Community paramedicine, also known as mobile integrated health, is catching on nationwide as a way to improve patient care while reducing costs. These programs are designed to better serve the community by redirecting the people using a disproportionate amount of emergency services to more appropriate, cost-effective providers.
Many of these so-called “frequent fliers” lack insurance and suffer from poor health literacy, chronic health problems, mental illness or addiction, and too often, these patients put a strain on EMS agencies even as they fall through the cracks. To determine whether a community paramedicine program is right for your agency and community, you must identify critical areas for improvement and gather data to support your argument.
Begin with a needs assessment
First, define the problem areas. What is the need? Are your agency’s resources stretched thin by a few frequent fliers? Is your local hospital looking to reduce readmissions? Are you getting a lot of calls for chronic, non-emergency issues?
A single frequent flier can put a lot of distress on a health care system. Anytime an ambulance is out of service, the capability of the system to treat the next patient is lower, plus the Medicare reimbursement rates for ambulance transport don’t cover the actual cost of an ambulance ride.
A patient who calls once a day or every other day becomes a significant stress on the system – but you can’t refuse a call, because you never know when that incident may be critical. However, when a person continues to call for non-emergency issues, you can monitor the pattern and determine how to redirect that patient to appropriate care.
“A lot of patients call EMS because they’re lonely, or they’re calling because they’re out of their meds, and if they get transported to the hospital they get their meds,” said Regina Godette-Crawford, advocacy liaison with EMS Management & Consultants. “We need to assess what the patient’s real issues are and stop the ambulance calls. Are they also tapped into social services? Are there behavioral issues? You’ll find out that there’s a common denominator in most.”
It’s important to identify these gaps in care and how EMS can help close them, working together with a variety of health care providers to find what’s best for your patients. This may require cooperation with local social services agencies to better understand the referral system, or with a hospital to define a set of frequently encountered conditions with repeated calls, high readmission rates and less-than-optimal outcomes. Look for opportunities to improve how you collaboratively care for those patients.
Generally, your target patients are both the most expensive and least likely to pay. In most cases, improved care also means reduced overall costs.
Gather data to demonstrate the need
You will need numbers to show that a problem exists so that you can make your case to policymakers. A good place to start is your patient care reports and billing data. Look for patterns. Are the majority of your calls non-emergency concerns? Is there a clearly identifiable set of high-frequency patients that every medic in your system knows by name?
Look beyond your response times and survival rates for local patterns and gaps in care. Tracking how frequently your agency makes referrals to social service agencies is another useful metric. Measuring these referrals will enable you to report these patterns to policymakers and show the need for interventions that can make a lasting difference in patients’ lives and ease the strain on the system by directing them to more appropriate providers.
“There really is more bang for your buck in doing what’s best for the patient,” said Godette-Crawford, “but you’ve got to be able to sell that, and the only way that you can sell that is to show data.”
Making the case for a community paramedicine program
In order to gain support for a community paramedicine program, you’ll need to communicate three things to policymakers: how the current system is not meeting the community’s health care needs, the adverse effects these problems have on your agency and the overall system, and how your proposed solution will help close the gap.
Be prepared to share and explain the data you’ve collected. You’ll also need these numbers to measure cost savings and improved patient outcomes to gauge the success of your program once it’s launched.
Once you’ve gathered your data to demonstrate the need for a new solution, it can be helpful to use an evaluation tool like the one from the federal Health Resources and Services Administration (HRSA) to help you assess your community’s needs and your agency’s strengths. Many states require agencies to complete the HRSA assessment before launching a program, and whether required or not, using a widely respected set of criteria will help you make your case.
Identify community partners and begin conversations
Community paramedicine is, by definition, a collaborative effort. Your needs assessment will tell you who should be involved in the planning discussions. Meet with representatives from the health care organizations that are most likely to play a part. Generally, this will include public health and social services agencies, but you may also want to bring private hospitals, home health agencies and other practitioners to the table, depending on who else is involved in treating your target population.
Some agencies may compete. For example, home health nurses may balk at the idea of paramedics making home visits that provide similar services. Others, like hospitals looking to reduce readmissions for a particular condition, may provide limited funding for a pilot program to establish cost savings. It’s important to bring these stakeholders to the table to establish the scope of your program, set goals and build consensus.
“Building a coalition and marketing it to build community engagement is critical,” said Godette-Crawford, an advocate for community paramedicine programs and other EMS issues in North Carolina. “You’re going to have a very fragmented system if you don’t partner together, and the whole point is coming together to have a unified approach to this that would benefit everybody.”
Is community paramedicine the right strategy for your agency?
There is no blueprint for success, but a comprehensive community paramedicine program must be built on a careful assessment of the health needs of your community and strategic partnerships with a spectrum of health care providers.
Stay tuned for How to Make Community Paramedicine Work for Your Agency, Part 2.