The MIH program has been a game-changer for our COPD patients. By providing personalized, in-home care, we are not only improving health outcomes but also enhancing the overall patient experience. Our success is a testament to the dedication of our team and the power of community collaboration.
Waivers as Catalysts for Rural Health Innovation
As an accountable care organization (ACO), patients seen by OneCare Vermont providers benefit from special legal permissions—known as “waivers”—granted by the Centers for Medicare & Medicaid Services (CMS) and the Department of Vermont Health Access. These waivers allow ACO participants to simplify compliance with certain federal regulations, such as those governing referrals and payments, provided the arrangements support the shift to value-based care.
Waivers are more than regulatory tools—they are strategic enablers of innovation. They allow providers to collaborate more effectively, reduce duplication, and deliver more coordinated, patient-centered care. OneCare Vermont not only leverages these waivers but also provides targeted funding to support projects that use them to further performance that improves quality, reduces cost, and expands access to care.
Mobile Integrated Health: A New Model for COPD Care
One standout example of a waiver project is the Mobile Integrated Health (MIH) program launched by Brattleboro Memorial Hospital (BMH) in partnership with Rescue Inc., a local EMS provider. Supported by OneCare’s waiver and special funding in 2024 and 2025, the program delivers in-home care to patients with Chronic Obstructive Pulmonary Disease (COPD)—a population at high risk for emergency department (ED) visits and hospital readmissions.
Travis Kumph, Director of Quality and Patient Safety at BMH, shared: “The MIH program has been a game-changer for our COPD patients. By providing personalized, in-home care, we are not only improving health outcomes but also enhancing the overall patient experience. Our success is a testament to the dedication of our team and the power of community collaboration.”
Without this waiver, only care performed by traditional workforce in a clinical setting—not Rescue Inc. in a patient’s home—would be paid for by insurance. Those rules would have prevented this innovation in care delivery which has proven to be more efficient and effective for patients and healthcare providers.
How the Program Works
The goals of the MIH program are centered on delivering high-quality, patient-centered care while improving system efficiency and reducing the cost of care. The MIH program focuses on high-risk patients with frequent ED or office visits. Through personalized action plans and in-home care, the program ensures safe transitions from hospital to home, reduces unnecessary visits, and improves health outcomes. Key services include:
• Rapid in-home intervention by EMS
• Medication management and patient education
• Telehealth support and scheduled or on-demand visits
• Coordination with primary and specialty care
• Identification of social needs and connection to community resources
The participation waiver allowed BMH to pay Rescue Inc. for providing COPD patients in-home services and disease education without requiring the patients to travel to a physician office, ED, or hospital for care. Carrie Weigand, Chief Medical Officer at OneCare Vermont and a practicing family physician stated, “Without this waiver, only care performed by traditional workforce in a clinical setting—not Rescue Inc. in a patient’s home—would be paid for by insurance. Those rules would have prevented this innovation in care delivery which has proven to be more efficient and effective for patients and healthcare providers.”
Patient Stories: Healing at Home
• A patient in his 70’s with severe COPD who struggled with managing his medications and equipment was enrolled in the MIH program. His personalized care at home, made possible by the waiver, included in-home assessments and education, helping the patient understand and follow his treatment plan better. His quality of life has improved, and he feels more confident in self-managing their condition. When he needs support, he can turn to EMS using telehealth rather than office visits or going to the ED.
• A senior COPD patient who was a frequent visitor to the ED due to exacerbations was enrolled in the MIH program. As a result, they received personalized care at home, including medication reviews and education on managing their condition. The patient’s health improved significantly, and they have not had any ER visits since joining the program.
Beyond the Clinic: Addressing Social Determinants
An unexpected benefit of the MIH model is its ability to identify and address health-related social needs. In one case, EMS providers discovered mold in a patient’s home. The team coordinated medication reconciliation, inhaler education, and a referral for environmental remediation—interventions unlikely to occur in a traditional clinical setting.
Challenges and the Path Forward
While the MIH program delivers care more efficiently and at lower cost, it also highlights a tension in the current payment system. Hospitals operating under fee-for-service models may lose revenue when admissions and ED visits decline. This underscores the need for a full transition to value-based payment models that reward outcomes over volume and focus on the total cost of a patient’s care.
For more information:
Please contact Public Affairs at OneCare Vermont. public@onecarevt.org | 802-847-1346
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