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Strategies for Sustaining Community Paramedicine Programs

Rural organizations can use different strategies for sustaining community paramedicine programs. When deciding which strategies to pursue, programs should consider their patient population, program activities, and funding mechanisms in their local health system and state Medicaid agencies. The Rural Community Health Toolkit provides information about general Sustainability Strategies and Sustainability Strategies for Specific Issues.

Reimbursement

As community paramedicine programs expand the scope of EMS providers, new opportunities for reimbursement may be possible from traditional healthcare payers. Payers are interested in reducing costs, improving care quality, and improving population health. As a result, there has been increased interest in recent years from private and public payers in community paramedicine models that can achieve these goals. Accountable care organizations (ACOs) and other value-based payment models are one way that providers can share in cost savings that result from successful community paramedicine programs.

The Centers for Medicare and Medicaid Services (CMS) developed Emergency Triage, Treat, and Transport (ET3), a five-year, voluntary payment model that allows EMS providers to offer more flexible services to Medicare beneficiaries. For more information about ET3, see Community Paramedicine Models for Reducing Use of Emergency Resources.

According to the National Association of State EMS Officials, state Medicaid agencies in Arizona, Georgia, Minnesota, Nevada, and Wyoming have begun reimbursement for community paramedicine services. Fourteen states provide some reimbursement for treatment without transport. In addition, commercial insurers have launched pilot projects in 17 states to explore payment models for community paramedicine programs.

As more payers begin reimbursing for community paramedicine services, programs will be able to build a sustainable revenue base that supports their work with a variety of patient populations.

Cost-Sharing with Partners

Because community paramedicine programs by design reduce overall costs to the healthcare system, some local organizations benefiting from the lower costs may be willing to invest in continuing the program. Building these relationships can help community paramedicine programs share scarce resources with rural hospitals, rural health clinics (RHCs), Federally Qualified Health Centers (FQHCs), and other healthcare providers serving rural communities.

To find the right partner, think about the specific services the community paramedicine program is providing and how they might reduce costs or improve outcomes. For example, assisted living facilities may be responsible for costs associated with bringing their residents to and from the hospital. If the community paramedic provides services to residents without requiring a hospital visit, those savings could be used to fund the community paramedicine program while keeping residents more comfortable at home. Similarly, community paramedicine services may reduce hospital readmissions, helping the hospital avoid penalties. Those savings could be invested in continuing the service. Not-for-profit healthcare organizations are also required to have community benefit programs, which might also provide a potential partnership opportunity.

Other emergency medical services (EMS) providers may also be good partners. When Rio Rico Fire District launched their community integrated paramedicine program with other EMS agencies in the county, the agencies found that pooling resources allowed them to stretch their services further. Other agencies were all-volunteer and did not always have the capacity to schedule patient appointments. By sharing responsibilities, all partners were able to more consistently provide emergency and community paramedicine services to their constituents.

Nonprofits and Foundations

Many community paramedicine programs seek start-up or maintenance funding support from nonprofits, foundations, and other grant-giving organizations. Depending on the scope of the grant, funds may be used for infrastructure costs like purchasing new vehicles or equipment, for personnel training, or for general operational support. Foundations funding rural community paramedicine/mobile integrated health research and programs include:

For more information about building relationships with rural philanthropic organizations, visit the Rural Philanthropy Toolkit.

Government Grants

In addition to private grant making organizations, community paramedicine programs can seek support from federal and state grants. Federal agencies that have offered grants to fund community paramedicine programs in the past include:

State EMS or public health agencies may also offer routine or special grant opportunities that can be used to fund community paramedicine services.

The Rural Health Information Hub provides a list of active and inactive community paramedicine funding opportunities.

Other Strategies

Some community paramedicine programs sustained services using other strategies. Rural community paramedicine programs can be funded by local tax dollars or by residents who are themselves interested in receiving the services. For example, residents could join a concierge medicine program. The fees would pay for the necessary additional EMS training and participants would then have a community paramedic to provide primary care or urgent care services (like suturing) in their home, without having to travel long distances to the hospital.

Resources to Learn More

2019 Rural Emergency Care Integration Summit
Document
Provides information to help rural EMS leaders and other healthcare providers during the transition from volume- to value-based care. Addresses the need for rural EMS agencies to move into new roles during this transition. Suggests strategies to prepare and integrate into this environment and offers ideas for collaborating with local partners.
Organization(s): National Rural Health Resource Center
Date: 8/2019

Top 10 MIH or Community Paramedicine Program Funding Sources
Website
Provides examples of innovative or novel funding streams for community paramedicine and mobile integrated health services. Also identifies partners who may be willing to work with EMS providers to develop or sustain programming.
Author(s): Zavadsky, M.
Organization(s): EMS1.com
Date: 11/2017