Mobile Integrated Healthcare: A Strategic Asset for Payers in Value-Based Care

As the health care landscape accelerates toward value-based care, health plans are under increasing pressure to control costs, improve outcomes, and enhance member satisfaction.

One of the most effective tools emerging to meet these demands is mobile integrated healthcare (MIH)—a model of care delivery that brings clinical and ancillary services directly to members in their homes or community settings.

For health plans seeking scalable solutions to reduce high-cost utilization and manage populations more proactively, MIH offers a compelling value proposition.

Why MIH Matters

MIH aligns directly with payer goals by targeting high-risk, high-cost members and addressing care gaps before they escalate to avoidable acute care events. The benefits include:

• Reduced emergency department (ED) utilization. MIH programs consistently reduce nonurgent 9-1-1 calls and ED visits by managing needs that don’t require transport or emergency care. For example, the MedStar Mobile Healthcare program in Texas reported a 52% reduction in 9-1-1 use among enrolled patients, translating into significant savings per member per month (PMPM).
• Lower inpatient and readmission rates. Hospitalizations—particularly readmissions—are among the most expensive components of care. MIH teams support care transitions by ensuring patients understand discharge instructions, reconcile medications, and have follow-up care. One study found a 17% reduction in 30-day hospital readmissions through MIH interventions.
• Improved chronic disease management. By providing frequent, in-home touchpoints, MIH helps manage chronic conditions such as CHF, COPD, and diabetes that drive much of the avoidable utilization. This leads to better outcomes, fewer complications, and improved adherence.
• Enhanced member satisfaction. When health plans invest in innovative, patient-centered services, they enhance the member experience. MIH increases patient satisfaction by reducing wait times, providing personalized care, and avoiding the need to visit an ED or clinic. Satisfied members are less likely to switch plans, improving retention and reducing churn costs.

Quantifying the ROI

For health plans focused on ROI, MIH delivers in measurable ways:

• Lower PMPM costs. Plans with MIH programs have seen reductions in PMPM costs, especially among high utilizers. These savings are often immediate and increase over time as the program scales.
• Avoided claims. Avoiding even a single unnecessary ED visit can more than cover the cost of several MIH encounters.
• Risk adjustment and quality measures. MIH contributes to improved HEDIS measures, star ratings, and risk score accuracy by closing gaps in care and ensuring data capture during home visits.

Additionally, MIH complements existing value-based payment models and accountable care initiatives, offering health plans a tool to partner more effectively with providers in population health management.

Strategic Considerations

To implement MIH effectively, health plans should:

• Identify target populations. Start with high-cost, high-utilization members—such as those with multiple chronic conditions, frequent ED use, or post-discharge care needs.
• Partner with capable providers. Work with EMS agencies or healthcare organizations with MIH experience and infrastructure.
• Incentivize outcomes. Structure contracts to reward quality and utilization reductions, not just volume of visits.
• Leverage data. Use predictive analytics to trigger MIH engagement and monitor performance over time.

A Scalable Solution

As health plans look to reduce costs while enhancing care delivery and member experience, MIH presents a proven, adaptable model. It supports the shift from reactive to preventive care, aligns with regulatory and financial incentives, and keeps members healthier at home.

Investing in MIH is not just a clinical innovation; it's a strategic business decision that pays dividends in cost control, quality performance, and member loyalty.

For More Information

The National Association of Mobile Integrated Providers (NAMIHP) is a recognized national voice and center of expertise for mobile integrated healthcare. NAMIHP’s mission is to create and support national partnerships in mobile integrated healthcare through education, open dialogue, business development, and community awareness.

Start your journey at www.namihp.org.  

Resources

Bigham, B. L., et al. (2013). Expanding paramedic scope of practice in the community: a systematic review. Prehospital Emergency Care, 17(3), 361–372.

Centers for Medicare & Medicaid Services. (2023). Emergency Triage, Treat, and Transport (ET3) Model Overview. https://innovation.cms.gov/innovation-models/et3

MedStar Mobile Healthcare. (2020). Mobile Integrated Healthcare Program Results. https://www.medstar911.org/

Munjal, K. G., et al. (2020). Mobile Integrated Health Programs: An Opportunity to Reimagine Care. Prehospital Emergency Care, 24(5), 628–636.

Patterson, D. G., et al. (2016). What is the evidence for community paramedicine? WWAMI Rural Health Research Center, University of Washington.