The Rock Township Ambulance District is the first emergency medical service provider to offer a program to expand its services into homes before someone calls 911.
Rock Township on Jan. 1 launched its Mobile Integrated Health (MIH) program, which aims to improve access to care, enhance patient outcomes and reduce unnecessary emergency department visits. The district does not charge people who are treated through the MIH program.
“It is the future of EMS,” Chief Jerry Appleton said. “The community will benefit greatly. We will try to keep folks out of the emergency room and get them the resources that they need.”
Nick Farrel, who was promoted to division chief when the program launched, is overseeing the MIH program. He has been with Rock Township for 27 years.
He said MIH programs were beginning to form throughout the nation and area just prior to the COVID-19 pandemic in 2020. He said the programs are starting to gain traction again with MIH programs established in the Mehlville Fire Protection District in St. Louis County and the St. Charles County Ambulance District.
MIH programs have community paramedics go to patients’ homes to provide medical visits, follow-up care and coordinate additional care with healthcare providers and social service agencies.
Farrel said to become a community paramedic, a paramedic needs to complete an additional 80 hours of class work, 40 hours of clinicals and receive a license from the state. He said he is one of six Rock Township employees to have a community paramedic license.
“We started the program with a narrow focus to get our procedures and policies in place,” Farrel said. “With this program, we are limiting ourselves at this point to falls and lift assists. That was one of our top calls for service among our 12,000 calls last year.
“We are getting into their homes to figure out why they are falling and help them, whether it is a medical need or a need in their home. We want to figure out why they are falling and hope to prevent them from falling in the future.”
Assistant Chief Andrew West said Rock Township spent approximately $196,000 to start the MIH program. He said the startup cost included Farrel’s salary, which is $102,876.80, and purchasing a vehicle, documentation software and additional medical direction support.
West said Rock Township will seek grants and donations to cover another $100,000 worth of equipment needs for the program, and the district anticipates the MIH program to cost between $200,000 and $225,000 annually.
“This program is currently fully funded through RTAD general revenue funds,” West said. “We did receive a $5,000 donation from Brockmiller Construction company to help purchase the vehicle for the division.
“There currently is not a strong reimbursement method from government or commercial insurance companies to cover the cost of these visits. We are continuing to investigate ways to establish some reimbursement with hopes that the insurance companies will see the importance of programs such as this.”
Farrel said the program’s goal is to stop or reduce the number of times someone needs to call 911.
“A lot of the time, an ambulance ride or emergency room visit is not the thing they need or is not very helpful,” he said. “If you are taking a chronic disease patient to the hospital over and over again, they kind of get stuck in that cycle. They get sick, call us, get taken to the hospital, get treated and go home. If they don’t have a lot of in-home care or ability to manage their own healthcare, they will be in a position where they are calling us back.
“The biggest benefit is being able to provide that level of care for a growing patient population that needs it. Instead of us sitting around and waiting for someone to get sick enough to call 911, we are now able to offer what care they need in their home and in the moment. The goal of the program is better health for our patients and residents.”
Farrel said potential MIH program patients are identified by paramedics during a call, by looking at reports to find people who are frequently calling for the same assistance and by him responding along with an ambulance on a call if the emergency sounds like something that can be avoided through MIH care.
He said as Rock Township expands the program, the district also plans to receive patient referrals from hospitals and physician offices.
“Our main goal is to have a healthier population,” Farrel said. “From that will flow reduced 911 calls and reduced visits to the emergency room.”
Farrel said Rock Township had 10 patients enrolled in the MIH program as of Feb. 3.
He said an example of how the program reduces calls is one man who has limited mobility and would call Rock Township often for assistance to get in and out of his car or because he fell.
After an initial visit – which included a medical evaluation, home safety evaluation, fall risk assessment and a review of any prescribed medication – Rock Township was to connect the man with transportation for doctor’s visits and get him a wheelchair, Farrel said.
“It is simple stuff,” he said of how MIH can benefit patients. “It is just having someone able to be there to help and provide resources.”
Farrel said the MIH program is not meant to replace other in-home healthcare services.
“We partner with all of the resources in Jefferson County, so we can make referrals,” he said. “The beauty of having paramedics do this work because we have a broad stroke of practice, if patients don’t qualify for in-home care or can’t find in-home care, that is something we can step up and fill in the gap.”
The MIH program is only available to those who live inside Rock Township’s coverage area, which includes Arnold, Imperial, Barnhart and Kimmswick in northeast Jefferson County as well as the eastern areas of House Springs and the Jefferson County portion of Fenton.
For more information about the MIH program, call Farrel at 636-296-5066 ext. 1408 or email NFarrel@rocktownship.com.