The ultimate goal of Mobile Integrated Healthcare is to deliver planned, non-emergency care to eligible individuals where they live, support them in meeting their health and wellness needs and connect them with community services and resources.
There will be 2 main considerations in the early stages of planning:
What do you hope to accomplish with your program? (reduction in unnecessary 911 requests, reduction in unnecessary hospital transports, reduction in hospital readmittance, etc.)
What population do you hope to impact with your program? Some common examples may include: homeless, veterans, medication non-compliant, CHF, MI, high frequency emergency system users, substance abuse, behavioral, post hospital discharge. With every AFFI affiliate serving their own unique community and population, there will be a wide range of variance between MIH programs throughout the state. Design your program to provide maximum benefit to the citizens that you serve.
HCHNAs for Illinois hospitals can be found at the link provided below
https://healthcarereportcard.illinois.gov/community-health-assessments
Engage with your EMS system Project Medical Director (PMD) for approval and collaboration.
This step will be essential because the system PMD will have the ultimate say as to whether or not your MIH program will be approved.
Having a clearly defined plan, and achievable goals for your program will help you gain approval from your PMD.
After receiving approval from your EMS system, engage in the IDPH Pilot Program Application Process (link below).
Engage with community partners that interact with the same population that you hope to impact with your program (police, social workers, village/county senior services, hospitals, Veterans Affairs, building department, local/county health department, area colleges).
Developing stakeholders outside of the fire department will help ensure program success. There will be essential resources that are outside the jurisdiction of the fire department.
The more non-fire department stakeholders that you are able to partner with, the greater the odds of your MIH program succeeding will be.
Identifying potential funding sources for an MIH program will be different for every department. Some may decide to roll the initial costs in to their general operating budget, and some may seek outside funding sources, or a combination of both.
Common funding sources include: Community Grants, Medicare Block Grants, DOJ opioid grants, non-profit organizations (private), County Health Department grants, direct service/billing contracts with insurance providers and/or hospitals, non-transport billing codes (1/1/2026).
In August of 2024, the AFFI helped pass Illinois Senate Bill 3599, which amended the Illinois Insurance Code to allow EMS providers operating under an MIH model to bill for services (link below)
Mobile Integrated Healthcare Model to Bill for Services
Cost Avoidance – MIH and Community Paramedicine are driven in part by the goal of avoiding the costs and risks created by responses and/or transports that are medically unnecessary. Cost reporting adopted by participating GEMT providers has shown that operating expenses can reach $2795.00 for a BLS response and transport, and $3025.00 for ALS. Some departments running MIH programs have seen 30-45% decreases in non-emergency calls, saving resources and reducing out of service time.
With your EMS system Project Medical Director, identify education and/or certifications to ensure that medics are prepared to accomplish the goals of your program.
Expanded Scope vs Expanded Role
Educational Examples:
Introduction to Strategic Community Risk Reduction
https://apps.usfa.fema.gov/nfacourses/catalog/details/10802
Introduction to Community Risk Assessment
Collaborate with employer to establish program staffing and schedule.
Staffing
Depending on initial demand, MIH programs may be staffed with permanent positions, overtime, or 7G.
Programs initially staffed through 7G can be upgraded to full-time, permanent positions as certain patient interaction benchmarks are met.
Example – in the event that the MIH program reaches 15 patient interactions per week for 3 consecutive months, 2 permanent positions will be created to staff MIH unit daily.
Investigate possible fire department partners in your area. Not every department interested in running an MIH program will have the staffing or financial resources required. Creating a consolidated response team with neighboring departments may be a viable option.
The AFFI Consolidation Committee can assist with exploring this option.
Schedule
Work with your employer to establish the work schedule for your MIH program. The goals and design of the program will dictate what schedule will create the best conditions for success.
Identify a patient referral system that will work best for your MIH Program.
In-house system where duty crews identify patients that would benefit from MIH.
Interagency system where other departments (police, senior services, public health department) can make referrals.
Direct partnership with area hospitals where doctors, nurses, case managers or insurance providers can make pre-discharge referrals.
A combination of in-house, interagency and direct hospital referrals will most likely provide the best results.
Engage with EMS system Project Medical Director and ambulance billing company to determine what documentation will be required or accepted.
Since every department running an MIH program will be offering different services to their community, it will be important to work with your ambulance billing company to have billing categories and codes developed to match the services provided.
Examples of MIH services that are currently being billed for in Illinois
Brief (20 minutes) in-home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
Limited (30 minutes) in- home visit for a new patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
Moderate (45 minutes) in-home visit for an existing patient post-discharge. For use only in a Medicare-approved CMMI model. (Services must be furnished within a beneficiary’s home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
Establish a plan for what short, and long-term program success will look like. This can vary depending on the population that you intend to impact with your program. Some common goals of MIH include: reduction in unnecessary 911 requests, reduction in patient readmittance to emergency department, patients “graduating from program, pairing patients with needed resources.
Use data collection to monitor program success and identify areas requiring improvement. Providing data that demonstrates program success will keep any outside stakeholders committed and will also ensure continued funding.
Create contingency plans to address any program setbacks (deadlines not being met, unexpected resource constraints, staffing issues, etc.)
Staffing and Scheduling – How your MIH program is staffed will need to bargained with employer.
Things to consider
Permanent/dedicated positions vs overtime or 7G?
How many members will staff MIH units?
What hours will MIH units or personnel be in service/operate?
What, if any additional training will be required to participate in MIH?
How will members be selected to staff MIH? (voluntary, rotation, promotion)
Revenue from MIH Billing
AFFI affiliates should consider where the revenue from MIH billing go. Specifically, municipal departments should make a concerted effort to direct MIH revenue to the FD budget as opposed to the general fund of the municipality.
CONTACT YOUR DVP FOR ANY ASSISTANCE, OR QUESTIONS WHEN BARGAINING LANGAUGE FOR A MOBILE INTEGRATED HEALTHCARE PROGRAM.
Douglas Mullen – Assistant Director of Health, Safety and Education
708-465-7898
927 S. Second Street
Springfield IL 62704
(217) 522-8180
Email: [email protected]
