DALLAS FIRE-RESCUE DEPARTMENTMOBILE COMMUNITY HEALTHCAREPROGRAMDALLAS FIRE-RESCUE DEPARTMENTMOBILE COMMUNITY HEALTHCAREPROGRAM
Norman Seals, Assistant Chief
Emergency Medical Service Bureau
Dallas Fire-Rescue Department
Dallas Fire-RescueDallas Fire-Rescue
•1,887 uniformed personnel
•58 stations
–57 engines
–21 trucks
–40 front line Rescues, 3 Peak Demand
•Robust all-hazards capability
•380 square miles, 1.2 million population
•In excess of 200,000 EMS calls per year
•Fire-based EMS system that occasionallyfights fires
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What is Mobile IntegratedHealthcare?What is Mobile IntegratedHealthcare?
•Proactive versus Reactive
•Scheduled versus unscheduled
•Case management versus incidentmanagement
•Integrated care – bridges the gap betweenpatients and service providers
•Cost avoidance/ revenue generating
•The best solution to an age-old problem forEMS
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Mobile Community HealthcareProgram (MCHP): OverviewMobile Community HealthcareProgram (MCHP): Overview
•Phase I officially started March 2014
•Proactive service delivery model
•Identifies high utilizers of the system
and seeks to reduce their dependence
on the 911 system
•120+ unique patients seen to date
•Intensive case management process that involvesa network of community organizations all workingfor the good of each individual patient
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Cost/Call AvoidanceCost/Call Avoidance
•1 year pre-enrollment: 2,870 calls
–1,103 transports x $1,578 = $1,740,534
–1,767 non-transports x $835 = $1,475,445
–Total service cost: $3,215,979
•During enrollment: 995 calls
–439 transports x $1,578 = $692,742
–556 non-transports x $835 = $464,260
–Total service cost: $1,157,002
•Post graduation: 510 calls
–81 transports x $1,578 = $127,818
–428 non-transports x $835 = $357,380
–Total service cost: $485,198
•Cost avoidance of $2,730,781 (82%)
•Call avoidance of 2,360
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Mobile Community HealthcareProgram: OverviewMobile Community HealthcareProgram: Overview
•Phase II involves contracts with area hospitals
•MCHP provides services to hospital programpatients:
–Accountable Care Organization (ACO)/Managed CareProgram patients
–Readmission avoidance
–High utilization patients
–Many possibilities
•A great deal of interest in this program has beenshown by our area hospital partners
•As of October 2015 have entered into threecontracts with two area hospitals that total inexcess of $700,000 per year
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Children’s HospitalChildren’s Hospital
•One part of larger program
•Working to reduce recidivism for high-riskpediatric asthma patients
•Involved additional program
specific training for paramedics
•Education, home evaluation,
treatment as needed
•Starting slow, gradually building
•Treatment algorithm jointly developed
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UTSW – NAIPUTSW – NAIP
•Network Access Improvement Program
•Managed care for approximately 20,000 inthe City of Dallas
•All Amerigroup patients
•Risk stratification profiling
•Goal is to reduce healthcare spending
•Patients who meet identified criteria arereferred to DFR MCHP
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UTSW – Clements Hospital EDUTSW – Clements Hospital ED
•High frequency patients from the ED
•Best contract to-date
•Most appropriate referrals
•Great coordination with
hospital social workers
•Their high frequency patients are not ourhigh frequency patients
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Phase II resultsPhase II results
•Very early data
•Total enrolled patients - 3 contracts: 48
•911 call reduction: 43 total 1 year prior to 3in 5 months
•ED visits reduction: 127 total 1 year prior to25 in 5 months
•Cautions about the data
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Contracts – Lessons LearnedContracts – Lessons Learned
•Don’t expect the legal process to go quickly
•Don’t expect the operational process to movequickly either
•Persistence and coordination will be required
•The end results are worth the effort
•Study what other systems are doing anddetermine how to make things work in yourenvironment
•Learn how to speak hospital administrator –it’s a whole new language!
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FutureFuture
•Increase number of contracts
•300-400 visits per week by next year
•Data management solution
•$1.9m revenue expected FY17
•Increase staffing of team
–1 Lieutenant and 5 medics now
–Will add 7 more by end of year
•Eventually will be its own division
•Hope to add social service worker, mentalhealth and substance abuse components
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QUESTIONS?QUESTIONS?
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