dr. michael wilcox kai hjermstad buck mcalpin december 2 2013 integrating community paramedic into...
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Dr. Michael WilcoxKai HjermstadBuck McAlpinDecember 2 2013
INTEGRATING COMMUNITY
PARAMEDIC INTO THE HEALTHCARE SYSTEM
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THE ACCESS DILEMMA RURAL AND REMOTE
1/4 of Americans live in rural and remote areasOnly 10% of America’s doctors practice there4 times as many rural and remote residents travel > 30 miles for health care compared to urban residents
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RURAL AND REMOTE DEMOGRAPHICS
More elderly More immigrants More poverty Poorer health
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Expand role, not scope Assess and identify gaps between community needs and servicesImprove quality of life/health
THE COMMUNITY PARAMEDIC PROGRAM
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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
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EXPANDED SERVICES
Primary careEmergency care Public health Disease management PreventionWellness Mental health
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KEYS TO COMMUNITY PARAMEDIC PROGRAM
GAP-FILLING
FLEXIBLE
RESOURCEFUL
SERVING THE UNDERSERVED
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FLEXIBLE
Identify specific needs in community health care
Standardized curriculum, modified for communities
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ADDRESSING THE NEEDS OF THE UNDERSERVEDTarget populations with
problems in access to health care
Address special population issues
Rising health disparitiesAging Decreasing medical workforce
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RESOURCEFUL
Identifies what is availableAnd what is missing
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GAP-FILLING
Creates “health home” for citizensEyes, ears, and voice of community
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COMMUNITY PARAMEDIC GUIDELINES
Essential oversight by community care providers
Practice where designated underserved
Approved and welcomedFunding specific to locale
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SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
Mobile Clinic
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SCOTT COUNTY MED-FIRE CLINICSMed-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
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TRAINED BY LOCATION
Florida
Minnesota
Maine
Canada Nova Scotia
Washington
North Dakota
Nevada
Idaho
MissouriKansas
New Jersey
North Carolina
South Dakota
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COMMUNITY PARAMEDIC TRAINED OR IN TRAINING
Spring Program 2008 Metro & Outstate MN8
Fall Program 2010 Rural5
Spring Program 2012 Metro12
Fall Grant Class 201318
Fall Program Class 2013Metro & Out of State 20
Spring Program 2013 Metro, Outstate MN24
Spring Grant Class 201324
Spring Northern MN 201313
Fall Program 2013 Metro, Outstate24
Fall Grant Class 201330
Fall Contract 2013 ME, NC, NJ21
Winter 201424
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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
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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 vehicle6-9 patients per dayElectronic medical records interface
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CP PROGRAM IN ACTION
Rural program Spring 2014Park Rapids, MN communityPopulation 3,700This 4th group of providers will work with public health and the Essentia Health Care system to provide care to area patients
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CP PROGRAM IN ACTION
Rural program Spring 20145th Group - Faribault, MN Population 22,000Care to patients dealing with chemical dependency, geriatric issues and mental health issues
Allina Clinic, District One Hospital and Rice County Public Health Services
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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
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CURRICULUM IS IN PLACE
Standardized multi-module delivery model
Applicable across America and internationally
14 credit certificate
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CONTENT
Chronic disease managementCardiac, respiratory, diabetes , neurological
Pathophysiology PharmacologyMental healthText books
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CURRICULUM PHASE II
Clinical Skills @ 196 hours
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THE CLINICAL EXPERIENCE
Primary careCommunity Health/Hospice
Wound careBehavioralCardiology & respiratoryPediatrics & geriatricsNetworking
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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.
Managing the cost of health care provided. Eliminating waste and unwanted variation.
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● 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
COMMUNITY PARAMEDICACHIEVING THE QUADRUPLE AIM
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● Community Paramedic solutions span health care fi nance, 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 off ers new solutions across the continuum of care and types of services….
FireHospitalPrivate Systems
● From initial 911 call to primary care integration
CP PAYMENT & DELIVERY MODELING
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Minnesota – Currently the only Community Paramedic program in the nation that is:
● Credentialed● Reimbursable● Integrated
Linking Primary Care & EMS
COMMUNITY PARAMEDIC SOLUTIONHOW DO WE DO THIS?
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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
Establ ished Community Paramedic Cert ifi cation
SF 119
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Establ ished Reimbursement
SF 1543
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
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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 Offi ce of Rural Health and Primary Care
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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
LAUNCHING A CP PROGRAM
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INTEGRATING COMMUNITY
PARAMEDIC INTO THE HEALTHCARE SYSTEM