About the MIH Program
The Washington County Mobile Integrated Healthcare (MIH) Network is the first mobile integrated care model in the country that is a primary partnership with an EMS agency (ambulance district) and a federally qualified health center (health center). The model is now replicated in counties in Missouri: Adair, Carroll, Cedar, Franklin, Gasconade, Hickory, Lincoln, Maries, Osage, Polk, Reynolds, St. Clair, St. Francois, and St. Charles. The networks operate in regions where many residents face poor health outcomes and lack transportation, insurance, and specialty health care and have diverse 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.
Our Goals for Implementation
Test and refine the evidenced-based MIH model of care for heart disease (and for other leading causes of death as resources allow) within high need/high risk populations in Washington County.
Increase workforce education, training and capacity that supports mobile integrated healthcare service delivery to improve population health and lower overall costs to the health care system.
Develop strong relationships and partnerships between health care providers and key local, regional and state stakeholders to further support the development, sustainability and replication of the MIH model of care in Missouri.
Our approach involves re-defining regulations regarding reimbursement for non-emergency care by allied health professionals (community paramedics) outside a traditional hospital or clinic. The MIH model, and more specifically the Washington County MIHN, 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 community, academic and professional partners to analyze the field work, operations and financial impact the work has on the communities, patients, and healthcare system, this project has the potential to create a payment model that can be used by Missouri and scaled nationally. MIHN 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, the burden is absorbed by an allied health professional—i.e., the 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.
Washington County MIHN 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. Washington County MIHN recognizes the need to build on this foundation and expand MIH to address Social Determinants of Health throughout the region, Missouri and surrounding states.
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 planning and implementation phases of this challenge have been used to help identify the population(s) of interest and to understand the potential reach in surrounding counties and, ultimately, the entirety of Missouri. With sustainable reimbursement models, as proposed, we anticipate more MIH programs will be created following the MIHN model. The current landscape of MIH programs in Missouri is shown in the map below. While the MIH Network has been successful securing resources to plan and implement MIHN in Washington County and the other sites identified in blue on the map below, there is still great need for additional resources to effect policy and regulatory change, which can often take five or more years from introduction.