This partnership between medical providers, emergency physicians, and Mobile Health Paramedics (MHPs) resulted in improved health outcomes and lower costs for heart failure patients. A comparison of 531 patients pre- and post-enrollment in the MHP program found a 51% reduction in hospital encounters, 40% reduction in admissions, 71% reduction in 30-day readmissions, and 56% reduction in bed days which saved over 1,700 days. The MHPs provide in-home clinical services including medication management, IV treatments, and monitoring to help coordinate care between providers and avoid unnecessary hospitalizations. This integrated model expands access to care in the community while improving outcomes for patients with chronic conditions like heart failure.

1. Background
In an innovative partnership between
medical homes, specialists, emergency
medicine physicians, and the Mobile
Health Paramedics (MHP), a patient
centered delivery model was created
to provide the right care, in the right
location, at the right time.
Results
Heart Failure Outcomes
90 day pre/post comparison of 531
Unique Patients enrolled in the
MHP program revealed significant
improvement.
Total number of Hospital
Encounters
(ED Visits and Admissions)
Reduced 51%
Total Admissions
Reduced 40%
442 Admissions Saved
Bed Days
Reduced 56%
1,781 Bed Days Saved
30 Day Readmissions
Reduced 71%
Aim
Provide coordinated, quality care
in lower cost settings that is timely,
effective and efficient.
Conclusions
This partnership provides patient-
centered care with enhanced
integration of care with and between
providers, nursing, case management,
home health and paramedicine. It also
expands the reach of the providers into
the community, while optimizing the
skills of the paramedic profession.
Awards/Recognition
Actions
The partnership integrates services
in the care continuum. To achieve
this, a flexible and nimble resource
was created to meet a wide variety of
patient needs including: assessment
of the patient, education/support,
diuresis, medication review and home
safety checks.
Ensuring high reliability of outcomes
and service standards was
paramount.
Using our fully integrated EHR, the
MHPs are able to receive orders in
the field and document in the medical
record in real time, and transmit 12
lead EKG's from the patient's home.
This provides optimal information
flow to the care team. The MHP
program provides integration without
duplication of existing programs and
services.
Community Based Care:
Mobile Health Paramedics
David J. Schoenwetter, DO, FACEP1
, Kathleen L. Sharp, MBOE, LBB2
Geisinger Wyoming Valley, Wilkes Barre, PA
20.69%
17.81%
20.69%
18.92%
2.78%
5.11%
4.00%
14.29%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Discharge PLUS Heart Failure Medical Home Post Discharge Pilot
Readmission Rates
Pre 90 Post 90
925
150
533
242
775
454
121
171 162
333
0
100
200
300
400
500
600
700
800
900
1000
Total Encounters ED Only Visits ED Admits Admits Non-ED Total Admits
Heart Failure Results
90 Day Pre-Post (531 Patients)
Pre 90 Days Post 90 Days
45
1781
73 88
0
200
400
600
800
1000
1200
1400
1600
1800
Discharge PLUS Heart Failure Medical Home Post Discharge
Pilot
SavedBedDays
1,987
Bed Days Saved!
(541 Admissions)
Patient Satisfaction:
(Response Rate 73%)
There's No Place Like Home:
Paramedic Home Care for
Cardiac Patients
“In a word –
WONDERFUL!”
“I didn’t have to go to
Emergency and wait
an eternity.”
“This is a Godsend!”
1. Emergency Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA 2. Population Health Initiatives, Geisinger Wyoming Valley
Medical Center, Wilkes Barre, PA 3. Hoste, B. (2015, August 18). [Geisinger Mobile Health Paramedic]. The Wall Street Journal.
Mobile Health
Paramedics
Medical
Home
Heart Failure
Clinic
Home
Diuresis
ProvenCare®
Discharge
PLUS
3
3
3
Medical Home Support
MHPs provide in home clinical care
to community practice medical home
patients as directed by the provider
and case manager. MHPs provide
physical assessments, medication
reconciliation, IV hydration, IV
diuresis, home safety checks and
telephonic support.
Home Diuresis
Under a delegated practice model,
the MHPs provide home diuresis
to Heart Failure patients. The plan
is developed with the Heart Failure
Nurse Coordinator who apprises the
cardiologist.
ProvenCare Heart Failure®
Follow-up
Geisinger established evidence-
based guidelines to reduce
admissions and ED visits for Heart
Failure patients. This was expanded
to include training of the MHPs.
The MHPs provide a series of
patient phone calls on a designated
schedule.
Heart Failure Clinic Support
MHPs provide diuresis in the clinic
and follow up with patients in their
home. Support is targeted to
patients at risk of admission as result
of exacerbations in their condition.
Discharge PLUS
MHPs provide focused clinical follow-
up to patients discharged from the
ED to address a specific clinical
need as identified by the emergency
physician. These patients may
or may not meet criteria for
hospital admission. MHPs provide
emergency physicians a conduit to
insure that the patient will receive
required outpatient management,
allowing safe discharge from the ED.
45
1781
73 88
0
200
400
600
800
1000
1200
1400
1600
1800
Discharge PLUS Heart Failure Medical Home Post Discharge
Pilot
SavedBedDays