Skip to main content
Rural Health Information Hub

Mobile Integrated Healthcare Network (MIHN)

  • Need: To bring preventive care and other services to rural Missouri patients with chronic illnesses and difficulties accessing primary care.
  • Intervention: Community paramedics and community health workers make home visits and provide basic care, home assessments, and medication reconciliation and facilitate telehealth visits.
  • Results: Patients experienced improved access to care, health status, and compliance with medication regimens along with increased patient engagement, satisfaction, and access to community resources.


The Mobile Integrated Healthcare Network (MIHN) in Missouri has community paramedics (CPs) and community health workers (CHWs) make regular home visits to patients who are chronically ill, at high risk of medical emergencies, and lacking access to primary care. In addition, patients who were recently in the hospital, have trouble managing their conditions, and/or were referred by a provider are eligible for the program.

MIHN began as a pilot project in Washington County serving patients with diabetes; the Washington County Ambulance District partners with the Great Mines Health Center (a Federally Qualified Health Center, or FQHC), Community Asset Builders, and Mineral Area College. When the project succeeded, it expanded to reach patients with other conditions and to more counties. The program has also offered COVID-19 testing, vaccinations, and monthly food bank deliveries to patients.

Local MIH Networks are currently in the rural counties of Adair, Carroll, Cedar, Dade, Douglas, Franklin, Gasconade, Hickory, Lincoln, Maries, Osage, Polk, Reynolds, St. Francois, Stone, Washington, and Webster.

MIHN Expansion Map

MIHN partners with the Missouri Department of Health and Senior Services, including the Office of Rural Health and Primary Care and the Bureau of Cancer and Chronic Disease Control. The program also collaborates closely with the Missouri Office of Rural Health and Primary Care and the Missouri EMS Association on education and training opportunities for new and existing MIH Networks.

The MIHN pilot project in Washington County received funding from the Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant program.

Services offered

CPs and CHWs make regular home visits and offer the following care:

  • Basic preventive care, including detailed assessments, vital signs, lab draws, EKGs, ultrasounds, wound care, and IV infusions
  • Home safety assessments
  • Medication reconciliation
  • Facilitation of telehealth visits with providers
  • Focus on addressing social determinants of health
  • Care coordination, primary care provider enrollment, and Medicaid navigation

Patients can refer themselves to the program or be referred by a healthcare provider, emergency medical services (EMS) provider, or hospital emergency department upon discharge.


In the Washington County pilot project's first year, it served 21 patients and recorded a 100% decrease in emergency transports for all participants. This county's MIHN made 7,000 encounters in 2021 and 8,000 encounters in 2022.

Learn more about the Washington County pilot project in the Rural Monitor article Breaking the Cycle: Missouri Community Paramedicine Program Brings Primary Care to High-Risk Patients.

In the larger program, patients also experienced improved access to care, health status, and compliance with medication regimens along with increased patient engagement, satisfaction, and access to community resources.

MIHN patient outcomes


Some patients struggled to connect to the internet for telehealth visits, so program coordinators added a mobile hotspot to the MIHN vehicle. The vehicle also has refrigerators to carry blood and urine samples.

Funding is a challenge. Medicaid in Missouri reimburses telehealth services but not CP or CHW services.


Build trust with patients. Take the time to talk with them and answer their questions.

All CPs and emergency medical technicians (EMTs) in the program are certified as CHWs. Mineral Area College allows students to earn a paramedic certification and a CHW certification at the same time. Program coordinators are working with the state health department to develop a statewide dual-certification curriculum.

Contact Information

Justin Duncan, CEO
Washington County Ambulance District
Mobile Integrated Healthcare Network

Community health workers
Community paramedics
Federally Qualified Health Centers
Home health

States served

Date added
September 12, 2023

Suggested citation: Rural Health Information Hub, 2023. Mobile Integrated Healthcare Network (MIHN) [online]. Rural Health Information Hub. Available at: [Accessed 5 December 2023]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.