{"id":103,"date":"2020-04-30T12:21:46","date_gmt":"2020-04-30T18:21:46","guid":{"rendered":"https:\/\/www.julota.com\/?p=103"},"modified":"2022-03-07T20:54:21","modified_gmt":"2022-03-08T03:54:21","slug":"should-private-insurance-companies-fund-local-community-paramedicine-programs","status":"publish","type":"post","link":"https:\/\/www.julota.com\/news\/should-private-insurance-companies-fund-local-community-paramedicine-programs\/","title":{"rendered":"Should Private Insurance Companies Fund Local Community Paramedicine Programs?"},"content":{"rendered":"\n

Community paramedicine is one of the most promising trends in American healthcare. More and more cities have implemented CP and mobile integrated healthcare (MIH) programs<\/a> to provide residents with the support and healthcare they need\u2014all while lowering the costs of delivering it.<\/p>\n\n\n\n

As more communities start community paramedicine programs, it\u2019s natural to wonder about the role private insurance companies might play in funding them. Most programs are not yet reimbursable through Medicaid. New techniques for reducing ER visits and costs might not yet be an established norm, but it\u2019s often in a private insurer\u2019s best interest to fund local community paramedicine. Why? Here are several reasons.<\/p>\n\n\n\n

Local community paramedicine helps lower all costs for the payer<\/strong>.<\/h2>\n\n\n\n

Every community has its EMS \u201cfrequent flyers.\u201d In Alameda County, Calif., for example, the same 25 people collectively called 9-1-1 nearly 4,300 times in two years. In Fort Worth, Tex., 21 patients have been transported to local EDs a total of 800 times over 12 months. Super utilizers like this rack up millions in costs for needs that are often nonemergency, increasing the burden on both commercial and public payers.<\/p>\n\n\n\n

But if a patient calls 9-1-1 repeatedly for the same concern, they are not getting what they need.<\/p>\n\n\n\n

Why does this happen? MIH-CP programs have identified several causes and aim to tackle each one at its root. On the reimbursement front, the current financial incentivization structure is outdated. Historically insurance companies have paid EMS only to transport patients to EDs\u2014incentivizing taking patients to hospitals. This incurs not only the transport expense for the payer but, more important, additional downstream costs.<\/p>\n\n\n\n

Community paramedicine<\/a> works to nip those cycles in the bud and prevent not only unnecessary transports but also the associated ED visits and expenses for problems that are better fixed by other organizations.<\/p>\n\n\n\n

Even most current commercial setups are still inadequate.<\/strong><\/h3>\n\n\n\n

While payers have become reliable in identifying super-utilizers, methods to solve their underlying issues have been lacking. As a result, these patients continue using the ER, their primary care provider (PCP), and the 9-1-1 system excessively even for non-emergency needs.<\/p>\n\n\n\n

The standard method for tackling this problem is for the insurance company to call, e-mail, and\/or mail the individual, offering them a free appointment at their PCP. However, the response rate to such attempts is only about 13%. And when the super-utilizers do respond, their PCPs often can\u2019t permanently fix their problems. Most doctors look only at what\u2019s physically wrong\u2014which is what they\u2019re trained to do. But a multitude of social determinants also factors into health\u2014things like substance abuse, mental health issues, and lifestyle behaviours. Even if doctors refer these patients to other organizations that can help alleviate their problems, no one knows whether the patient followed through or even arrived for treatment. This situation drastically increases payers\u2019 costs.<\/p>\n\n\n\n

Community paramedicine steps in and helps these super-utilizers fix the underlying causes of their system usage. These programs educate, redirect, and account for the different social determinants that can affect the patient\u2019s health.<\/p>\n\n\n\n

The system needs to change, and private payers have the ability to make that happen by funding community paramedicine.<\/p>\n\n\n\n\n\n

The trend has already begun.<\/strong><\/h3>\n\n\n\n

Community paramedicine has an incredible potential to bend the cost curve. But without adequate funding, these well-intentioned programs won\u2019t get off the ground.<\/p>\n\n\n\n

Some states have seen that Medicaid reimbursement of community paramedicine services can change the game. Community paramedicine teams in Indiana, for example, can support many more people but also have become a potentially profitable enterprise as a result.<\/p>\n\n\n\n

But for states that are not as fast-moving (most other states), it\u2019s the commercial payers who have begun stepping up to the challenge. Commercial payers like UnitedHealthcare in Milwaukee have reengineered their initiatives to pay for MIH measures like post-acute follow-up visits, enrollment fees for high utilizers, and response fees that aren\u2019t tied to whether patients are transported to the hospital. They have reaped the benefits.<\/p>\n\n\n\n

In the Albuquerque area, Blue Cross Blue Shield\u2019s MIH-CP has reduced emergency room visits by nearly 62%, decreased ambulance use by 63%, and saved the insurer about $1.7 million within a year.[1]<\/sup><\/a> Especially when these private insurance companies are contracted by the government to provide for underserved populations, MIH-CP is among the cost-reducing measures private insurers can fund that are proven to work.<\/p>\n\n\n\n

Where government funding can be frustratingly slow to change, commercial payers are agile and nimble enough to innovate in this area. When private insurance companies fund community paramedicine programs, it sets a critical precedent for payers both public and private. The ball is beginning to roll.<\/p>\n\n\n\n

Technology has made it easier.<\/strong><\/h3>\n\n\n\n

Funding these programs means nothing if there isn\u2019t good support for implementation. That\u2019s where Julota comes in, helping an entire community\u2019s health system, EMS, law enforcement, social services, mental health, and other care organizations work together effectively and, of course, lower payer costs. As a completely compliant (HIPAA, 42 CFR part 2 [mental health and substance abuse], Criminal Justice Information System) software system that manages secure multidirectional sharing of consented information, Julota <\/a>facilitates getting patients needed help they might otherwise lack.<\/p>\n\n\n\n

Julota can help private insurer companies track patients and verify they\u2019re receiving help from resources suitable for their needs. With the ability to pull and centralize health records from multiple sources (EMS, hospital systems, PCPs, mental health, etc.), Julota automates MIH-CP programs to help their patients. If the patient has a food insecurity issue, for example, community paramedicine teams can visit their home and link them to food pantries.<\/p>\n\n\n\n

Instead of spending company resources on trying to contact the individual, private payers can fund city and county MIH-CP programs<\/a> to task CP teams to do what they do best: follow up on super-utilizers and connect them to the local community network of partners. Already insurance companies have seen the benefits as the rate of healthcare use dramatically drops, resulting in cost savings for the insurer.<\/p>\n\n\n\n

Funding MIH-CP is a win-win for everyone, and Julota is here to make the transitions easier.<\/strong><\/p>\n\n\n\n

[1]<\/sup><\/a>www.emsworld.com\/news\/12340279\/blue-cross-blue-shield-mih-cp-program-cuts-er-visits-saves-medicaid-dollars\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Community paramedicine is one of the most promising trends in American healthcare. More and more cities have implemented CP and mobile integrated healthcare (MIH) programs to provide residents with the support and healthcare they need\u2014all while lowering the costs of delivering it. As more communities start community paramedicine programs, it\u2019s natural to wonder about the […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","om_disable_all_campaigns":false,"footnotes":""},"categories":[1],"tags":[],"ppma_author":[],"class_list":["post-103","post","type-post","status-publish","format-standard","hentry","category-news"],"acf":[],"yoast_head":"\nWhy Private Insurance Companies Should Fund MIH-CP Programs | Julota<\/title>\n<meta name=\"description\" content=\"As communities adopt community paramedicine programs, Julota explores the role private insurance companies might play in their funding.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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