MetroHealth Launches a Medicare-Backed Mobile Integrated Health Program

Cleveland’s MetroHealth System is partnering with three EMS agencies in a Medicare-based mobile integrated health (MIH) program aimed at bringing virtual care to the patient and reducing unnecessary ED transports.

The health system is joining forces with the Brecksville Fire Department, Life Care Ambulance and North Central EMS to give the EMS providers virtual access to a MetroHealth emergency physician for 911 calls that don’t require emergency transport. The on-site care team will also be able to assess the patient and recommend an alternative services, such as treatment at an urgent care facility or an appointment with the patient’s primary care provider.

"The ability to provide virtual care during a 911 scene is an exciting opportunity for both patients and EMS providers as it helps to avoid unnecessary trips to the hospital or emergency room,” North Central EMS Director Ashley Ballah said in a press release. “This keeps our patients safer and provides the most appropriate care for the people who call on us.”

The program adheres to the Emergency Triage, Treat and Transport (ET3) model, a voluntary five-year demonstration project launched last year by the Center for Medicare and Medicaid Innovation (CMMI). Through ET3, Medicare will cover alternatives to ED transport, including transport to other locations – such as clinics, community health centers or doctor’s offices – and telehealth services.

“The ET3 model is the perfect example of what we believe virtual care can achieve for our patients,” Michael Dalton, MetroHealth’s vice president for the virtual care enterprise, said in the press release. “This model and virtual care empowers patients to get the most convenient and appropriate treatment in the setting that makes the most sense for them. This is a goal that all of our partners share.”

MIH programs, which include community paramedicine and a wide range of connected health services, are seeing a surge in interest as health systems and emergency care providers look to reduce unnecessary ED transports and crowded hospital waiting rooms and improve care for people who see the hospital as their only – and frequent – primary care provider.

In many cases health systems are partnering with EMS providers to screen patients at the scene of a 911 call to determine the best course of care. Other programs send care teams to the patient’s home for scheduled wellness and care management visits.

CMS developed the ET3 model in 2019, launched it in February of 2020, then briefly paused it as the coronavirus pandemic took precedence. The current program has been expanded for the duration of the COVID-19 public health emergency to include more potential destinations for ambulance transports.

“During the COVID 19 PHE, ambulance transports may include any destination that is able to provide treatment to the patient in a manner consistent with state and local Emergency Medical Services (EMS) protocols in use where the services are being furnished,” the agency says. “These destinations may include, but are not limited to: any location that is an alternative site determined to be part of a hospital, CAH or SNF, community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers (ASCs), any other location furnishing dialysis services outside of the ESRD facility, and the beneficiary’s home.”

MetroHealth, which comprises four hospitals, four EDs and more than 20 health centers and 40 additional sites of care, the goal of the new program is to keep more patients at home and reduce traffic and strain on the regions hospitals and EMS providers.

“The advances in virtual care, amplified by our response to COVID19, allow MetroHealth’s Emergency Medicine physicians and our EMS partners to provide more complete care in certain 911 situations,” EMS Division Director Thomas Collins, MD, FACEP, FAEMS, said in the press release. “Ultimately, this helps patients stay at home and allows EMS to be more available to their community as a whole.”