INTEGRATING
COMMUNITY PARAMEDIC
INTO THE HEALTHCARE
SYSTEM
D r. M i c h a el W i l c ox
Kai Hjermstad
Buck McAlpin
D e c e m b e r 2 2 01 3
THE ACCESS DILEMMA
RURAL AND REMOTE
1/4 of Americans live in rural and remote
areas
Only 10% of America’s doctors practice
there
4 times as many rural and remote
residents travel > 30 miles for health care
compared to urban residents
RURAL AND REMOTE
DEMOGRAPHICS
More elderly
More immigrants
More poverty
Poorer health
THE COMMUNITY
PARAMEDIC PROGRAM
Expand role, not scope
Assess and identify gaps
between community needs and
services
Improve quality of life/health
VOLUNTEER AND PAID
PARAMEDICS
EMTs/Paramedics already know how
to deliver care locally
Assess resources and make decisions
They can fill gaps in care with
enhanced skills through targeted
training
EXPANDED SERVICES
Primary care
Emergency care
Public health
Disease management
Prevention
Wellness
Mental health
KEYS TO COMMUNITY
PARAMEDIC PROGRAM
RESOURCEFUL
FLEXIBLE
SERVING THE
UNDERSERVED
GAP-FILLING
FLEXIBLE
Identify specific needs in community
health care
Standardized curriculum, modified
for communities
ADDRESSING THE NEEDS
OF THE UNDERSERVED
Target populations with problems in
access to health care
Address special population issues
Rising health disparities
Aging
Decreasing medical workforce
RESOURCEFUL
Identifies what is available
And what is missing
GAP-FILLING
Creates “health home” for citizens
Eyes, ears, and voice of community
COMMUNITY PARAMEDIC
GUIDELINES
Essential oversight by community
care providers
Practice where designated
underserved
Approved and welcomed
Funding specific to locale
SHAKOPEE MDEWAKANTON
SIOUX COMMUNITY
Mobile Clinic
SCOTT COUNTY
MED-FIRE CLINICS
Med-Fire medical van
travels to five areas
throughout Scott County
every two weeks
14-20 patients per session
Access issues – cannot
afford insurance
Identify a medical home
TRAINED BY LOCATION
Canada
Nova Scotia
Maine
Washington
North Dakota
Idaho
Minnesota
South Dakota
New Jersey
Nevada
Kansas
Missouri
North Carolina
Florida
COMMUNITY PARAMEDIC
TRAINED OR IN TRAINING
Spring Program 2008
Metro & Outstate MN
8
Fall Program 2010
Rural
5
Spring Program 2012
Metro
12
Fall Grant Class 2013
18
Fall Program Class 2013
Metro & Out of State
20
Spring Program 2013
Metro, Outstate MN
24
Spring Grant Class 2013
24
Spring Northern MN 2013
13
Fall Program 2013
Metro, Outstate
Fall Grant Class 2013
Fall Contract 2013
Winter 2014
24
30
ME, NC, NJ
21
24
CARING FOR
HIGH-RISK PATIENTS
Patients taking 10 or more medications
Patients who have tight therapeutic
window medications such as “warfarin”
Patients who have 3 or more chronic
diseases
Patients with mental health and disabling
conditions
CP PROGRAM IN ACTION
Metro program went live on October 1,
2012
CPs are available every day, seven days a
week
Carry their own supplies and vehicle
6-9 patients per day
Electronic medical records interface
CP PROGRAM IN ACTION
Rural program Spring 2014
Park Rapids, MN community
Population 3,700
This 4th group of providers will work with
public health and the Essentia Health Care
system to provide care to area patients
CP PROGRAM IN ACTION
Rural program Spring 2014
5th Group - Faribault, MN
Population 22,000
Care to patients dealing with chemical
dependency, geriatric issues and mental
health issues
Allina Clinic, District One Hospital and Rice
County Public Health Services
THE COMMUNITY
PARAMEDIC PROGRAM
Level 1 -- Non-paramedic filling some
roles of the Community Paramedic
Level 2 – Certificate or Associate
Degree
Level 3 -- Bachelor’s Degree
CURRICULUM IS IN
PLACE
Standardized multi-module delivery
model
Applicable across America and
internationally
14 credit certificate
CONTENT
Chronic disease management
Cardiac, respiratory, diabetes , neurological
Pathophysiology
Pharmacology
Mental health
Text books
CURRICULUM PHASE II
Clinical
Skills @
196 hours
THE CLINICAL EXPERIENCE
Primary care
Community Health/Hospice
Wound care
Behavioral
Cardiology & respiratory
Pediatrics & geriatrics
Networking
MEETING THE NEEDS OF
ACCOUNTABILITY
Conducting the necessary readiness
analyses and enabling a ready medical
work force.
Managing the cost of health care
provided. Eliminating waste and
unwanted variation.
COMMUNITY PARAMEDIC
ACHIEVING THE QUADRUPLE AIM
● Viable option for improving
the experience of care, improving the
health of populations and reducing per
capita costs of health care
● Bridge existing health care gaps,
avoid duplication
● Reduce the cost of overall health
care expenditures
● Reduce stress on vulnerable patients
and improve care coordination
● Reduce hospital readmissions and
emergency department utilization and
avoid penalties
CP PAYMENT &
DELIVERY MODELING
● Community Paramedic solutions span health care
finance, government reimbursement modeling and
care delivery innovations
● In the brave new world of PMPM, capitation and
shared savings for total cost of care, and a drive for
the premium dollar, CP offers new solutions across the
continuum of care and types of services….
 Fire
 Hospital
 Private Systems
● From initial 911 call to primary care integration
COMMUNITY PARAMEDIC SOLUTION
HOW DO WE DO THIS?
Minnesota – Currently the only Community
Paramedic program in the nation that is:
● Credentialed
● Reimbursable
● Integrated
 Linking Primary Care & EMS
CP Certification Established
●
2 Years Experience as a Paramedic
Completion of Board-Approved CP
Course
• Accredited College or University
● Practice under Ambulance Medical
Director Supervision
●
●
Continuing Education in Primary Care
SF 119
Established
C o m m un i t y
P a r a m e d ic
C e r t i fi c a t io n
CP Reimbursement Established
● Authorized Medicaid Coverage

Health Assessment,
Immunizations and Vaccinations,
Chronic Disease Monitoring and
Education, Laboratory Specimen
Collection, Medication
Compliance, Hospital Discharge
Follow-up Care, Minor Medical
Procedures as Approved by
Medical Director
● Primary Care Provider Order
Required
● Medical Director Bills Medicaid
SF 1543
Established
Re i m b ur s e m e n t
APPETITE FOR
COMMUNITY PARAMEDIC
Calls pouring in from healthcare providers, EMS
services, policymakers interested in a CP solution
●
●
Increasing industry CP demand and growth
●
Regulators Embrace and Support CP
 CP Highlighted by the State in $45 Million State
Innovation Model Grant
 CMS Approved State Plan Amendment for CP as a
Covered Service
 CP Included in State DHS Primary Care
Coordination Grant, Diabetes Focus
 Implementation Grants Awarded for CP by Office of
Rural Health and Primary Care
LAUNCHING A CP PROGRAM
Responding to the demand for information and
assistance, CP Program consulting services are
tailored to meet needs around:
● LEGISLATIVE AND REGULATORY
● MEDICAL DIRECTION
● TRAINING
● IMPLEMENTATION
● REIMBURSEMENT
INTEGRATING
COMMUNITY PARAMEDIC
INTO THE HEALTHCARE
SYSTEM