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Community Paramedicine and the Changing Face of Pre-Hospital Care

Author: Experts from the CMS Innovation Center
Published Date: 5/20/2016 10:59:00 AM
Category: Public Health Preparedness; Response & Recovery; Innovations; Hospital Preparedness;

For decades, emergency medical services (EMS) have conjured an image of ambulances speeding to save a life. We’re all familiar with their customary and important roles: rapid response for those in medical crisis; stabilization at the scene when necessary; and transport to hospital emergency departments (EDs) for continued management. Activated by a national network of 911 call centers, EMS professionals are poised for deployment to almost any site in the country to intervene in an emergency.

Today, however, many EMS systems have evolved from responding to medical emergencies to providing a broad range of mobile health and clinical services. In this regard, EMS professionals are serving as the safety net for patients with chronic conditions who lack reliable, responsive primary care. The dataExit Icon seem to suggest that these efforts can address chronic health problems before they become emergencies. From transporting patients with less acute problems to an urgent care clinic or physician’s office as opposed to an ED to helping individuals more effectively manage their condition at home, the face of EMS is changing.

Related challenges and opportunities for the future of EMS are being addressed by innovative programs for enhancing paramedic services, including several interesting model tests supported through the Centers for Medicare & Medicaid Services (CMS) Innovation Center’s Round One and Round Two Health Care Innovation Awards (HCIA-1, HCIA-2). For the last several years, awardees have tested a range of EMS interventions, such as:

  • basic primary care by nurse practitioners/paramedic teams who treat and release patients in their homes or in the field following a 911 call [City of Mesa Fire & Medical Department];
  • use of community paramedics to conduct home assessment for fall risk [Yale] and transition patients from an in-patient hospital stay to a successful recovery in the home [REMSA];
  • ambulance transport of patients with less urgent medical conditions to locations other than the ED (e.g., urgent care centers, detoxification centers, behavioral health facilities) [City of Mesa Fire & Medical Department, REMSA];
  • nurse triage and referral to health care and community services via a non-emergency nurse health line [REMSA] or a 911 call [City of Mesa Fire & Medical Department]; and,
  • treatment at home for patients who would otherwise be admitted to a hospital admission for selected conditions [Mount-Sinai].

These approaches to enhancing EMS were discussed at a recent roundtable hosted by the CMS Innovation Center on March 17, 2016. The roundtable was convened as part of a Population Health Summit Series, in which the CMS Innovation Center brings key payer and provider stakeholders from across the HCIA landscape to identify alternative payment strategies that combat big population health problems. Over the course of this recent full-day gathering, four HCIA awardee teams, relevant payers, and federal partners across the U.S. Department of Health and Human Services and other agencies explored barriers, opportunities, and solutions to sustainability. The primary aim was to assist awardees in continuing to provide better care in their communities. Ultimately, the dialogue served as a catalyst for awardees to strategize on ways to optimize EMS within their own markets and to model success for other markets across the U.S.

CMS has a vision for a high-quality health care system in which patients receive better care, our health care dollars are spent more wisely, and people are healthier. In some instances, federal awards, such as those delivered via the CMS Innovation Center’s HCIA portfolio inform this vision. In the context of EMS specifically, HCIA is providing a pathway for key players in the EMS system – whether fire departments, non-profit EMS providers, or academic medical centers – to test new ways to deliver and pay for the rapidly changing face of pre-hospital care. Independent evaluations of the HCIA projects are ongoing. In the meantime, a wealth of learning is happening in the EMS world as a result of these projects. As similar innovations emerge across the country, we encourage EMS organizations to collect meaningful data that can be used to drive performance improvement, reduce costs, and most importantly, improve the health of communities in need.


The following experts contributed to this article:  Mollie Howerton, PhD, MPH, Division of Health Innovation and Integration, Preventive and Population Health Care Models Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services & Nevin Laib, PhD, Division of Stakeholder Engagement & Policy, Policy & Programs Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services & Tiffany McNair, MD, MPH, Director, Division of Health Innovation and Integration, Preventive and Population Health Care Models Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services & Darshak Sanghavi, MD, Group Director, Preventive and Population Health Care Models Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services

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