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Dr. Michael Wilcox Kai Hjermstad Buck McAlpin December 2 2013 INTEGRATING COMMUNITY PARAMEDIC INTO THE HEALTHCARE SYSTEM.

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Presentation on theme: "Dr. Michael Wilcox Kai Hjermstad Buck McAlpin December 2 2013 INTEGRATING COMMUNITY PARAMEDIC INTO THE HEALTHCARE SYSTEM."— Presentation transcript:

1 Dr. Michael Wilcox Kai Hjermstad Buck McAlpin December INTEGRATING COMMUNITY PARAMEDIC INTO THE HEALTHCARE SYSTEM

2 THE ACCESS DILEMMA RURAL AND REMOTE 1/4 of Americans live in rural and remote areas 1/4 of Americans live in rural and remote areas Only 10% of America ’ s doctors practice there 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 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 elderly More immigrants More immigrants More poverty More poverty Poorer health Poorer health

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

5 VOLUNTEER AND PAID PARAMEDICS EMTs/Paramedics already know how to deliver care locally EMTs/Paramedics already know how to deliver care locally Assess resources and make decisions Assess resources and make decisions They can fill gaps in care with enhanced skills through targeted training They can fill gaps in care with enhanced skills through targeted training

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

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

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

9 ADDRESSING THE NEEDS OF THE UNDERSERVED Target populations with problems in access to health care Target populations with problems in access to health care Address special population issues Address special population issues Rising health disparities Rising health disparities Aging Aging Decreasing medical workforce Decreasing medical workforce

10 RESOURCEFUL Identifies what is available Identifies what is available And what is missing And what is missing

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

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

13 SHAKOPEE MDEWAKANTON SIOUX COMMUNITY Mobile Clinic Mobile Clinic

14 SCOTT COUNTY MED-FIRE CLINICS SCOTT COUNTY MED-FIRE CLINICS Med-Fire medical van travels to five areas throughout Scott County every two weeks Med-Fire medical van travels to five areas throughout Scott County every two weeks patients per session patients per session Access issues – cannot afford insurance Access issues – cannot afford insurance Identify a medical home Identify a medical home

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

16 COMMUNITY PARAMEDIC TRAINED OR IN TRAINING Spring Program 2008Metro & Outstate MN8 Fall Program 2010Rural5 Spring Program 2012Metro12 Fall Grant Class Fall Program Class 2013Metro & Out of State20 Spring Program 2013Metro, Outstate MN24 Spring Grant Class Spring Northern MN Fall Program 2013Metro, Outstate24 Fall Grant Class Fall Contract 2013ME, NC, NJ21 Winter

17 CARING FOR HIGH-RISK PATIENTS CARING FOR HIGH-RISK PATIENTS Patients taking 10 or more medications Patients taking 10 or more medications Patients who have tight therapeutic window medications such as “ warfarin ” Patients who have tight therapeutic window medications such as “ warfarin ” Patients who have 3 or more chronic diseases Patients who have 3 or more chronic diseases Patients with mental health and disabling conditions Patients with mental health and disabling conditions

18 CP PROGRAM IN ACTION Metro program went live on October 1, 2012 Metro program went live on October 1, 2012 CPs are available every day, seven days a week CPs are available every day, seven days a week Carry their own supplies and vehicle Carry their own supplies and vehicle 6-9 patients per day 6-9 patients per day Electronic medical records interface Electronic medical records interface

19 CP PROGRAM IN ACTION Rural program Spring 2014 Rural program Spring 2014 Park Rapids, MN community Park Rapids, MN community Population 3,700 Population 3,700 This 4 th group of providers will work with public health and the Essentia Health Care system to provide care to area patients This 4 th 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 Rural program Spring th Group - Faribault, MN 5 th Group - Faribault, MN Population 22,000 Population 22,000 Care to patients dealing with chemical dependency, geriatric issues and mental health issues Care to patients dealing with chemical dependency, geriatric issues and mental health issues Allina Clinic, District One Hospital and Rice County Public Health Services 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 1 -- Non-paramedic filling some roles of the Community Paramedic Level 2 – Certificate or Associate Degree Level 2 – Certificate or Associate Degree Level 3 -- Bachelor ’ s Degree Level 3 -- Bachelor ’ s Degree

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

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

24 CURRICULUM PHASE II Clinical 196 hours Clinical 196 hours

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

26 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.

27 ● ● 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 COMMUNITY PARAMEDIC ACHIEVING THE QUADRUPLE AIM

28 ● ● 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 CP PAYMENT & DELIVERY MODELING

29 Minnesota – Currently the only Community Paramedic program in the nation that is: ● ● Credentialed ● ● Reimbursable ● ● Integrated  Linking Primary Care & EMS COMMUNITY PARAMEDIC SOLUTION HOW DO WE DO THIS?

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 Established Community Paramedic Certification SF 119

31 Established Reimbursement SF 1543 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

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 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 LAUNCHING A CP PROGRAM

34 INTEGRATING COMMUNITY PARAMEDIC INTO THE HEALTHCARE SYSTEM


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