911 is for emergencies only! Helping frequent-fliers decrease their reliance on EMS: Lessons from a pilot program

The Baltimore City Fire and Ambulance Service responds to the needs of approximately 640,000 residents and answers close to 235,000 emergency calls each year. The pressure on Baltimore Emergency Medical Services (EMS) is exacerbated by “frequent-fliers,” those residents, without life threatening issues, who repeatedly call EMS for transport to the hospital. These few individuals add to an already overburdened system by demanding first responders’ time, over-using local resources, and increasing hospital emergency room workloads. To address these issues, Baltimore-based program Operation Care (OC) provides case-management, support, and referral services to these frequent-fliers, with the goal of improving their health and housing stability, subsequently decreasing their reliance on EMS.

The purpose of this paper is to highlight key findings from the retrospective evaluation of OC and provide information about the client engagement process, to include improvements to clients’ access to health care and other social services, and how this translates to cost-savings to the health system. To understand program outcomes and cost savings to the health system, the evaluators analyzed data previously collected from clients referred to the program between January and December 2012. Client demographics, referrals, tracking and engagement data, and decrease in call volume was examined, and a cost benefit analysis was completed.

Challenges involved in enrolling and engaging clients in the OC program will be explored and lessons learned in case management, cultural competency and care coordination will be also be discussed.