Experts discuss issues facing community paramedicine

Leaders from established MIH/CP programs presented their most pressing issues at the NAEMSP conference


NEW ORLEANS — The National Association of EMS Physicians started their 2017 Annual Meeting with a day-long intensive session for EMS medical directors on mobile integrated health care and community paramedicine programs. The sessions were not intended to be an introduction to MIH/CP, but rather designed to provide insights to pre-existing programs.

The topics covered included financial sustainability, shifting the paradigm by which providers treat patients in the long-term and proving value to stakeholders. Here are some memorable quotes, key takeaways and a summary from some of the sessions at NAEMSP.

Memorable Quotes

Dan Swayze of CONNECT Community Paramedicine program discussing the importance of collaboration when trying to sustain a MIH/CP program. (Photo/Catherine Counts)
Dan Swayze of CONNECT Community Paramedicine program discussing the importance of collaboration when trying to sustain a MIH/CP program. (Photo/Catherine Counts)

This year’s session put together over a dozen experts from across the industry. Some focused on summarizing what their system is doing while others discussed more generic trends within MIH/CP. Here are some of the most memorable quotes from the day:

"MIHCP needs to become part of a central thread of EMS systems."
– Kevin Munjal, MD, from Mount Sinai Health System

"If you are looking for cash today, find it somewhere else."
– Dan Swayze, DrPH, CONNECT Community Paramedic program discussing the lag time for getting a contract signed

"Providers are becoming payers and payers are becoming providers, the line is being blurred."
– Jonathan Washko, Northwell Health Center for Emergency Medical Services

"If the patient hasn’t been compliant in the hospital, they are relatively certain the patient isn’t going to be compliant when they leave the hospital, so we essentially get the train wrecks and try to keep the wheels on for 30 days."
– Matt Zavadsky, MedStar Mobile Healthcare, discussing the types of patient their 30-day readmission program is likely to take care of

"There is an incredible toolbox that paramedics can bring to the bedside that doesn’t exist elsewhere in the community."
– Mike Guttenberg, MD, from Northwell Health Center for Emergency Medical Services

"The people paying for this program put the economics as the primary driver, the clinical outcomes are secondary."
– Matt Zavadsky discussing the hard truths of the economic model of health care delivery that drives many payers

"The most common question I get: can people other than paramedics do this stuff?"
– Andy Gienapp, administrator for the state of Wyoming Emergency Medical Services, explaining why he calls it Community EMS vs. Community Paramedicine

"As you face these legal and regulatory hurdles, Medicaid is your friend because Medicaid is highly interested in seeing [MIHCP programs] be successful."
– Andy Gienapp

"Data equals funding, a concept that can’t be over emphasized."
– Kevin Munjal

5 key takeaways on community paramedicine programs

The information presented varied, but a few common themes emerged. Here are a few key takeaways from the day:

1. Revenue generation

There is no mission without a margin. Community paramedicine programs don’t need to make a profit, but they have to break even or they’re doomed.

2. Measuring success

Different partnering agencies will have different metrics for measuring success, including the data being using, the expected return on investment, and even the integration between the MIH/CP program and their organization.

3. Multiple roles for EMS

EMS wears four hats: public health, emergency health care, public safety and disaster response. Each of those areas have their own regulatory and response requirements, which are likely going to continue to diverge as the social determinants of health and novel delivery models receive more focus.

4. Rural and urban

Although MIH/CP in the United States started in rural areas, as expected, the type of progress seen in rural versus urban systems is very different. Whether it’s with another EMS agency, or a forward-thinking payer or provider, competition is coming to the provision of MIH/CP.

5. Unique educational needs

The education model for MIHCP programs is very different from training paramedics for a 911 response. It focuses on individual chronic disease and transporting patients to alternative destinations compared to the 911 model which is time-sensitive complaint specific and transport focused.

Established programs discussed at NAEMSP

1. REMSA
2. MedStar 
3. University of Pittsburg CONNECT
4. Northwell Health 
5. Hennepin County Medical Center 

List of resources on MIH/CP

Check out these articles and videos to learn more about community paramedicine and mobile integrated health care.

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