A New Model for Ambulance Care

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by Trudie Bruno, Customer Success Manager

Earlier this month, the Department of Health and Human Services (HHS) announced a new initiative termed Medicare ET3, or Emergency Triage, Treat, and Transport (ET3) Model.1 Although the program will largely serve Medicare beneficiaries, it has the potential to create a long-term impact on how Americans think about transportation, cost savings, and health.

ET3 is a program which increases the flexibility for how ambulance care teams can choose to respond to emergency calls. In the existing model, ambulance care teams are directed to transport the patient to the nearest hospital ER. Under the ET3 model, these teams respond to an emergency call but have the option to take any of the following actions:

  • Treat the patient onsite;
  • Treat the patient with a provider through a telemedicine service;
  • Transport the patient to a nearby primary care provider; or
  • Transport the patient to the nearest hospital ER.

The initiative also sets aside funding to assist 911 dispatch services with setting up a medical triage line which can serve anyone who calls in. Together, these processes lend the new initiative its three Ts: Triage, Treat, and Transport.

For now, the ET3 model is simply an initiative by The Centers for Medicare & Medicaid Services (CMS). While it’s limited in timeline and scope (with a five year performance period serving a specific population) the most important takeaway from this initiative is what it means for US healthcare as a whole. The model aims to reduce healthcare costs by increasing the flexibility of responses to emergency calls, improving transportation options for immediate care, and encouraging medical triage. In doing so, the initiative highlights the importance of these factors for the future of healthcare.

Transportation is a social determinant which can significantly impact a patient’s ability to get the care they need.2 To date, though, this need has not been largely acknowledged by the US healthcare system. The launch of this initiative by CMS signals that this may soon be changing. Approximately 40% of health spending in the US is funded by Medicare and Medicaid programs3, representing more than a trillion dollars. This gives CMS significant buying power and influence in the US healthcare space, meaning other payers may take note and go down the same path.

For example, some commercial health insurance companies have begun to offer transportation to healthcare appointments as a value-add for members, although this is hardly a widespread practice. One plan will offer a scheduled car service, while another offers a transportation escort for those who may need assistance to travel to medical appointments. Additionally, several new companies are popping up to partner with rideshare services to help get patients to their appointments.

While these innovative efforts are beginning to address transport barriers to healthcare access in select markets, they are still fragmented and inconsistent in their availability across the country. That’s why it’s important to pay attention to the new ET3 model announced by CMS. While the model will largely serve Medicare beneficiaries, the significant purchasing power and influence of CMS hopefully signals a shift towards addressing the social domain of transportation for all people in need.


  1. Emergency Triage, Treat, and Transport (ET3) Model. (n.d.). Retrieved from https://innovation.cms.gov/initiatives/et3/
  2. Syed, S., Gerber, B., & Sharp, L. (n.d.). Traveling Towards Disease: Transportation Barriers to … Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/
  3. National Health Expenditures 2017 Highlights. (n.d.). Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf

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