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.
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
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
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
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.
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, see
A Guide to Working with Rural Philanthropy.
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
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
Rural Emergency Care Integration Summit
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
10 MIH or Community Paramedicine Program Funding Sources
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.