About the MIH Program

The SHO-ME MIH Network is the first mobile integrated care model in the country that is a primary partnership between an EMS agency and a federally qualified health center. The model is now replicated widely across rural Missouri and in parts of Kansas. The networks operate in regions where residents often face poor health outcomes and lack transportation, insurance, and specialty health care. Networks are comprised of multi-disciplinary partners based on the composition of their community (hospital, rural health clinic, public health, local physicians, etc.). The MIH Networks primarily serve individuals who are below 200% of the Federal Poverty Level who overuse emergency services for non-emergency care.

Three SHO-ME MIH staff stand together smiling at the camera.

EMS attends to a man sitting in his kitchen.

An MIH staff member holds a laptop displaying a telemed appointment for a patient.

MIH Model

The MIH point of entry can be self referral, provider referral (internal or external), hospital emergency department discharge, or EMS referral. Referrals are received by a Community Health Work or "mission control." They assess non clinical needs, link to resources, and schedule a Community Paramedic visit. The CP assesses home/environment safety and health risks, performs meidcacl reconciliation, basic labs, and documents in clinical record. A telehealth visit is provided and can result in a specialty care referral if needed. That referral is coordinated by the Community Health Worker

Our Approach

Our approach involves redefining regulations regarding reimbursement for non-emergency care by allied health professionals (community paramedics) outside a traditional hospital or clinic. The SHO-ME MIH Network model is still a new form of healthcare at the national level that lacks a comprehensive standard payment model for the work completed. By partnering with key academic, professional, and community partners to analyze field work, operations and fiscal impact on communities, patients, and healthcare system, this project has the potential to create a payment model that can be scaled statewide and nationally. The model addresses underlying factors that contribute to health disparities by fundamentally reframing how care is delivered. Rather than placing the burden and expectation for seeking care on the patient, an allied health professional absorbs the burden — community paramedic (CP) — with support of a trained community health worker (CHW). These individuals, combined with a primary care team, take care to the patient in whatever environment they are in, whether this be their home, assisted living, a shelter, or even a street corner. The model creates a more sustainable (reimbursement) and standardized (common data repository) approach for the implementation of these programs in Missouri and elsewhere.

Existing regional infrastructure creates a structural barrier of limited access to care. In Washington County, a structural intervention to change MIH reimbursement regulations supports the MIH model of care, utilizing common metrics and data elements and an MIH data repository, leading to patient and system-level outcomes related to access to care.

MIH Services

The SHO-ME MIH Network addresses medical and non-medical needs of vulnerable populations, i.e., transportation, access to health insurance coverage, food insecurity, and health literacy, which has helped enrolled patients reach self-sufficiency and a higher quality of life. The SHO-ME MIH Network recognizes the need to build on this foundation and expand MIH to address barriers to care throughout the region, Missouri, and surrounding states.

Services include: Telehealth provider appointments, diagnostics, point of care testing, in-home safety assessments, medical reconcilliation, care coordination, non-emergency transportation (WC Van/Ride Program), and Public health.

Our Future

Currently, this data and data on MIH encounters for other programs across Missouri are widely unavailable due to inconsistent data collection and reporting processes. The ongoing growth and development of the SHO-ME MIH Network model have been used to help identify population(s) of interest and to understand the potential reach in surrounding counties and the entirety of Missouri. With sustainable reimbursement models, more MIH programs will continue to develop and evolve in the nation’s Midwest. The current landscape of MIH programs in Missouri is reflected below. While the SHO-MI MIH Network has been successful in securing resources to plan and implement the model, there is great need for additional resources to affect policy and regulatory change to ensure sustainability.

Map of Missouri with counties color coded to indicate when MIH programs were established. 16 counties prior to 2019, 1 in 2019, 6 in 2022, 8 in 2023, 4 in 2024, and 1 in 2025. An additional 43 counties have indicated interest while the remaining 36 counties are unaccounted for.