Palm Beach County Advances Innovative Care, Achieves Impressive Outcomes and Savings
Mobile Integrated Multidisciplinary Care
With over 1,100 patients under management in the past year, Palm Beach County Fire Rescue (PBCFR) continues to advance their innovative Mobile Integrated Health (MIH) programs using HealthCall to further reduce costs while improving care for Palm Beach County residents.
PBCFR operates a series of diversified Mobile Integrated Health programs consisting of the following:
- High Frequency Utilizer Program: Provides proactive outreach to ensure patients are receiving the care and resources they need to reduce their reliance on emergency medical services.
- Chronic Disease Management Program: Supports patients with complex medical needs to successfully transition from the hospital to home by acting as an extension of the Delray Medical Center, their physicians, and home care agencies.
- Addiction Program: aims to reach individuals who have recently experienced an addiction related 911 call who may benefit from emotional support and connection to addiction intervention resources.
- Crew Referral Program: extends the opportunity for additional care to patients and families beyond initial emergency medical services provided on scene to connect them to community resources, support, and assistance.
- Pregnancy Outreach Program: promotes the health of both mother and baby by offering support from specially trained paramedics and medical social workers and connecting pregnant teens and women to prenatal care and pregnancy/childbirth resources.
- Monitoring Program: assists patients in getting the right level of proactive care to help reduce risk and mitigate the future need for expensive emergency medical services.
- CARES Fall Intervention Program: responds to patients at risk of falling providing immediate intervention by professional volunteer team of social service and health professionals who assess home safety needs, fall risk hazards, and make referrals to fall intervention programs.
In late 2018, PBCFR began using the HealthCall cloud-based care coordination platform to enable a more robust approach to patient care. HealthCall worked with PBCFR to create Care Programs to help manage their collaborative, clinically-driven MIH processes. For example, the MIH team uses a heart failure Care Program as a guide to following best practices and providing individualized care over a 30-day period. The HealthCall software prompts MIH team members of needed patient followup and guides them in assessing clinical, medical, mental, cognitive, social, economic, and safety needs of patients. This highly patient-centric approach fosters healthier patient self-care behaviors while improving outcomes and reducing healthcare utilization.