Experts weigh in on community paramedicine implementation

An expert panel at the NAEMSP pre-conference explored data, regulations, policy, financing and sustainability for EMS administrators and medical directors implementing MIH or CP programs

By Catherine R. Counts

SAN DIEGO — The Mobile Integrated Health Care/Community Paramedicine committee hosted a well-attended and engaged pre-conference at the annual NAEMSP meeting to discuss advanced MIH/CP topics to better inform EMS administrators and medical directors implementing these programs.

The four-hour session was split into three panels around the themes of data and metrics, regulations and policy, and financing and sustainability. Here are memorable quotes, key takeaways and a summary of each panel's presentation.

Memorable Quotes
"EMS has previously used public acts of heroism, but it is the private acts of humility that will bring recognition." — Shaughn Maxwell

"There is no new money … Reinvest the savings in order to sustain you savings." —Brenda Staffan

"Please stop waiting for a map. We reward those who draw maps, not those who follow them." — Seth Godin. Used by David Schoenwetter to convey that there is no roadmap for creating or sustaining a MIH/CP program. We are in the innovation phase, so any organization with one of these programs isn’t using a map. 

"In God we trust, all others must bring data" — W. Edwards Deming. Used by David Schoenwetter to convey importance of collecting data.

Key takeaways on development of MIH/CP
Key takeaways for EMS professionals on the innovation and development of MIH/CP:

  • MIH/CP programs are innovations within EMS and within health care; therefore there is no right way to do things. Variation within and across models will consolidate with time.
  • EMS organizations implementing an MIH/CP program must consider local health care environment as well as the broader national health care policy moving forward. 
  • Only way to prove success of MIH/CP program is via data and regardless of data quality you have to start somewhere.
  • Medical director engagement is imperative to success of MIH/CP program.

Panel 1: Data and metrics
Panelists: Brenda Staffan, Dan Swayze, and Brent Meyers.

Since most of health care has recognized that the IHI Triple Aim is an important guide for making clinical and organizational decisions, data should and can be used to help convey those ideals. This means implementing evidence-based guidelines when available and evaluating the success of MIH/CP programs with research designs and methodologies that go beyond basic analytics. Data that is collected should measure the four categories first introduced by Donabedian: structure, process, outcomes and balancing measures. 

Panel 2: Regulations and policy
Panelists: William Snoke, Carol Cunningham, Shaughn Maxwell.

Lobbyists across all health care industries have played a critical role at the state level for creating support within state legislatures for regulatory changes. By engaging those outside of EMS, a broader spectrum of support is provided, a critical element given the number of stakeholders required to pass a bill into law. Although numerous states have seen recent success in passing laws related to MIH/CP, each was forced to take a different path based on the unique pre-existing laws and regulatory climates of their state. Advocates can apply the lessons learned from others and redeploy modified versions in their environments

Panel 3: Finance and sustainability
Panelists: Brent Meyers, Brenda Staffan, and David Schoenwettter.

Health care reimbursement is changing more rapidly than many realize. Last summer Health and Human Services Secretary Burwell outlined her goals regarding the implementation of value-based purchasing, which can be used as evidence of the value added to other organizations by partnering with MIH/CP programs. Partnerships throughout the community are the key to sustainability, but they aren’t possible without proper engagement and advocacy. 

About the author
Catherine R. Counts is a doctoral candidate in the department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine where she also previously earned her Master of Health Administration. Counts has research interests in domestic health care policy, quality and patient safety, organizational culture and prehospital emergency medicine. She is a member of AcademyHealth, Academy of Management, the National Association of EMS Physicians, and National Association of EMTs.

Counts is the author of a blog focused on applying the concepts of health services research to the field of prehospital emergency medicine. Connect with her on Twitter or contact her via email at

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