MedStar Mobile Healthcare Programs Improve Patient Health While Reducing ED Utilization and Hospital Costs

Purpose: Locally, over 50% of Emergency Department (ED) visits in Tarrant County are associated with inappropriate ED use totaling ~$2 billion. To help mitigate inappropriate local ED use, the county’s primary 9-1-1 emergency response team, MedStar Mobile Healthcare, introduced several Mobile Health Program (MHP) interventions. Here, we evaluated outcomes from a high utilizer group (HUG) and a congestive heart failure (CHF) group to determine whether or not the MedStar MHP intervention would reduce ED transports and overutilization, inpatient admissions, and hospitalization costs. Hypothesis: Patients participating in the MedStar MHP intervention will experience a significant reduction in ED transports, utilization, inpatient admissions, and generate less hospitalization costs than before they participated in the MedStar MHP. Methods: Pre- and post-program data of patients who participated in the HUG or CHF Readmission Avoidance program from July 2009 to October 2015 were evaluated retrospectively. Hospitalization costs were determined using data from 2013-2015. Data were analyzed using SPSS (version 21) and included descriptive statistics, frequency distributions, paired t-tests, ANOVA, and regression modeling, as appropriate. All analyses were conducted using a 95% confidence level and an alpha level of 0.05 was used to determine statistical significance. Results: A total of 629 participants participated in the HUG (n = 406) or CHF (n = 223) MedStar programs. Those in the HUG program experienced an overall reduction in ED encounters of 72.5% resulting in a cost avoidance of over $ 6 million for ED transports. They also self-reported a 22% decrease in pain-discomfort and a 26% reduction in anxiety and depression. Participants in the CHF program had 48% fewer ED visits and experienced a 56% drop in inpatient encounters resulting in a total of $378,741 cost avoidance for ED transports during the program. Conclusion: The HUG and CHF MedStar MHP interventions appear highly effective at reducing ED transports, utilization, and inpatient admissions while improving patient health outcomes. Reducing ED overutilization and inpatient admissions also resulted in a significant reduction in hospitalization costs. MedStar MHP interventions appear to promote substantial health improvements in chronically ill patients which frees emergency transport and hospital teams to provide acute crisis treatment to high-acuity patients community-wide.