This Could be a Roadmap for Other Programs to Emulate
FAIRFIELD COUNTY – Paramedicine is an innovative community health care program aimed at reducing health care barriers as well as costs.
The pilot program, formally known as “Improving Rural Health Care Through Community Paramedicine,” stations a specially trained community paramedic in a rural medical clinic, where they are also on call to travel to patients’ homes as needed.
When visiting a patient, a community paramedic is able to assess medical needs, help the patient access care, and transport them if necessary – whether that’s to the doctor’s office or to a hospital.
The program brings together the expertise of three partners: a rural medical practice, a medical transport ambulance service, and the state EMS Association, the second two of which won grant funding to jump-start the Fairfield program. They helped bring the pieces together to get it started.
“Community paramedicine is a program that takes EMS workers and puts them out in the field… doing proactive care to address social determinants of health,” says Henry Lewis, executive director of the South Carolina EMS Association, who says this is the only program like it in the state.
“[Social determinants of health are] things like inability to navigate the health care system, resources like transportation, pharmacy delivery, things like that.”
The medical practice involved is Fairfield Medical Associates, and the ambulance service is First Priority Medical Transport.
“Really, the vision is to be proactive to prevent folks form having a need to seek out an emergency room for treatment of their chronic illness,” says Michael Hall, chief of operations at First Priority, noting that emergency rooms are both the most expensive and statistically least effective form of care – and chronic conditions can often be managed best with the ongoing help of a primary care doctor.
“We can certainly reduce the number of emergency room visits, the number of hospital admissions, and we can help the community be healthier,” Hall says.
Some of the barriers to care that patients face can be as simple as not having transportation to a doctor’s office, not having the ability to pick up a prescription, or simply not knowing how to access the health care system.
Other Barriers to Care
Liz Mann, practice manager at Fairfield Medical Associates, says other social factors can also impact patients’ health.
If they can’t access healthy food or pay to heat their homes, for example, or if they live in a home that’s fallen into disrepair, their health can be negatively impacted – and, once someone is aware of the need, they can – through this program – be connected with services in the community that can help.
She says that in an era where many things can be brought to a person’s door – from groceries to products from the Internet – this program aims to bring needed health care services as well.
“Some of it is convenience, but some of it is for us to get to the patients who, for numerous reasons, struggle to get to us. So, how can we get qualified people out to them?” says Mann. “It’s a house call, but in a new way. It’s kind of a house call and telemedicine all wrapped up into one.”
A community paramedic, she says, is a paramedic who’s achieved some additional training that is more typical of a primary care nurse.
When a community paramedic responds to a call, they can assess the patient and then communicate with a doctor back at the primary care office. Then, if the doctor orders labs, such as a flu swab or a blood test, the community paramedic can collect the sample right then.
If the patient needs to be seen by the doctor, then the community paramedic can also provide transportation – whether for an acute problem or simply to complete annual health screenings.
In the case of a true emergency, they also have the means to transport the patient to the hospital.
In addition to the health benefit to patients, Lewis and Hall say the numbers make a compelling case on the potential for cost savings.
They say roughly half of the 1.6 million ambulance transports taking place each year statewide are calls that could be handled through a primary care practice.
If even 10 percent can be assisted by a community paramedic and primary care doctor, that would take a lot of pressure off emergency services, Hall says – from ambulance companies to hospital emergency departments.
And, considering that those transported hospital visits typically cost about $5,000 apiece, he says, the potential cost savings is considerable.
Goal of the Program
Ultimately, Lewis says, the goal of the pilot program is to demonstrate through improved health outcomes and cost savings that a community paramedic program like this one brings real value to rural health care – enough that, if reimbursable by health insurance and government health care programs, it could have a big cost-cutting impact.
He says they’re confident that the numbers work – and the paradigm shift it requires in how paramedics practice (from primarily reactive to more proactive) is well worth the effort.
“We think this is a great opportunity here in South Carolina to demonstrate for the rest of the nation how these programs can work,” says Lewis. “Our goal is to take information from this and apply it to our overall state health policy and kind of let this program be a roadmap that other programs can emulate.”
Now, three weeks into the program, Mann says she’s happy to have the community paramedic based inside her practice – and is looking forward to seeing the positive impact of the program on patients’ health.
“We’re just really excited about this collaboration to open up the access of health care a little bit more, get those patients into primary care, and cut down on the use of unnecessary ER visits,” she says.
“Transportation is a problem in this community, so we are trying to get our patients connected to quality health care, and we think the community paramedicine program is going to be a wonderful asset to our practice.”