COMMUNITY PARAMEDICINE IN WISCONSINWHERE ARE WE AND WHERE ARE WE GOING?

Community Paramedic: Accountable Care Partners

● 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

THE VALUE of CP in ACCOUNTABLE CARELinking Primary Care & EMS

Enabling Legislation,

Credentialing

Reimbursable CP Practitioner

Services Identified

Partnership Between

Hospital and EMS or FD

ED Utilization Complex Patients Without Services

Patient Primary Care Plan, PCP

Driven

COMMUNITY PARAMEDIC WORKFLOW

WHAT DOES SUCCESS LOOK LIKE?

NEW HANOVER REGIONAL – NORTH CAROLINA

ABBEYVILLE SOUTH CAROLINACOMMUNITY PARAMEDIC EVALUATION REPORT

NOVEMBER 2015ED UTILIZATIONCP PATIENTS – 58.7% DECREASE VS. CONTROL – 4%

INCREASEINPATIENT UTILIZATION

CP PATIENTS – 60% DECREASE VS. CONTROL – 500% INCREASEED CHARGES

CP PATIENTS – $879 DECREASE VS. CONTROL – $126 DECREASEINPATIENT CHARGES

CP PATIENTS – $1,249 DECREASE VS. CONTROL – $19,960 INCREASE

LEGISLATION IN WISCONSINSTAKEHOLDERS

• PROFESSIONAL AMBULANCE ASSOCIATION OF WI - PAAW

• PROFESSIONAL FIRE FIGHTERS OF WISCONSIN – PFFW

• WISCONSIN EMS ASSOCIATION - WEMSA

• WISCONSIN STATE FIRE CHIEFS ASSOCIATION – WSFCA

LEGISLATIVE PROCESS• Process started by PFFW and Rep. Katrina Shankland (D) Stevens

Point

• Bill drafted in late summer 2015

• Outreach to other medical groups:• WI Nurses Association• Medical Society of Wisconsin• Office of Rural Health• DHS

LEGISLATIVE PROCESS

• Stakeholder phone conferences started by PAAW and archived at www.paaw.us

• List serv started by Rural Health and archived at www.paaw.us

• Stakeholder meeting in Stevens Point – summer 2015

• Support offered by Rep. Amy Loudenbeck (R) Clinton

• Legislation session ended with bill in draft form

LEGISLATIVE PROCESS• All inclusive Stakeholder group reconvened May

2016

• New draft circulated July 2016

• General consensus across the board on issues

HIGHLIGHTS OF BILL DRAFT• Expands definition of EMT to add CP function to current

definition

• Actions and training to be authorized by DHS

• Agreement with a hospital or physician

• CP endorsement by DHS

• CP must be part of ambulance provider or hospital

• No Medicaid reimbursement in the bill

NEXT STEPS

• Introduce vetted bill when legislative session opens

• Build consensus across other disciplines

• Reach out to local legislators to garner support

• Establish discussions with local hospitals to forge partnerships for pilots and/or services

• Work to increase training opportunities for certification

WISCONSIN PIONEERS• Green Bay Fire Department

• Greenfield Fire Department

• Madison Fire Department

• Milwaukee Fire Department

• Ryan Brothers Ambulance

• West Allis Fire Department

MILWAUKEE FIRE DEPARTMENT COMMUNITY PARAMEDIC

PROGRAM

Captain Michael Wright NREMT-P CPMIH TEMS

PILOT PROGRAM RESULTS OCTOBER

PATIENT 6 MTH PRE 6 MTH POST % CHANGEHours of engagement

DA 33.5 15 25 66.67RB 17 2 4 100CS 15.5 8 3 -62.5MK 15 1 1 0TB 15 3 0 -100BL 12.5 2 0 -100SR 38.5 10 1 -90CH 17 9 1 -88.89NS 17 4 2 -50TOTALS 181 54 37

1

-150

-100

-50

0

50

100

150

66.67100

-62.50

-100 -100 -90 -88.89

-50

October 2015 Pilot Data

DA RB CS MK TB BL SR CH NS

PILOT PROGRAM RESULTS NOVEMBER

PATIENT 6 MTH PRE 6 MTH POST% CHANGEHours of engagement

RG 14 9 0 -100CS* 7.5 4 2 -50DP 27 29 51 75

TW* 16 12 1 -92JS 13 2 0 -100

GW 7.5 10 16 60JA 16.5 4 1 -75

MB* 5 3 3 0MM 13.5 14 9 -36

TOTALS 120 87 83

1

-150

-100

-50

0

50

100

-100

-50

75

-92 -100

60

-75

0 -36

November 2015 pilot data

RG CS DP TW JS GL JA MB MM

PILOT PROGRAM RESULTS DECEMBER

PATIENT 6 MTH PRE 6 MTH POST % CHANGEHours of engagement

RL 21 38 14 -63.15JN 14.5 4 0 -100HH 16.5 1 1 0LL 22 14 0 -100

PG* 23 13 4 -69DM* 15.5 21 15 -28.57JJ* 4.5 21 7 -66.66GT* 4.5 5 3 -40MT* 4.5 6 0 -100DT 21 6 7 14.28

TOTALS 126 123 51*did not complete program

1

-120-100-80-60-40-20

02040

-63.15

-100

0

-100

-69

-28.57

-66.66

-40

-100

14.28

December Pilot data

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