Community paramedicine: ‘They trust us’
Finally, reimbursement for community paramedic home visits on the horizon
The landscape of EMS has changed substantially over the last decade. Agencies are struggling with recruitment, retention, the COVID pandemic, mass causality incidents, ED overcrowding and extended wait times to transfer care, causing transport units to be out-of-service at the hospital.
One company is aiming to change that this year with the final push for reimbursement for community paramedics, relieving some of the burden on our nation’s EMS system and bringing compassion, empathy and attention back to the patient.
MedAware Solutions, a Missouri-based company, is working to bring universal reimbursement for mobile integrated health/community paramedicine programs for their involvement in home visits. According to Chief Operating Officer, Chris Cebollero, the company has partnered with insurance payers to reimburse EMS agencies for visiting their high utilizers.
“The Mobile Care Access program has been active since 2022 in eight states,” Cebollero said. “By the end of 2023, we will be adding 11 more states, bringing the total to 20 states and 60-70 EMS systems nationwide.”
MedAware Solutions employs nearly 40 operational, clinical, outreach, integration and IT professionals to assist EMS agencies and the insurance members.
“The program is revolutionary. MedAware Solutions works together with EMS agencies that want to build a community paramedicine program, if they don’t already have one established,” Cebollero said. “We will help you develop your program, get the members and then get paid for your service. This is an all-encompassing program.”
Cebollero reported the company is currently active in counties and cities in South Carolina, Indiana, Missouri, Kentucky, Iowa, Nebraska, Texas and Florida. By the end of 2023, they will be active in Georgia, Washington, Virginia, Maryland, New York, New Jersey, North Carolina, Louisiana, Wisconsin, Ohio and Tennessee.
How the program works
MedAware Solutions works with the insurance company to provide local agencies with a list of members classified as high utilizers. These members use the EMS system and emergency departments on a regular basis, because for decades they have been told to “call 911 and go the emergency department,” Cebollero said.
“The way the program works is the insurance company will give a list of high utilizers to MedAware and they will make the initial contact with the member,” Cebollero explained. “This way, the EMS agencies are not cold calling members.” Working with the EMS agency’s calendar for initial visits, MedAware will set up the initial meeting with the member.
MedAware Solutions has access to all the resources the insurance company does, including case management, pharmacy, financial assistance and free cell phones for Medicaid members.
“From there, the community paramedic will see the member and create a care plan,” Cebollero added. “This care plan is approved by the primary care physician or the EMS medical director. In the care plan, the community paramedic will outline the objectives they want to attain over the visits.”
The insurance company pays a per-visit fee for this work and will allow 11 visits. The EMS agency’s community paramedics set the outcome of the visits, including financial assistance with rent, electricity or food insecurities, or connecting members with their primary care physicians.
“Medicaid members are not really taken care of in the medical community,” Cebollero said. “We find that primary care physicians don’t have good engagement with their patients and put Medicaid patients in a horrible place. Their trust in the healthcare world is minimal.”
“They trust the paramedic”
The patients often say they trust the community paramedics more than their own physicians, Cebollero noted.
“They trust the (community) paramedics coming into their home because we can spend time with them. We get to know them. They trust us,” Cebollero said, adding that at a minimum, the community paramedic could spend 11 hours with a member compared to short office visits with their primary care physician.
According to Cebollero, the EMS systems in the program are seeing a reduction of high utilizer volume upwards of 60% in systems that are already short EMS professionals. They’re helping members who have literacy issues, have challenges using a computer or who don’t have access to a computer, those who don’t understand the medications they are taking or their health conditions.
The community paramedic talks with the member about their medications, their living situation and good nutrition, and educates the Medicaid patient on their health conditions, providing a better quality of life.
“Some of these members are living in garages and tool sheds. Community paramedics can get them Section 8 housing, assist with getting them jobs and to understand the importance of trending their blood sugar … we are treating people,” Cebollero said.
Some of the agencies involved go above and beyond the scope of the program. Examples include the Lexington Fire Department, which had a patient who underwent a double mastectomy and had to move. The community paramedics took a truck from their motor pool and moved the patient. In another display of compassion and empathy, when a member lost his cell phone, the community paramedic retraced his steps to locate the missing device, Cebollero said.
MedAware provides the blueprint
MedAware Solutions helps EMS agencies build their program, teaching initial training, and they have written sample policies, procedures, protocols and as a blueprint, as well as a CQI program – everything needed to begin a community paramedic program.
“What is different about the MedAware Solutions program is we bring everything to you,” Cebollero said. “We bring the community paramedic course, the policy and procedures, the infrastructure, a book of business and the reimbursement for your services.”
Cebollero has been working in community paramedicine space for the past 15 years.
“Even though people say it is a new model, it has been around for over 15 years with the first program starting in 2007 or 2008, with more programs popping up over the years,” Cebollero said. “MedStar was the first in Texas.”
Cebollero, a paramedic since 1987, served in the United States Air Force. After leaving the military, he worked in the Northeast United States as a paramedic before moving to Fort Worth, Texas, and starting a career with MedStar. He became the clinical coordinator and clinical director before accepting a position as the Chief of EMS for Christian Hospital in St. Louis, Missouri. He has a national footprint including serving on the board of director for NAEMT.
Services performed by a community paramedic
- Coordinating health services for patients/clients
- Determining the need for and providing referrals to community resources (such as mental health, substance abuse, public health and social services).
- Assessing safety risks for the community paramedic
- Providing oral health education and/or screening
- Educating on identified healthcare goals
- Performing a physical safety inspection (for example, home, property and vehicle)
- Screening for chronic disease (such diabetes, asthma and coronary artery disease)
- Educating on proper use of healthcare resources
- Providing service with the local public health agency (for example, immunization and disease investigation)
- Providing service with the local social service and aging agencies (for example, adult protection, child protection senior services and housing)
- Participating in wellness clinics (such as immunization and screening)
The community paramedic can assist members with arranging temporary foster care, transportation, child/social services, meals-on-wheels, women’s shelter, primary care direction, treat and release, urgent care or dialysis center needs.
If you want to find out more about the program, interested agencies can contact Chris Cebollero, chief operating officer of MedAware Solutions at email@example.com.
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