challenges to health care access, lower health literacy and the complexity of chronic diseases.

This innovative new partnership with the University of Maryland Medical Center offers the potential to transform the health prospects of those in our community most at risk.  Through this integrated mobile healthcare delivery model, we will reduce the burden on emergency medical personnel and on emergency rooms across our City, while still providing superior care to our underserved citizens,” said Mayor Catherine E. Pugh.

As one of the busiest EMS systems in the U.S., per capita, MIH-CP sheds light on the need for additional resources that support the Baltimore City Fire Department. The high demand from non-emergency patients affects hospital and emergency department overcrowding and severely limits the number of medic units available to rapidly respond to medical emergencies,” said Baltimore City Fire Chief Niles Ford, PhD.  As a result, MIH-CP’s focus is on enhancing patient care with home visits, community medical intervention and a more personalized medical treatment option that will mitigate the strain on our emergency departments and EMS providers. BCFD is proud to be part of this partnership because we know the direct, positive impact it will have on the community we serve,” said Ford.

We’re thrilled that UMB will be adding another layer of expertise and support for these patients,” said Jay A. Perman, MD, president of the University of Maryland, Baltimore. Whether our guidance is in the treatment patients need, the medications they should (and shouldn’t) be prescribed, or the social services that allow them to get and stay well, we’re ready to help our city neighbors stay on their journey to better health.”

How MIH-CP Works

MIH-CP is a 2-year pilot program that employs trained paramedics and nurses to provide community- based care through two types of initiatives: Minor Definitive Care Now and Transitional Health Support. Initial goals of MIH-CP are to improve coordination of medical, behavioral and social services; enhance existing health care systems and resources; help fill the resource gaps within the local community; and, to improve quality of care while reducing avoidable cost.

MIH-CP will improve patient care by: offering ways patients can better manage their health; developing stronger partnerships with the community; and providing patients the opportunity to receive medical care at home.

Minor Definitive Care Now is focused on pre-hospital health care delivery. After responding to a 911 call, BCFD EMS personnel determine if the patient is appropriate for on-site evaluation and definitive care by a paramedic-nurse practitioner team. With an estimated 32% of patient calls qualifying for this service, BCFD anticipates nearly $1.4 million/year* in cost avoidance by appropriately reducing patient transport while delivering quality care on-scene. UMMC will experience cost savings of approximately $520,000/year*. Baltimore 911 response times will be reduced and over 2,000 patients per year will avoid the emergency department. Additionally, a greater quality of care at a lower cost to both the patient and Baltimore City will be rendered.  

• After placing a 9-1-1 call and before going to the emergency room the patient will be informed of the services and have the ability to opt in.
• Paramedic-Nurse Practitioner team will determine if a patient is appropriate for on-site evaluation and definitive care (geared towards low acuity patients)
• A Paramedic-Nurse Practitioner team will arrange follow-up with appropriate care providers; this will hopefully eliminate the need for transport
• After being evaluated, patients still have the option to request to be taken to the emergency department if they choose

Transitional Health Support improves the transition of care from the hospital to the home, specifically targeting individuals with chronic diseases requiring frequent hospitalization, particularly those covered by Medicare (an estimated 2,000 patients served by UMMC). In coordination with BCFD, UMMC will identify 50 of these patients at discharge and link them with a community paramedic nurse team. This team will deliver follow-up care and assist with chronic disease management for 30 days, including facilitating care coordination. This program will save BCFD nearly $300,000/year* by reducing transports; decrease avoidable costs for UMMC by $3.5 million/year*; and, eliminate approximately 450 or more EMS calls per year by providing alternatives for patients who are historically high-utilizing patients of the 911 system. It will also:

• allow the Community Paramedicine Team to follow 50 patients who opt-in; the team will conduct follow-up home assessments during the first 30-days after patients have been discharged from the hospital
• features 30-day follow-up care which includes arranging outpatient clinic follow-up with the patient, and providing secondary support such as transportation, social resources and education
• provides patients with additional education about chronic disease management for the patient by the advanced paramedic team
• may provide certain medications to be administered to the patient at home

During the 2-year pilot, data will be collected and analyzed to understand outcomes of patients, cost savings, patient satisfaction and the potential scalability across the city and state. It is anticipated that it will dramatically change health care delivery to the citizens of Baltimore. 

*Figures based on modeling.

About the University of Maryland, Baltimore

Founded in 1807, the University of Maryland, Baltimore is Maryland’s only public health, law, and human services university, dedicated to excellence in education, research, clinical care, and public service. UMB enrolls 6,500 students in six nationally ranked professional schools — medicine, law, dentistry, pharmacy, nursing, and social work — and an interdisciplinary Graduate School. The university provides more than $40 million each year in uncompensated care to Maryland citizens, and receives more than $667 million in extramural research funding annually.

About the University of Maryland Medical Center

The University of Maryland Medical Center (UMMC) is comprised of two hospitals in Baltimore: an 800-bed teaching hospital — the flagship institution of the 14-hospital University of Maryland Medical System (UMMS) — and a 200-bed community teaching hospital, UMMC Midtown Campus. UMMC is a national and regional referral center for trauma, cancer care, neurocare, cardiac care, diabetes and endocrinology, women's and children's health, and has one of the largest solid organ transplant programs in the country. All physicians on staff at the flagship hospital are faculty physicians of the University of Maryland School of Medicine. At UMMC Midtown Campus, faculty physicians work alongside community physicians to provide patients with the highest quality care. UMMC Midtown Campus was founded in 1881 and is located one mile away from the University Campus hospital. For more information, visit www.umm.edu. 

About the Baltimore City Fire Department

The BCFD is a diverse and evolving extension of the community, committed to providing excellent service to all we serve, in a professional and humanitarian way. We pledge to protect lives, property and the environment through a safe, effective, and timely response. We will be innovative in providing service in emergency medical services, fire suppression, rescue, emergency communications, fire prevention, community outreach, education, and other services.