INTEGRATING Community paramedic INTO THE HEALTHCARE SYSTEM Dr. Michael Wilcox Kai Hjermstad Buck McAlpin December 2 2013

THE ACCESS DILEMMA RURAL AND REMOTE 1/4 of Americans live in rural and remote areas Only 10% of America’s doctors practice there 4 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

THE COMMUNITY PARAMEDIC PROGRAM Expand role, not scope Assess and identify gaps between community needs and services Improve quality of life/health

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 care Emergency care Public health Disease management Prevention Wellness Mental health

KEYS TO COMMUNITY PARAMEDIC PROGRAM RESOURCEFUL FLEXIBLE SERVING THE UNDERSERVED GAP-FILLING

FLEXIBLE Identify specific needs in community health care Standardized curriculum, modified for communities

ADDRESSING THE NEEDS OF THE UNDERSERVED Target populations with problems in access to health care Address special population issues Rising health disparities Aging Decreasing medical workforce

RESOURCEFUL Identifies what is available And what is missing

GAP-FILLING Creates “health home” for citizens Eyes, ears, and voice of community

COMMUNITY PARAMEDIC GUIDELINES Essential oversight by community care providers Practice where designated underserved Approved and welcomed Funding specific to locale

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY Mobile Clinic

SCOTT COUNTY MED-FIRE CLINICS Med-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 Canada Nova Scotia Maine Washington North Dakota Minnesota Idaho South Dakota New Jersey Nevada Kansas Missouri North Carolina Florida

COMMUNITY PARAMEDIC TRAINED OR IN TRAINING Spring Program 2008 Metro & Outstate MN 8 Fall Program 2010 Rural 5 Spring Program 2012 Metro 12 Fall Grant Class 2013 18 Fall Program Class 2013 Metro & Out of State 20 Spring Program 2013 Metro, Outstate MN 24 Spring Grant Class 2013 24 Spring Northern MN 2013 13 Fall Program 2013 Metro, Outstate 24 Fall Grant Class 2013 30 Fall Contract 2013 ME, NC, NJ 21 Winter 2014 24

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 vehicle 6-9 patients per day Electronic medical records interface

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

CP PROGRAM IN ACTION Rural program Spring 2014 5th Group - Faribault, MN Population 22,000 Care 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 management Cardiac, respiratory, diabetes , neurological Pathophysiology Pharmacology Mental health Text books

CURRICULUM PHASE II Clinical Skills @ 196 hours

THE CLINICAL EXPERIENCE Primary care Community Health/Hospice Wound care Behavioral Cardiology & respiratory Pediatrics & geriatrics Networking

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

Community Paramedic ACHIEVING THE QUADRUPLE AIM ● 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

CP Payment & Delivery modeling ● 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…. Fire Hospital Private Systems ● From initial 911 call to primary care integration

COMMUNITY PARAMEDIC Solution How DO WE DO THIS? Minnesota – Currently the only Community Paramedic program in the nation that is: ● Credentialed ● Reimbursable ● Integrated Linking Primary Care & EMS

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 SF 119 Established Community Paramedic Certification

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 SF 1543 Established Reimbursement

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

LAUNCHING A CP PROGRAM 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

INTEGRATING Community paramedic INTO THE HEALTHCARE SYSTEM