Mobile Integrated Healthcare Network (MIHN)

Description

The Mobile Integrated Healthcare Network (MIHN) in Missouri has community paramedics (CPs) and community health workers (CHWs) make regular home visits to patients who are chronically ill, at high risk of medical emergencies, and lacking access to primary care. In addition, patients who were recently in the hospital, have trouble managing their conditions, and/or were referred by a provider are eligible for the program.

MIHN began as a pilot project in Washington County serving patients with diabetes; the Washington County Ambulance District partners with the Great Mines Health Center (a Federally Qualified Health Center, or FQHC), Community Asset Builders, and Mineral Area College. When the project succeeded, it expanded to reach patients with other conditions and to more counties. The program has also offered COVID-19 testing, vaccinations, and monthly food bank deliveries to patients. Most recently, the program has expanded to provide substance use and opioid use disorder services, including field initiation of suboxone.

Local MIH Networks are currently in the rural counties of Adair, Audrain, Carroll, Cedar, Dade, Dallas, Douglas, Franklin, Gasconade, Hickory, Lincoln, Maries, Osage, Polk, Reynolds, St. Clair, St. Francois, Stone, Washington, and Webster and urban Christian County. The program will expand to rural Caldwell and Ray counties in 2025.

MIHN partners with the Missouri Department of Health and Senior Services, including the Office of Rural Health and Primary Care and the Bureau of Cancer and Chronic Disease Control. The program also collaborates closely with the Missouri Office of Rural Health and Primary Care and the Missouri EMS Association on education and training opportunities for new and existing MIH Networks.

The MIHN pilot project in Washington County received funding from the Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant program.

Services offered

CPs and CHWs make regular home visits and offer the following care:

• Basic preventive care, including detailed assessments, vital signs, lab draws, EKGs, ultrasounds, wound care, and IV infusions
• Home safety assessments
• Medication reconciliation
• Facilitation of telehealth visits with providers
• Focus on addressing social determinants of health
• Care coordination, primary care provider enrollment, and Medicaid navigation

Patients can refer themselves to the program or be referred by a healthcare provider, emergency medical services (EMS) provider, or hospital emergency department upon discharge.

Results

In the Washington County pilot project's first year, it served 21 patients and recorded a 100% decrease in emergency transports for all participants. This county's MIHN made 7,000 encounters in 2021 and 8,000 encounters in 2022.

Learn more about the Washington County pilot project in the Rural Monitor article Breaking the Cycle: Missouri Community Paramedicine Program Brings Primary Care to High-Risk Patients.

In the larger program, patients also experienced improved access to care, health status, and compliance with medication regimens along with increased patient engagement, satisfaction, and access to community resources.

MIHN is featured in our Chronic Disease Management Toolkit Program Clearinghouse.

Challenges

Some patients struggled to connect to the internet for telehealth visits, so program coordinators added a mobile hotspot to the MIHN vehicle. The vehicle also has refrigerators to carry blood and urine samples.

Funding is a challenge. Medicaid in Missouri reimburses telehealth services but not CP or CHW services.

Replication

Build trust with patients. Take the time to talk with them and answer their questions.

All CPs and emergency medical technicians (EMTs) in the program are certified as CHWs. Mineral Area College allows students to earn a paramedic certification and a CHW certification at the same time. Program coordinators are working with the state health department to develop a statewide dual-certification curriculum.

Contact Information

Justin Duncan, CEO
Washington County Ambulance District
Mobile Integrated Healthcare Network
jduncan@wcadems.org