Community Paramedics…Adapting to the changing face of health care

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By: Allen Smith, Manager of the Emergency Medical Services Department

We all know that trips to the hospital are EXPENSIVE and getting there via an ambulance doesn’t decrease the price tag. Tri-County Health Care believes that the emergency department is necessary, but sometimes sadly it is an option that just fills a void. To help minimize health care costs to the community, reduce readmissions to the hospital, avoid unnecessary trips to the emergency room and help patients receive the best care possible, Tri-County Health Care has implemented a Mobile Integrated Health Care Program.

Allen Smith

Allen Smith

In its simplest definition, Mobile Integrated Healthcare (MIH) is the provision of health care using patient-centered, mobile resources in the out-of-hospital environment. It may include, but is not limited to, services such as providing community paramedicine care, chronic disease management, preventive care or post-discharge follow-up visits; or transport or referral to a broad spectrum of appropriate care, not limited to hospital emergency departments. These alternative pathways to receive care, help bridge gaps in patient care, seek appropriate health care options and offer early preventative measures to prevent hospital readmissions. This program improves patient care, improves population health and reduces the cost of health care (the triple aim). The right care in the right place at the right time.

Traditionally, the role of the paramedic was…

  • To respond as a health care provider to 911 emergencies;
  • To quickly assess the patient’s condition;
  • To provide interventions according to protocol;
  • To transport patients to an acute care hospital.

The Mobile Integrated Health Care program was developed to redefine the role of the paramedic and be an extension of the primary care provider into the patient’s home. Physicians recommend high-risk patients for this program and the Community Paramedic visits are individualized based on patient needs. The program sends paramedics into the community to make home visits and works in collaboration with the medical team, including physicians and the care coordinators. During home visits, paramedics often focus on patient well-being, medication reconciliation and home safety. When needed paramedics conduct post-stroke follow-ups, EKG (heart rhythm tests), blood glucose checks, vital signs taken and blood draws.

This program was never intended to be a substitute for long-term care. It was designed for short-term care and is now considered part of the Health Care Home model. The paramedics also refer patients to other programs in the community. The trained community paramedics provide individualized care and take pride in transitioning patients to other community programs, such as home care, at the appropriate time.

In 2015, the Tri-County’s Mobile Integrated program has…

  • Seen 203 total patients
  • Saved $102,000
  • Received $143,00 in grants

And, since its inception, the program has been recognized at a state and national level. The program has been published in the Minnesota Physician magazine and Tri-County leaders have been asked to be a member of a state advisory group, as well as present program components at both state and national conferences. The program was also a featured organization in the most recent edition of the National Association of EMT magazine.

Most recently, Tri-County has become one of two nationally featured agencies identified by the NAEMT (National Association of Emergency Medical Technicians) in a white paper to Congress. Tri-County was recognized as the rural health care model in defining what a Mobile Integrated Health Care program should look like. The other organization resides in Reno, Nevada and represents large metro agencies.

One example of the Community Paramedic’s impact in the community is a man with violent mental health issues. Prior to the program, this patient had eight visits to Tri-County’s Emergency Department in 2013 and six visits to other facilities. These encounters didn’t just impact the Emergency Department, but also law enforcement. All of these visits resulted in the patient needing to be chemically or physically restrained and eventually ended in being committed to a mental health facility.

Since being visited regularly by a Community Paramedic this same patient is no longer committed and in the last 17 months has only had two Emergency Department visits, neither which required restraint nor security interventions. And, the patient is currently looking for employment.

Savings for the Patient:

Average cost per visit = $5,420

  • ED Facility and professional Charges = $1,500
  • EMS Transport to ED                        = $2,120
  • EMS Transport to Mental Health     = $1,800

Total for 14 ED Visits in 2014                                         = $75,880

Total cost for all Community Paramedic visits              = $918

(16 months’ worth of visits at $57.37 per visit / month)

Emergency Department costs in last 16 months         =$16,260

Health care savings in last 16 months                           = $58,702

No people being harmed                                                 = PRICELESS

The Mobile Integrated Health Care program is a wonderful program that not only meets the federal guidelines outlined in the Affordable Care Act, but it also makes a difference to patients. To see our patients return to a more normal way of life is a true indicator that we are doing the right things for the right reasons.

Allen Smith speaks in Duluth at the League of Minnesota Cities Conference in June 2015…


About the Author…

Allen Smith has more than 35 years of accumulated experience encompassing a variety of Emergency Service roles including fire fighter /paramedic, flight paramedic, EMS Educator, and currently the Manager of the Emergency Medical Services department at Tri-County Health Care. Allen lives in Baxter with his wife Kirsten. He has four children ranging in age from 17-32 years old.