$715K in grants helps Ind. county departments create community paramedicine program

Mobile Integrated Health in Clark County will focus on reducing non-emergency 911 calls and providing resources for the medically-vulnerable population

By Brooke McAfee
The Evening News and the Tribune

CLARK COUNTY, Ind. — The Clark County Health Department and Clarksville Fire Department are starting new programs to meet health care needs in the community.

Both departments are preparing to launch Mobile Integrated Health (MIH) programs in Clark County. This will allow EMS professionals to meet residents at their homes for non-emergency services that do not require transportation to the hospital.

Clark County Health Officer Dr. Eric Yazel and Clarksville Fire Chief Brandon Skaggs described the programs as ways to fill gaps in the community, including services for medically-vulnerable people who may have trouble finding the care they need.

"What our program is going to look at doing is, No. 1, look at folks who were calling 911 a lot and try and figure out what's missing that could help them not have to utilize 911," Yazel said.

The programs could be used to help with fall prevention for the elderly, newborn education, follow-ups to overdoses or behavioral health issues and chronic disease management.

"When someone gets discharged from care — it could be the hospital or LifeSpring or something like that — there's no follow-up with people in their home, and this would allow us to go in their home and actually make sure they are taking their medications properly or they're doing their follow-up care and even assist them medically...," Skaggs said.

Skaggs said the MIH will involve educating people on healthy habits and connecting them with the proper resources. It could include guidance on how to get their Medicare or Medicaid paperwork filled out.

The Clark County Health Department received matching grants using opioid settlement funds from the Indiana Family and Social Services Administration to support the MIH pilot and other programs. This included about $400,000 from the state and $400,000 from the Clark County Commissioners.

The Indiana Department of Health awarded $315,000 to the Clarksville Fire Department through its Health Issues and Challenges grant to support the MIH pilot program.

Yazel said as the Clarksville Fire Department focuses on the Town of Clarksville, the Clark County Health Department's MIH program will likely focus on the other areas of the county. He credits Skaggs for leading the way on the project, saying the fire chief came to him several years ago with the idea.

"We want to make sure we're joining forces to make our resources go further and not essentially doing the same thing a few miles apart from each other," he said.

Yazel said he expects to see the first MIH visits in Clark County this month. The health department's public health educator, Mike Ross, is a paramedic, and he will play a major role in the implementation of the program.

"It won't be all the bells and whistles yet because we're still getting our ducks in a row, but I do think we'll have some preliminary visits," he said.

The Clark County Health Department also has enough funding to hire another employee to help as needed, and the program will include partnerships with local providers.

"We're going to lean on all of our community partners to both get patients referred in and for us to get them set up with wraparound services," Yazel said.

Skaggs said the grant funding for the town's MIH program began this week, and the department is putting together job descriptions and protocols as it prepares to launch the program.

The Clarksville Fire Department will hire a civilian community paramedicine worker for the program. This will be a part-time position, but if the program is successful, the department would consider hiring a full-time employee or another part-time employee.

"I really think that once this program gets up and running, it's going to be used quite frequently," Skaggs said. "And I think that the caseload or the workload will pile on really quick."

The MIH is a referral-based model, Yazel said.

"[EMS providers] will say, 'Hey, we went out to this house today, and they needed a,b, and c, and we're happy to help them, but that's really not a 911 call — let's refer them to the Mobile Integrated Health program,'" he said. "And then our person comes out there the next day and says, 'Hey, let's sit down and look at some of these things. What happened yesterday, and what can we do to prevent that?'"

Skaggs notes that the Clarksville Fire Department will be taking referrals from LifeSpring Health Systems and Clark Memorial Health for the MIH program.

Skaggs and Yazel have looked at other parts of the state that have used the MIH model, and Yazel is a member of a statewide MIH committee. Skaggs has shadowed the Bloomington Fire Department to learn about their MIH program.

Yazel said that "absolutely everyone wins" through MIH, and it will be a flexible program that will adapt based on the needs of the community.

"Obviously by being identified as a potential patient for Mobile Integrated Health, there's some vulnerability or barrier to care or things like that a patient has," Yazel said. "So you're delivering direct at-the-home care to the most in-need in your community, which is honestly what health care is all about."

Skaggs said one of his focuses is prenatal and postnatal care to reduce the infant mortality rate in the community. The MIH could educate people on safe sleeping for infants, and personnel can make sure people have cribs and car seats.

The MIH model helps out EMS providers by "freeing them up to respond to true emergencies," Yazel said.

"It basically starts taking some of those non-acute EMS runs out of their line-up so they can focus on the sickest of the sick, get there faster, things like that, so they're not bogged down in some of these other more social service-based tools," he said.

Yazel said MIH programs also support hospitals by reducing non-urgent visits.

One of the aspects of Mobile Integrated Health is to help people who've been discharged from the hospital transition to home, so it helps keep people home," he said. "It helps stop re-admissions to the hospital and things like that, so it helps your emergency department wait times, it helps your hospital crowding and things like that."

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