Optimizing Civilian EMS to Reduce Purchased Care Expenditures

Abstract: This project would enable local, civilian emergency medical services (EMS) agencies to transport beneficiaries to the nearest MTF, if clinically appropriate. In FY11, the Military Health System (MHS) paid over $352 million on emergency department claims for MTF enrollees and active duty personnel living within 20-miles of an MTF (PRISM Area). By having the direct care system take ownership of its beneficiaries, the MHS can reduce its overall expenditures on purchased care and implement a program that is patient-centered and presents mutual benefits for all stakeholders.

This initiative can meet all tenants of the Quadruple Aim by having the MHS take ownership of its patients. Bringing in beneficiaries for definitive hospital-based emergency care will enable readiness through diversified case-mixes and sustainment of clinical competencies, supports population health through patient-ownership, enhances experience of care through a patient centered systems approach, and reduces per capita cost for enrollees and the MHS.

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