BRATTLEBORO-An ounce of prevention can sometimes truly lead to a pound of cure.
One example of this maxim in action is the Mobile Integrated Health (MIH) program — run by Brattleboro Memorial Hospital and Rescue Inc. — which just won the 2026 American Hospital Association Rural Hospital Excellence in Innovation Award.
Traditionally, emergency medical technicians (EMTs) respond to medical emergencies in a time of crisis. With MIH, EMTs come to a patient’s home and prevent the crisis before it can escalate.
“The MIH program shifts the focus away from just providing care to patients for emergencies and more toward helping keep patients healthy and well,” said Rescue Inc. Chief of Operations Drew Hazelton.
He said the program works with patients who have had total joint replacements, or have a diagnosis of congestive heart failure, or chronic obstructive pulmonary disease (COPD) — a term used to describe chronic lung diseases including emphysema and chronic bronchitis.
“Using patient-specific care protocols, we’re able to provide in-home care and options when their disease process needs acute management,” he said.
“It’s pretty exciting,” Hazelton added. “Our outcomes are amazing.”
He described the MIH program, the only active one of its kind in the state, as “revolutionary” for Vermont.
“The state is trying to model our program into other areas of the state,” Hazelton said, noting that the state is planning to use some of the recently announced federal funding from the Centers for Medicare & Medicaid Services’ Rural Health Transformation Program to fund such initiatives.
The irony here is that when fewer people are hospitalized for emergencies, it lowers medical costs. It also means BMH’s Emergency Department loses money.
This is not a minor issue for a struggling rural hospital like BMH, which has seen a chief executive abruptly take leave and quit, a chief financial officer also leave the role, an influx of hospital financial experts, a budget deficit of $14.5 million that will take between two and three years to eradicate, and an ongoing top-to-bottom examination of costs and services that includes mediation with two unions. And, potentially, a nurses strike.
But the goal here is not economic. It is about doing the right thing in an old-fashioned way: preventing minor medical issues from becoming major ones by bringing medical care into the home.
And while the new state initiatives might be funded by new federal funds, the program that inspired them is on its own.
“When we first started this program, we had a grant,” said Dr. Tony Blofson, acting co-CEO of BMH, at a recent press conference. “Our grant money has run out, and we are now funding this.”
Blofson called the situation “a double-edged sword.”
“We’re paying for the program,” he said. “We have decreased visits to the emergency room and we have decreased readmissions. Guess what? That’s less income for the hospital.”
As a result, “not only are we paying for something, but we’re losing money because we’re not getting the admissions and we’re not getting the visits to the emergency department,” Blofson said. “Even with that, it’s still the right thing to do for our community.”
Expanding on a good idea
MIH began three years ago. Its first patients were orthopedics patients needing total joint replacements. At the same press conference, Dr. Elizabeth McLarney, an orthopedist — and BMH’s other interim co-CEO — called the MIH program “my baby.”
“The idea came out of a discussion of, ‘How do we provide care for our patients out in the community without them having to come to us?’” McLarney said. “And we started with orthopedics, obviously my department, because it was a very contained patient population.”
For patients needing a total joint replacement, Rescue Inc. would go into their homes ahead of time, assess them, and get them set up for the surgery.
Then, after the procedure, after a patient came home, Rescue Inc. would meet them at their house, make sure they were settled once again, review their medications with them, make sure they were taking them appropriately, and make sure everything else was settled.
EMTs also offered a phone number for Rescue Inc. that patients could use if they had issues or concerns.
“Patients could reach out to us,” McLarney said. “They could send us pictures.”
She said that at the hospital, “we saved on re-admissions, on revisits to the hospital, and we gave a lot of patients and their families peace of mind. So that was very successful, and then we transitioned into doing COPD and congestive heart failure.”
Today, MIH serves 421 patients in Windham County, including in Brattleboro, Putney, Bellows Falls, Wardsboro, and Jamaica. It has completed 1,855 home visits, according to Recue Inc.’s Director of Special Programs Chris Finnell, who runs MIH.
“We’ve worked with patients from all different walks of life in terms of their means,” Finnell said. “We have some patients who have a lot of support, and we have some patients who don’t have any support.”
One example is a patient the program sees every other week.
“Unfortunately, he lost his spouse a few years ago, and he is kind of struggling to manage his medications,” Finnell said. “That has resulted in several hospitalizations. He would just forget to take his medications.”
At MIH, “we’ve been able to work with him, and he has not had to be back in the hospital since we started almost a year ago. That’s a real good patient success story.”
Seeing patients in the context of their day-to-day environment also lets the EMTs intervene appropriately sooner.
Sometimes, EMTs have found mold issues in patients’ homes and have been able to help get them mold remediation services, Finnell said. “And that might have been a contributing factor to the decline in their health.”
“We’ve many, many times found patients who have medications that are no longer prescribed to them. Just masses and masses of medications. And they’ve inadvertently ended up in the hospital because they’ve taken medications that they weren’t supposed to be taking,” he continued.
“We help them get everything cleaned up so they can be successful in managing their medications,” Finnell said. “Then we help them dispose of the medications that are no longer utilized or prescribed.”
The MIH technicians are cross-trained to provide in-home health care as well as emergency medicine, Hazelton said.
“We have established a specialty training and credentialing program through our EMS Academy up in Newfane in conjunction with BMH to provide clinical rotations and medical oversight,” he said.
That team provides MIH services 24 hours a day, seven days a week.
“We also do scheduled appointments six days a week for patients and follow-ups six days a week,” he added. “Then those same providers do provide one-on-one emergency coverage when they’re not doing MIH.”
Home care is almost as good for the EMTs as it is for the patients, Finnell said.
“It’s been a very good thing for our staff, because they’re able to provide help to people,” Finnell said. “It’s not just getting called for 911 and only having the ability to do a few things and transport the patient to the [emergency department]. The whole goal of this is preventative health.”
Overcoming obstacles
To start the program, dispensation had to come from the state to allow Rescue to enter patients’ homes, to allow them to evaluate patients, and to not force them to transport patients to the hospital immediately.
The state not only granted that dispensation, it is now looking to see how it can expand the program statewide. The way the MIH program changes emergency medicine is especially meaningful to Hazelton.
“I’ve been working my entire career at changing the way that we deliver EMS,” Hazelton said. “That’s been one of my goals for a long time — trying to make sure that we provide our patients with appropriate options.”
He added that he has “testified many times in Montpelier about the challenges in EMS and the challenges in health emergency response in general, where our system is not well designed.”
To illustrate, suppose somebody calls 911, he said. The 911 dispatcher has three options: They can send an ambulance, they can send a fire truck, or they can send a police cruiser.
“Those are really the only options, even though sometimes those may not be the most appropriate answers,” Hazelton said. “And when an ambulance crew arrives, they’re only given two options: They can take you to the hospital emergency department, or they can leave you at home.”
The system, he said, has “evolved to this point where the number of options for people when they’re having some of these life-changing events is very limited.”
The MIH program provides Rescue with more options to provide emergency help.
“So when we first met with BMH leadership, we were very excited about the possibility of improving health outcomes and partnering,” Hazelton said. “I don’t personally go out and provide MIH services, but I do get the pleasure of receiving phone calls from patients, almost on a weekly basis, and family members will tell me how meaningful it is to them and how much changed their life to not spend days at a time in the hospital.”
The MIH program is also meaningful to McLarney because the hospital’s mission is to keep the community healthy.
“Our mission is to provide quality health care to the entire community,” she said, acknowledging the “variety of reasons” — perhaps mental health or physical in nature — that keep them away.
“The more we can keep people out of the hospital, the healthier our community is going to be,” McLarney said. “We need to reach out to them and meet them where they are.”
This News item by Joyce Marcel was written for The Commons.