116 3rd St SE
Cedar Rapids, Iowa 52401
‘A paradigm shift within emergency response’: How Johnson County’s mobile integrated health care keeps clients out of the hospital
A Johnson County program is one of a few in Iowa working to reduce 911 calls with preventive care
Nov. 23, 2025 5:30 am, Updated: Nov. 23, 2025 8:51 am
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Mike Mothershed paced around the house, using the paths of beige carpet cleared between piles of papers and clothes to scan rooms from floor to ceiling. Having found something to do, he returned to the living room, where 78-year-old Marlene sat neatly on the couch.
“Need to find you some new nine-volt batteries for your smoke detectors,” Mothershed said.
“I do think I noticed a nine volt in that side cupboard cabinet in the kitchen, I think it’s at the bottom,” Marlene replied. She slowly shifted to watch him dig in the kitchen drawer.
Marlene, whose name was withheld for privacy reasons, has a hard time moving around her house. Her respiratory and cardiac issues make it challenging for her to live alone at home. Mothershed helps her with small tasks — like changing her smoke detector’s batteries or creating wider walking paths throughout the house — to prevent falls or other accidents.
Mothershed is a community paramedic with Johnson County’s mobile integrated health program, and Marlene is one of the 13 to 15 clients he actively works with to prevent avoidable hospital visits. The program is one of a handful in the state providing preemptive care to at-risk patients, easing pressure on emergency rooms and saving money at the same time. Though a relatively new concept in Iowa, practitioners in the state are working to implement mobile integrated health programs and gain official recognition for their work.
Mobile integrated health care closes gaps
Mobile integrated health is a blanket word for a variety of short-term, pre-hospital interventions. It’s not the same as home health care, which involves caretakers working with patients for long periods of time, or house calls, where physicians conduct appointments in patients’ homes.
The goal of mobile integrated health, said Mothershed, is identifying emergencies before they happen.
“Community paramedicine really is taking the skill set, the traditional EMS skill set of a paramedic, and giving us more education, augmenting that to bias more towards primary care and preventative care versus emergency stuff,” he said.
Mothershed works with Nancy Genoar, a nurse clinician with University of Iowa Health Care’s Population Health team. Genoar uses the organization’s charting system to identify patients who are frequently in the emergency room and show other signs of slipping through the cracks in the health care system: canceled visits and no-shows, transportation challenges and not picking up medication.
“I think we’re in a very good position to fill in those gaps,” Genoar said. “I feel like we’re bridges, especially to people that have been in the ER.”
Although UI Health Care acts as one source of potential clients, Mothershed said most of his referrals come from other paramedics. He started working with Marlene in February after an Iowa City Fire Department inspector referred her to him. Now, he ensures she’s taking her medications properly, helps her understand her medical test results and coordinates care with the multiple physicians she sees.
Mothershed said the bulk of what he does is more aligned with social work than clinical work. He’s showed Marlene how to make the text on her phone larger so it’s easier for her to use, and linked her to Heritage Area Agency on Aging in Cedar Rapids, which sent cleaners to her home.
It’s been life changing for Marlene.
“I had been praying so long for help. Just please, I need help,” said Marlene, tearing up. “He is one good, caring person. And I’m astounded at the help I’ve been given. And it continues.”
Motivated patients are the most successful
Johnson County’s mobile integrated health program is entirely voluntary. Whether he’s responding to a referral from UI Health Care or a colleague, Mothershed starts every client relationship by reaching out to set an intake appointment. If the client is receptive, he meets them in their home for regularly scheduled visits until his help is no longer needed.
Mothershed doesn’t see just anybody, though. He seeks out clients who are invested in changing their own lives.
“If we can get a sense that the person really has that motivation to take our education and our guidance to really improve themselves, those are the ones we hone in on pretty quickly, and those are a bit of our most successful clients,” said Mothershed.
Since community paramedicine isn’t long-term care, Genoar said the end goal is to empower clients to function independently.
“I think the most important thing is to give the person agency to engage in their care and take ownership, and that builds their self-esteem,” she said.
Since its start in February 2024, 18 clients “graduated” from the program. Graduation looks different for each client; for some, it means moving out of the program’s service area. Some find longer-term solutions to their health needs, like assisted living facilities. Others are able to independently manage their care after Mothershed connected them with appropriate resources. When one client moves on, Mothershed just finds the next one.
‘The right care in the right place’
During his in-home visits, Mothershed is a Swiss army knife of resources. He functions as an extension of clients’ physicians by measuring certain vitals or educating clients on how to use medical equipment like glucose monitors.
Mothershed said medication management is one of the key interventions he implements. Some clients stop taking medications without telling their doctors, or struggle to take them correctly. Mothershed works with clients’ network of care to confirm the medication regimen they need and works with the clients themselves to make sure they’re able to stick to it.
Tom Striegel, the medical director for the Johnson County program, supervises Mothershed. Rather than standard EMS work, which can be fairly cut-and-dry, the factors that need to be considered in preventive health care are complex. As the medical director, Striegel helps Mothershed navigate those complex decisions on the spot.
Though a lot of Mothershed’s work is geared toward preventing unnecessary hospital visits, Genoar says the true aim is “the right care in the right place.” Marlene called Mothershed twice to ask if she should go to the hospital for symptoms she was experiencing, and both times he walked her through her transportation options for seeking additional care.
“Had you not talked to me, I think you would have been a little bit more reserved about going to the hospital in the first place, and things could’ve gotten worse,” Mothershed said to Marlene. “Even though we had to go to the ER, it was still preventative.”
What’s more, when Marlene does need to call an ambulance, he can give responding paramedics a deep medical background in a moment where Marlene wouldn’t have the capacity to.
“I’m able to give them a better picture of what they’re coming to before they get here,” he said.
Mobile integrated health is just getting started in Iowa
Addressing health issues before they reach a crisis point just makes sense, said Striegel.
“I think one of the easiest comparisons that I have when I’m thinking about the work that’s done for mobile integrated health is like in the ‘60s and ‘70s the fire service identified, hey, if we are waiting for a fire to start and then we respond, we’re already behind,” Striegel said.
Beyond saving his clients from the stress of hospitalization and saving emergency departments from tackling preventable incidents, mobile integrated health care saves money. Mothershed said every dollar spent on the county’s program saves the health care system five or six.
How many mobile integrated health programs are there in Iowa?
Given that mobile integrated health isn’t defined or regulated in Iowa, it’s challenging to give an exact number for how many programs exist in the state. Jacob Dodds, EMS field coordinator at the Bureau of Emergency Medical and Trauma Services under the Iowa Department of Health and Human Services, confirmed the following programs are active:
Johnson County Mobile Integrated Health: A collaboration between University of Iowa Health Care and Johnson County. It began in February 2024 and has one dedicated paramedic.
City of Des Moines Fire Department Mobile Integrated Healthcare: A city-run effort with a focus on homeless individuals. It began in April 2024 and is staffed by a team of two key paramedics with an additional paramedic filling in as needed.
Greater Regional Health: A hospital-based initiative that began in June 2025 and is staffed by one paramedic.
Mary Greeley Hospital Alternative Response for Community Health (ARCH): A collaboration between Mary Greeley Medical Center, Iowa State University Police Department and Ames Police Department. It focuses on mental health response.
Decatur County Hospital Community Paramedicine: A hospital-based program with a team of one paramedic and a nurse case manager. It focuses on discharge follow-ups for frequently hospitalized patients.
MercyOne Des Moines: A hospital-based program focused on preventing the readmission of at-risk congestive heart failure patients.
He referenced one client who, before Mothershed’s interventions, called for an ambulance 100 times in a six-month period. Mothershed put the total cost of the client’s ambulance fees for that time at $300,000. Compare that to the less than $200,000 the county spends annually on Mothershed’s salary and supplies.
Johnson County’s mobile integrated health program is a year and a half old and shows “no signs of slowing down,” according to Mothershed. The practice itself isn’t new, however. Mobile integrated health programs have been initiated in over 40 states, according to a 2023 survey from the National Association of Emergency Medical Technicians. States like Idaho and Maine started introducing bills in the 2010s that define and recognize community paramedicine as a discipline.
Right now, the county pays for Mothershed’s work. But in some of the states where mobile integrated health is legally defined, community paramedics are reimbursed for their work through Medicare or, sometimes, a private insurer.
“It’s a paradigm shift within emergency response,” Striegel said. “It comes down to insurers looking at the activities in which MIH (mobile integrated health) paramedics are involved, recognizing the cost savings that they are the beneficiary of.”
Mothershed is currently the only paramedic in Johnson County’s mobile integrated health program. When he took a few weeks off, no one was able to fill in during his absence. That’s one incentive to create legislation around community paramedicine: when the state defines and regulates it, insurers may be more willing to reimburse program expenses, which could in turn provide the resources for additional staff. What’s more, Striegel said, it creates a standard of care.
Mobile integrated health “becomes more efficient and effective when we have adopted a level playing field, when we say, OK, this is what’s expected if you want to do the work of a mobile integrated health paramedic,” Striegel said.
Striegel said community paramedics need to understand “larger aspects of health care”: the dynamics that govern how a client moves between physicians, how to care for multiple diagnoses at once, the ways substance use disorder can play into mental health issues. He also stressed the need for community paramedics to see how socioeconomic realities affect clients’ health.
“There are the traditional socioeconomic factors that inhibit somebody’s ability to maintain health if they don’t have disposable income that allows them to purchase medications outside of their insurance plan or if they don’t have a vehicle that allows them to be transported to their follow-up appointments,” Striegel said. “It impacts how effective the medicine, the medical plan, the psychiatric plan, can be.”
Legislative action could expand mobile integrated health care in Iowa
Striegel said he hopes within the next 6-12 months the Bureau of Emergency Medical and Trauma Services under the Iowa Department of Health and Human Services will create a reimbursement structure and establish operating parameters for mobile integrated health programs. He’s part of a working group of six mobile integrated health care programs in the state that meets regularly with HHS officials to discuss potential legislation.
Their plans may get a welcome push depending on how funding is distributed for the Rural Health Transformation Plan. The plan, a grant program created by the One Big Beautiful Bill Act, will divide $10 billion among states annually through 2030 for proposals they submit to the Centers for Medicare and Medicaid Services.
Documents submitted by Iowa HHS for its Rural Health Transformation Plan mention an initiative to invest in a mobile integrated health care program for rural residents to reduce preventable hospital visits in those communities. They describe mobile integrated health care as an “evidence-based strategy” and say programs will “provide post-discharge follow-up, chronic disease and cancer management, acute care, and preventive services.”
The proposal acknowledges mobile integrated health care expenses are not currently reimbursed, and says data gathered from the initiative “will support efforts to establish treat-in-place services as a reimbursable benefit.”
However mobile integrated health develops in Iowa, Striegel said he predicts it will soon become integrated in EMS work.
“It's my vision and the vision of the EMS community, that by 2050 this is just going to be routine work for emergency medical technicians and paramedics,” said Striegel, “not just under the banner of mobile integrated health.”
Johnson County has an ambulance training center that Mothershed said could be a great place to host the state’s first community paramedic training program someday. In the meantime, Mothershed will keep making his rounds and supporting his clients.
“Emergencies happen,” said Mothershed. “They're going to. But if we can solve unnecessary emergencies from better medication management, better patient education, that's what we're going after.”
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