How Paramedics helped BlueCross BlueShield of New Mexico Reduce ED Usage, Readmissions

The EMS profession has been suggesting Alternate Payment Models (APMs) for the services we provide for several years.  Many of us believe that the payment model used by most third party payers (Medicare, Medicaid, commercial insurers) provides what’s referred to as “perverse incentives," in essence forcing EMS to transport patients to an emergency department (ED) in order to be eligible for payment.  A recent article outlines a new initiative in New Mexico and a shift in thinking from some third party payers:   Since the program’s full launch in 2016, BCBSNM estimates that it saved $1.7 million—after taking into account the cost of the program itself. Among the 1,100 participating members, there was a 62% reduction in ER utilization and a 63% reduction in ambulance usage. In addition, the 30-day readmission rate among BCBSNM’s members has dropped from 15% to 11.2% since it began the paramedicine program. While the insurer has undertaken multiple initiatives to lower that percentage, “we’re confident that this program was a big part of that reduction,” Ross said.  Read more...   Finally, with initiatives such as this one in New Mexico, as well as payer arrangements agencies like MedStar in Ft. Worth; REMSA in Reno, NV; and Northwell Health’s Center for EMS in Syosset, NY; it appears third party payers are beginning to realize they can improve patient outcomes and experience of care, while at the same time reduce preventable hea...
Source: JEMS: Journal of Emergency Medical Services News - Category: Emergency Medicine Authors: Tags: News Mobile Integrated Healthcare Source Type: news