The payers perspective on MIH-CP programs. How to make a case for funding your project

Area of Science:

• Healthcare Management
• Public Health
• Emergency Medical Services

Background:

• Healthcare systems are realigning fiscal incentives, promoting collaboration between providers and payers.
• Payers and providers often underestimate the value EMS agencies offer through patient navigation.
• The landscape necessitates a shift towards value-based care and innovative service delivery.

Purpose of the Study:

• To guide EMS agencies in engaging with payers for Mobile Integrated Healthcare – Community Paramedicine (MIH-CP) programs.
• To highlight the importance of demonstrating the value of EMS patient navigation services.
• To equip EMS professionals with knowledge of healthcare metrics relevant to payer partnerships.

Main Methods:

• Understanding healthcare metrics such as readmission rates, value-based purchasing penalties, and HCAHPS scores.
• Developing business cases tailored to payer perspectives and motivations.
• Potentially conducting demonstration projects to showcase program effectiveness.

Main Results:

• Payers are increasingly open to partnerships for services beyond traditional ambulance transport.
• Demonstrating tangible benefits, like improved patient outcomes and reduced healthcare costs, is key.
• Successful engagement requires a deep understanding of payer priorities and the healthcare ecosystem.

Conclusions:

• EMS agencies can successfully partner with payers for MIH-CP programs by proactively demonstrating value.
• A thorough understanding of healthcare metrics and payer motivations is essential for building a strong business case.
• Collaboration between EMS, providers, and payers can lead to improved patient experience and reduced healthcare system costs.