Community paramedicine programs
give health systems an mHealth platform upon which to improve care management
and coordination at home for high-need patients.
Community
paramedicine programs offer hospitals and health systems an opportunity to
leverage mHealth to reduce emergency department costs and improve care
management for patients with complex chronic diseases.
Mobile Integrated Health Community Paramedic
(MIH-CP) programs are often rooted in partnerships with
local EMS and ambulance companies. They deploy specially trained paramedics to
the homes of selected residents, often targeting frequent users of the 911
system.
These programs have
two primary goals.
The first is to
reduce unnecessary ED transports by visiting “frequent flyers” . This, in turn,
reduces the strain on crowded EDs and, in the long run, reduces the number of
non-emergency 911 calls.
Secondly, community
paramedics aim to help those with complex chronic conditions improve their
health and wellness at home, thereby improving care coordination and the
relationship between patient and primary care doctor.
“Community paramedicine
is not a new field, but it is a growing one in the era of innovative care
delivery models that emphasize integration across disciplines, a comprehensive
approach to care coordination, and a commitment to reducing health
disparities,” Carol Backstrom and Jennifer Ryan, both of Harbage Consulting,
wrote in a 2017 Health Affairs article.
Developing an
impactful, cost-effective CP program requires communities and healthcare
providers to collaborate on implementing technologies and care strategies that
harness all the resources at their disposal.
BUILDING
UPON THE MIH-CP PROGRAM FRAMEWORK
The MIH-CP movement
got its start in 1996, when the National Association of Emergency Medical
Technicians (NAEMT) unveiled an EMS Agenda for the Future that shifted some of
the focus to community health services. The NAEMT now offers a mission statement for
MIH-CP programs.
“Recent changes in
the healthcare finance system have created an unprecedented opportunity for EMS
to evolve from a transportation service to a fully integrated component of our
nation’s healthcare system,” the document states.
“Aligned financial
incentives now focus stakeholder awareness on the value of EMS in providing
either “patient navigation” throughout the healthcare system, efficiently and
effectively directing each patient to the right care, in the right setting at
the right time, or providing primary care in medically underserved areas.”
According to this
mission statement, an effective MIH-CP program should be:
- Fully integrated – acts as a vital component of the
existing healthcare system, with efficient bidirectional sharing of
patient health information.
- Goal directed – is predicated on meeting a defined need
of a specific patient population in a local community articulated by local
stakeholders and supported by formal community health needs assessments
(HNAs).
- Patient-centered – incorporates a holistic approach
focused on the improvement of patient outcomes.
- Collaborative – works together with existing healthcare
systems or resources and fills resource gaps within the local community.
- Consistent with the Triple Aim - improves the patient
experience of care, improves the health of populations; and reduces the
per capita cost of healthcare.
- Data-driven – leverages data to develop evidence-based
performance measures, research and benchmarking opportunities.
- Physician-led – is overseen by engaged physicians and
other practitioners, as well as the patient’s primary care
network/patient-centered medical home, using telemedicine technology when
appropriate and feasible.
- Team-based – integrates multiple providers, both
clinical and non-clinical, in meeting the holistic needs of patients who
are either enrolled in or referred to MIH-CP programs.
- Educationally appropriate – includes more specialized
education of MIH-CP practitioners, with the approval of regulators or
local stakeholders.
- Financially sustainable – includes proactive discussion
and financial planning with federal payers, health systems, managed care
organizations,, legislatures, ACOs, and other stakeholders to establish
MIH-CP programs and component services as an element of Triple Aim
approach.
- Legally
compliant – meets all legal criteria through strong, legislated enablement
of MIH-CP component services and programs at the federal, state and local
levels
In a January 2019 blog post on Health Affairs,
Caitlin Thomas-Henkel, a senior program officer at the Center for HealthCare
Strategies (CHCS), and Sandi Groenewold, a family physician with ThedaCare,
note that such a CP program can put specially trained paramedics right into the
home, “where they may discover unexpected barriers and underlying factors that
affect health outcomes.”
“A community
paramedic can investigate these issues firsthand and seek ways to solve them
through patient education (such as needing to take food with certain
medications, developing reminders for medication schedules, or special
packaging), connecting the patient with community resources, or both,” they
wrote. “This approach is a paradigm shift that differs from the traditional
one-way model of medication prescribing and dispensing to a patient-centered
approach.”
In this model,
Thomas-Henkel and Groenewold suggest using a telehealth platform to keep the
primary care provider, pharmacist, specialists and other care team members in
the loop, letting them know when home visits are conducted, allowing them to
communicate with the patient and even looping them in for a virtual visit when
needed.
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