Dr. Michael Wi lcoxKai HjermstadBuck McAlpinDecember 2 2013

INTEGRATING COMMUNITY

PARAMEDIC INTO THE HEALTHCARE SYSTEM

THE ACCESS DILEMMA RURAL AND REMOTE

1/4 of Americans live in rural and remote areasOnly 10% of America’s doctors practice there4 times as many rural and remote residents travel > 30 miles for health care compared to urban residents

RURAL AND REMOTE DEMOGRAPHICS

More elderly More immigrants More poverty Poorer health

Expand role, not scope Assess and identify gaps between community needs and servicesImprove quality of life/health

THE COMMUNITY PARAMEDIC PROGRAM

VOLUNTEER AND PAID PARAMEDICS

EMTs/Paramedics already know how to deliver care locally

Assess resources and make decisions

They can fill gaps in care with enhanced skills through targeted training

EXPANDED SERVICES

Primary careEmergency care Public health Disease management PreventionWellness Mental health

KEYS TO COMMUNITY PARAMEDIC PROGRAM

GAP-FILLING

FLEXIBLE

RESOURCEFUL

SERVING THE UNDERSERVED

FLEXIBLE

Identify specific needs in community health care

Standardized curriculum, modified for communities

ADDRESSING THE NEEDS OF THE UNDERSERVEDTarget populations with

problems in access to health care

Address special population issues

Rising health disparitiesAging Decreasing medical workforce

RESOURCEFUL

Identifies what is availableAnd what is missing

GAP-FILLING

Creates “health home” for citizensEyes, ears, and voice of community

COMMUNITY PARAMEDIC GUIDELINES

Essential oversight by community care providers

Practice where designated underserved

Approved and welcomedFunding specific to locale

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

Mobile Clinic

SCOTT COUNTY MED-FIRE CLINICSMed-Fire medical van

travels to five areas throughout Scott County every two weeks

14-20 patients per session

Access issues – cannot afford insurance

Identify a medical home

TRAINED BY LOCATION

Florida

Minnesota

Maine

Canada Nova Scotia

Washington

North Dakota

Nevada

Idaho

MissouriKansas

New Jersey

North Carolina

South Dakota

COMMUNITY PARAMEDIC TRAINED OR IN TRAINING

Spring Program 2008 Metro & Outstate MN8

Fall Program 2010 Rural5

Spring Program 2012 Metro12

Fall Grant Class 201318

Fall Program Class 2013Metro & Out of State 20

Spring Program 2013 Metro, Outstate MN24

Spring Grant Class 201324

Spring Northern MN 201313

Fall Program 2013 Metro, Outstate24

Fall Grant Class 201330

Fall Contract 2013 ME, NC, NJ21

Winter 201424

CARING FOR HIGH-RISK PATIENTS

Patients taking 10 or more medications

Patients who have tight therapeutic window medications such as “warfarin”

Patients who have 3 or more chronic diseases

Patients with mental health and disabling conditions

CP PROGRAM IN ACTION

Metro program went live on October 1, 2012

CPs are available every day, seven days a week

Carry their own supplies and vehicle6-9 patients per dayElectronic medical records interface

CP PROGRAM IN ACTION

Rural program Spring 2014Park Rapids, MN communityPopulation 3,700This 4th group of providers will work with public health and the Essentia Health Care system to provide care to area patients

CP PROGRAM IN ACTIONRural program Spring 20145th Group - Faribault, MN Population 22,000Care to patients dealing with chemical dependency, geriatric issues and mental health issues

Allina Clinic, District One Hospital and Rice County Public Health Services

THE COMMUNITY PARAMEDIC PROGRAM

Level 1 -- Non-paramedic filling some roles of the Community Paramedic

Level 2 – Certificate or Associate Degree

Level 3 -- Bachelor’s Degree

CURRICULUM IS IN PLACE

Standardized multi-module delivery model

Applicable across America and internationally

14 credit certificate

CONTENT

Chronic disease managementCardiac, respiratory, diabetes , neurological

Pathophysiology PharmacologyMental healthText books

CURRICULUM PHASE II

Clinical Skills @ 196 hours

THE CLINICAL EXPERIENCE

Primary careCommunity Health/Hospice

Wound careBehavioralCardiology & respiratoryPediatrics & geriatricsNetworking

MEETING THE NEEDS OF ACCOUNTABILITY

Conducting the necessary readiness analyses and enabling a ready medical work force.

Conducting the necessary readiness analyses and enabling a ready medical work force.

Managing the cost of health care provided. Eliminating waste and unwanted variation.

● 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 PARAMEDICACHIEVING THE QUADRUPLE AIM

● 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….

FireHospitalPrivate Systems

● From initial 911 call to primary care integration

CP PAYMENT & DELIVERY MODELING

Minnesota – Currently the only Community Paramedic program in the nation that is:

● Credentialed● Reimbursable● Integrated

Linking Primary Care & EMS

COMMUNITY PARAMEDIC SOLUTIONHOW DO WE DO THIS?

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

Establ ished Community Paramedic Cert ification

SF 119

Establ ished 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

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

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

INTEGRATING COMMUNITY

PARAMEDIC INTO THE HEALTHCARE SYSTEM