1. INTEGRATING Community paramedic INTO THE HEALTHCARE SYSTEM
Dr. Michael Wilcox
Kai Hjermstad
Buck McAlpin
December

2. 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

3. RURAL AND REMOTE DEMOGRAPHICS
More elderly
More immigrants
More poverty
Poorer health

4. THE COMMUNITY PARAMEDIC PROGRAM
Expand role, not scope
Assess and identify gaps between community needs and services
Improve quality of life/health

5. 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

6. EXPANDED SERVICES Primary care Emergency care Public health
Disease management
Prevention
Wellness
Mental health

7. KEYS TO COMMUNITY PARAMEDIC PROGRAM
RESOURCEFUL
FLEXIBLE
SERVING THE UNDERSERVED
GAP-FILLING

8. FLEXIBLE Identify specific needs in community health care
Standardized curriculum, modified for communities

9. 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

10. RESOURCEFUL
Identifies what is available
And what is missing

11. GAP-FILLING Creates “health home” for citizens
Eyes, ears, and voice of community

12. COMMUNITY PARAMEDIC GUIDELINES
Essential oversight by community care providers
Practice where designated underserved
Approved and welcomed
Funding specific to locale

13. SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
Mobile Clinic

14. 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

15. TRAINED BY LOCATION Canada Nova Scotia Maine Washington North Dakota
Minnesota
Idaho
South Dakota
New Jersey
Nevada
Kansas
Missouri
North Carolina
Florida

16. COMMUNITY PARAMEDIC TRAINED OR IN TRAINING
Spring Program Metro & Outstate MN 8
Fall Program Rural 5
Spring Program Metro
Fall Grant Class
Fall Program Class 2013 Metro & Out of State 20
Spring Program Metro, Outstate MN 24
Spring Grant Class
Spring Northern MN
Fall Program Metro, Outstate 24
Fall Grant Class
Fall Contract ME, NC, NJ 21
Winter

17. 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

18. 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

19. 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

20. 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

21. 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

22. CURRICULUM IS IN PLACE Standardized multi-module delivery model
Applicable across America and internationally
14 credit certificate

23. CONTENT Chronic disease management
Cardiac, respiratory, diabetes , neurological
Pathophysiology
Pharmacology
Mental health
Text books

24. CURRICULUM PHASE II
Clinical 196 hours

25. THE CLINICAL EXPERIENCE
Primary care
Community Health/Hospice
Wound care
Behavioral
Cardiology & respiratory
Pediatrics & geriatrics
Networking

26. Meeting the NEEDS OF ACCOUNTABILITy
Conducting the necessary readiness analyses and enabling a ready medical work force.
Conducting the necessary readiness analyses and enabling a ready medical work force.
The new environment of health care
Managing the cost of health care provided. Eliminating waste and unwanted variation.

27. 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

28. 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

29. 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

30. 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 Community Paramedic Certification

31. 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 Reimbursement

32. 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

33. 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

34. INTEGRATING Community paramedic INTO THE HEALTHCARE SYSTEM