Mobile Integrated Healthcare Implementation Services

The Vendor is required to provide the state intends to support the implementation of regional mobile integrated healthcare (MIH) programs to achieve the following goals:
• Improving the quality of health care services;
• Reducing health care costs; and
• Strengthening the rural health care workforce.
- Emergency Medical Services (EMS) agencies and hospital-based EMS programs to implement Mobile Integrated Health (MIH) services at five (5) MIH implementation sites through funding provided by the agency.
- At a minimum, each core service bundle shall include:
• Defined schedule of patient contact following hospital discharge
• In-home clinical assessment and treatment appropriate to the patient’s condition and diagnosis
• Medication reconciliation and adherence review
• Review and reinforcement of discharge instructions
• Disease-specific education
• Communication to referring provider or care team regarding in-home findings and any follow-up care needs
• Identification of social, environmental, or access barriers that may impact recovery and care plan adherence, with a preference for using evidence-based tools
- Telehealth use may include real-time consultation with the MIH Medical Director or another licensed health care professional, such as a specialist (e.g., cardiologist, pulmonologist, orthopedist, primary care).
- Remote Patient Monitoring - MIH sites may, but are not required to, incorporate remote patient monitoring components to support post-discharge care, early identification of clinical deterioration, and coordination with referring providers.
- Remote patient monitoring shall not replace in-home care unless approved by the MIH Medical Director.
- All remote patient monitoring components must be compliant with applicable State and Federal laws.
- Remote patient monitoring activities may include use of home-based monitoring devices to support disease-specific management and review of transmitted data by EMS clinicians subject to MIH Medical Director oversight.
- Communication of clinically significant findings must be made to the referring provider and/or patient’s specialist(s).
- Implementation Plan - Applicants must provide the following information for each service bundle they intend to implement:
• Sponsoring hospital or healthcare facility supporting the MIH core service bundle.
• Description of referral pathways (e.g., hospital discharge coordination, emergency department referral, specialty clinic) and anticipated referral sources.
• Communications planning with referring providers.
• Clinical service components.
• Proposed visit structure.
• Discharge and/or transition planning process.