How to Build Better Systems of Healthcare

Last May, Brent Myers, MD, joined Evolution Health, a Dallas-based, national integrated medical practice, as the chief medical officer and executive vice president for medical operations, and AMR, the nation’s largest ambulance service, as an associate chief medical officer.

Before making this move, Myers worked at Wake County EMS in Raleigh, NC, for more than a decade. He has been widely recognized for his work to build a mobile integrated healthcare program there to offer in-home care, care referrals and a better system for treating people with mental illness.

His experience trying to get patients mental healthcare and being faced with regulations that he describes as “truly frustrating and not patient-centered” was the impetus for him to try to build better systems of care.

“In the emergency department in the area I was responsible for we had 14 beds,” Myers says. “I would go in on a Saturday or Sunday morning, eight to 10 of those beds would be occupied by patients with mental health conditions.”
 
The hospital did not offer psychiatric care, but under the Emergency Medical Treatment & Active Labor Act (EMTALA), it was legally required to screen the patients. Myers went on to explain that the hospital was located across the street from a university-based, well-funded psychiatric facility that had psychiatrists, psychologists and social workers. The psychiatric facility, however, was not covered by EMTALA and could not accept the mental health patients waiting in the emergency room for psychiatric treatment.
 
“We were literally boarding these patients in the ED, waiting on a bed at an appropriate facility to open up,” says Myers. “It was absurd to me to be standing across the street from help these patients needed and not be able to send them there. I said to myself, there has to be a better way to do this.”

Building a Mobile Integrated Healthcare (MIH) Program

Myers went on to launch a successful MIH program at Wake Country EMS. Using 14 advanced practice paramedics, the program offers treatment and patient navigation to patients with mental illness as well as the elderly, and people living in assisted living facilities or with chronic illnesses, often without a trip to the emergency room.

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