1. Community Paramedicine/ Mobile Integrated Healthcare
Elizabeth Westfall, IDHS
Nathanial Metz, Prompt Ambulance Service
Steve Davison, Fishers Fire Department

2. Goals of this presentation.
For our audience to learn about the Community Paramedicine role in MIHS and how Indiana is collaborating to make this program operational
Learn how other providers can collaborate with your EMS agencies to develop Community Paramedic programs in your communities.
Identify some of the potential roadblocks that exist for the programs creation.

3. Understanding our environment.
Per Capita Spending.
Lets talk about cost. This compares Industrialized nations against each other in regards to Cost per capita a year vs average life expectancy. Japan as you can see spends roughly per capita and has an impressive 83 year LE. UK is just under with an LE of 79. Want to take a guess who is throwing the bell curve? US spends 8,000$ per capita/yr and only has an LE of 76….something is wrong.
Guess Who?

4. The proliferated problem
Population?
population over 65 will triple.
Will we be Healthy?
CDC states:
In that population,
1 in 3 will be Obese
1 in 4 will have diabetes
1 in 2 arthritis
3 in 5 will have a chronic medical condition

5. The Emergency Dilemma…
CDC and RAND corporation
Over reliance on ER for Primary Care
Expensive care in an unnecessarily expensive setting.
60% of non-elderly patients in Public Health Plans use the ER for Primary Care.
45% of non-elderly adult patients on Private Health Plans use the ER as the primary access to health.
15% of 136 million patients arrived to the ER via ambulance, 38% of 65 and older population arrive by ambulance.
45% of Medicare patients admitted to the ER were never admitted costing Medicare apx 1.98 BILLION DOLLARS, not including co-pay.

6. “Regardless of your position on the Affordable Care Act
(ACA), its intent is to move the U.S. healthcare system away from one that provides financial incentives
based on the quantity of services to incentives based on the outcomes of care. Two of the most significant
drivers of this change are payments to groups of providers based on the outcome of the bundled episode of
care, and shared savings programs where groups of providers collaborate to share the savings generated
from quality and logical courses of care.”
“What Community Paramedicine is and why it’s the future of our profession” by Matt Zavadsky

7. MOVIE BREAK!

8. What is Community Paramedicine?
Remember This?
A service designed for health care cost reduction
A service to increase continuity of care between providers
Specified response to health care gaps in our individual communities
Look Familiar?
Mobile Integrated Healthcare, “EMS agenda for the future” in 1996 stated that ems becoming a player in preventative care and alternative destination would be the most beneficial to our care system and EMS.
This is actually a picture of a CP from Allina Health’s Program. Twin Cities in Minnesota.
A service designed for health care cost solutions
A service to maintain continuity of care
Response to the health needs of communities

9. Roles of the Community Paramedic
Emergency Care
Primary Care
Public Health
Public Education
Readmission Reduction
Wellness
Outreach
Wellness
Immunizations
Disease management
Wound care
Patient Safety
Improving Patient Outcomes
Mental Health Improvement
Social Networking
Public Education
Readmission Reduction Programs
Medication Reconciliation
Primary Care Extension
Lab draws
STD testing
Community Outreach
Risk analysis
Car Seat Checks
Discharge Continuity
Disease Management
Lab and STD testing
Prevention

10. “Collaboration is the key to success”
Stakeholders!!!
Hospitals
EMS Services
Rural Health Associations
“Collaboration is the key to success”
Nurses and their associations
Educators
Case Managers
Social Services
Government Health Agencies
Home Healthcare
Hospice

11. Our surrounding states
Canada
Nova Scotia
First Grouping- Dark are education programs with trained CP paramedics with the Curriculum presented by the Paramedic Foundation. Light are education programs in the works.
Secodn Grouping- notable active CP prorgams.
CP manual produced by Western Eagle County EMS now Eagle County Paramedic Services produced in 2009, downloaded over 100 times a day worldwide since.
Curriclum with ANA support developed in conjunction with the Paramedic Foundation, NCEMSI and IRCP.

12. Trailblazers! Canada United States
Nova Scotia, Toronto, Manitoba, Winnipeg
United States
Minnesota, Colorado, Texas, North Carolina, South Carolina, Pennsylvania
Nova Scotia- Due to the Gaps in healthcare developed by the pure geography, CP’s in conjucntion with RN’s and PA’s operate stand alone Emergency Rooms.
Manitoba and Winnipeg- Use CP’s in community outreach centers to operate in house clinics to treat the homeless population. They work with labs to do disease testing and treatments at the clinic. Including but not limited to HIV testing and AIDS treatment.
Minnesota- First state to pass legislation to recognize CP as a provider level and a fee schedule for the state’s Medicaid. They do vaccinations for the elderly community, provide in house education on medical disorders like diabetes, able to provide a full vision of the bio-physio model assessment for physicians and their care plans. Medication reconciliation programs. Help bridge Gaps in the transition period between Care plans. AHRQ (Agency for Healthcare Reseach and Quality” states that things fall between the cracks during these transition periods. 20% of medication errors are a result of poor communication during a patient’s transition period. 1 in 5 patients leaving the hospital suffers and adverse affect 72% of which are related to medications.
Dan Swayze story about sodium. CP visits house and ladie with CHF is filled with fluid. He asks her if she has stayed away from sodium, she says “Yes, I don’t put sodium on anything” looking over at the stove and seeing a large container of “Sea Salt” he says, “You know Salt is soudium, right?” “Well no she says, no one ever told me to stay away from salt”
Wake County Deployment Model- Alternative Destinations and NARCAN program.
Minnisota RN triage call center.
- ability to identify acuity level prior to sending EMS resources.
REMSA- readmission reduction program, customer loyalty program reduction.

13. GAP ANALYSIS!
Resources: FIND YOUR RESOURCES AND STUDY YOUR COMMUNITIES NEEDS!!
The only true similarity between programs.

14. Indiana’s Direction Current implementation
Mobile Integrated Healthcare Summit
Curriculum
Credentialing
Financial Reimbursement
Legislative Plan
System Development

15. What’s Next? Identifying future hurdles for the programs
Getting Involved

16. Survey Please take this time to complete our short survey.

17. Contact info:
Nathaniel Metz
Elizabeth Westfall
Steve Davison