Dave Johnson, BS, CP-C, would be one of the first people to say there are a few misconceptions about community paramedicine — what it is and why it’s gaining ground.
Johnson is a community paramedicine lead instructor with Relias and an active community paramedic in Minneapolis, Minn. He teaches a class that prepares paramedics for their national certification in community paramedicine.
Remember when doctors made house calls? Now community paramedics (CPs) do just that.
Community paramedicine is a model that allows paramedics and EMTs to work in a public health role that targets underserved populations and those in rural locations where access to healthcare is limited, according to Rural Health Information Hub. Each state has their own regulations. But CPs generally partner with physicians and public health organizations to determine the health needs of people in specific communities.
“Each state chooses how to license paramedics,” Johnson said. “In Minnesota, we are a ‘certification state’ so we don’t carry a medical license, but we work under a licensed physician.”
CPs increase access to healthcare by filling gaps for people who need preventive care services like diabetes and nutrition education or mental health services, Johnson said. By doing so, it often drives better health outcomes and less consumption of emergency care.
The term “frequent flyers” has become a common way to refer to people who use the ER as a replacement for primary care. Johnson said that term is “pejorative” and tends to marginalize people who lack access to healthcare professionals.
“We prefer the term friendly faces or comfortable customers,” he said.
Tracking the results of community paramedics
Ultimately, community paramedicine helps lower the cost of healthcare by providing people with the care they need when they need it — something that helps avert emergency situations, said Peter Carlson, MBA, NRP who works for Mayo Clinic Ambulance as a community paramedic coordinator in Minneopolis, Minn.
“The CPs’ work focuses on patients in the community with both medical and non-medical needs,” Carlson said.
Mayo Clinic Ambulance has a single full-time employee split between two paramedics whose work is making a significant impact on the community in Barron County.
“Over the last three years, they have surpassed 911 volumes,” he said. “They did just over 1,000 house calls in 2018.”
The community paramedic model is getting traction. When CPs connect with community resources, they receive referrals from clinics, the ER and hospital discharging floors when follow up patient care is required, Carlson said.
“Community paramedicine focuses on reducing hospitalizations and 911 calls,” he said. “We are focused on improving health outcomes and the end result is that using CPs reduces hospital utilization and 911 calls.”
Besides getting care at the right time, Carlson also attributes the success of community paramedicine to the idea that patients can stay in their home to receive the care they need.
How community paramedics lower healthcare costs
The CP model helps decrease hospital use rates because paramedics and EMTs fill a demand that physicians cannot always meet. Compared to busy physicians, CPs can spend more time with patients and gain a better understanding about their health challenges. By creating meaningful relationships, CPs are sometimes more efficient at getting to the root of the problem, he said. Essentially, the CP and physician work as a team.
Some physicians like the idea of working with CPs because it lessens their load, Johnson added. For instance, getting help with the tedious work of patient charting after the patients go home.
But the CP model works best when paramedics and EMTs create measurable results. For example, helping the diabetic community lower A1Cs numbers.
“We meet with the customer at their home, and we figure out what the barriers are that their physician cannot see,” Johnson said. “We provide healthcare that is strongly informed by the social determinants of health.”
To better understand the social determinants of health, see the Centers for Disease Control and Prevention.
An example of community paramedicine
Johnson works with homeless populations and provides mental health services; his colleague specializes in pediatric care that includes asthma/respiratory illnesses.
“Community paramedicine is customized to the area you are serving,” Johnson said.
Johnson said his team doesn’t focus too much on reimbursement functionality. Instead, they focus on helping people improve their health — that is their first goal.
Ultimately, improved health translates into better reimbursements. He said the goal is to meet the triple aim of healthcare. When that happens, evidence suggests better reimbursements from Medicaid, commercial payers and through Medicare Shared Savings Plan.
“We get paid per member per month to work with these customers,” Johnson said. “But if these people consume more healthcare than what our budget allows, then we don’t receive payment for that overage. On the Medicare side, if we go over budget we receive fines, like if a customer goes to the ER too much.”
Looking for a community paramedicine program?
Mayo Clinic is one resource to start learning more about a career in community paramedicine.
“We have a school for community paramedicine,” Carlson said. “We have 10 students doing clinicals and 10 more starting, so we’ve made an institutional commitment to community paramedicine.”