Mobile Integrated Healthcare and Community Paramedicine Models

Mobile integrated healthcare (MIH) refers to the practice of providing patient-centered healthcare services outside of the hospital or traditional clinical environment. MIH often refers to community paramedicine; however, MIH differs in that it integrates a broader range of services and types of providers. MIH may involve, for example, emergency medical services (EMS) personnel, nurses, and social workers, whereas community paramedicine involves only EMS personnel. Because MIH providers include a range of specialists, they can offer services like chronic disease management, referrals to other care providers, and telephone advice instead of immediate dispatch of EMS services to 911 callers. Some programs prefer to use the term "mobile integrated healthcare" instead of community paramedicine, particularly if providers have not been required to complete advanced community paramedic training.

Community Paramedicine

MIH services can include community paramedicine, in which paramedics and emergency medical technicians (EMTs) are trained to provide non-emergency services and collaborate closely with other providers, services, and organizations to fill gaps in access to healthcare in rural communities.

Community paramedics (CPs) provide a wide range of direct clinical and preventive services in patients’ homes and communities including:

In-home clinical care and monitoring. Community paramedics conduct home visits to assess patient health status, monitor vital signs, and manage chronic conditions such as hypertension, diabetes, and COPD.
Post-discharge care and follow-up. CPs provide follow-up care after hospital discharge, including medication reconciliation, symptom monitoring, and early identification of complications to prevent readmissions.
Preventive services and screenings. CPs deliver preventive care such as immunizations, health screenings, and routine health checks.
Health education and self-management support. CPs educate patients on disease management, medication adherence, and healthy behaviors to support long-term health outcomes.
Basic treatment and clinical interventions. Depending on training and program scope, CPs may provide services such as wound care, injections, and other basic treatments typically delivered in outpatient settings.

In addition to delivering direct clinical care, CPs play an important role in coordinating care and facilitating transportation, including:

Coordinating with non-emergency healthcare facilities. In communities where non-emergency healthcare services are available, community paramedics can help patients access non-emergency care by coordinating with and providing transportation to facilities such as primary care, urgent care, mental healthcare, and substance use disorder treatment. In this way, community paramedics can support access to care in locations other than an emergency department (ED).
Transporting patients between care locations. CPs are trained to assess a patient’s need for alternate care. For example, an individual experiencing a mental health crisis who calls EMS may need transportation to a behavioral health center, rather than an ED. CPs can facilitate this access by providing transportation directly to the appropriate care location.
Transporting patients to medical appointments. Rural community paramedicine programs may work with the local authority that coordinates non-emergency medical transportation (NEMT) to ensure reliable transportation to medical appointments. CPs can provide and facilitate use of NEMT services for eligible patients.

Street Medicine

Street medicine involves multidisciplinary teams who provide care directly to people where they live — thus eliminating logistical access barriers. While street medicine is often associated with outreach to unhoused populations in urban areas, its principles are being successfully implemented in rural settings through MIH programs. Street medicine teams increase direct access to individuals who may never seek traditional healthcare services and prevent avoidable ED visits and hospitalizations. Street medicine teams are also well positioned to build trust when they repeatedly initiate care within the same communities.

For example, the West Hawaii Community Health Center is incorporating street medicine practices to provide care to unsheltered individuals in remote and rural areas. Services include wound care, pain management, naloxone distribution, blood pressure monitoring, and access to feminine hygiene products.

Examples of Rural Mobile Integrated Healthcare and Community Paramedicine Programs

Prosser Memorial Health (PMH) received a Centers for Medicare and Medicaid Services (CMS) Health Care Innovation Award to fund their Community Paramedic Program. PMH serves a large, rural population in eastern Washington state that experiences difficulties accessing services from long distances. The Community Paramedic Program uses community resource paramedics to follow-up with patients who have chronic conditions. Their role is to ensure patients understand and follow discharge and medication instructions and provide necessary referrals.
Located in Edwards, Colorado, Eagle County Paramedic Services runs one of the longest-standing community paramedicine programs in the U.S. The program delivers primary and acute transitional care as well as behavioral support in-home or in the community. The program’s comprehensive services include a well-baby program, blood draws, wound checks, immunizations, and intravenous catheter changes. In 2024, Eagle County Paramedic Services’ Community Paramedics conducted 688 Mobile Integrated Health calls, 74 community clinics, and 53 behavioral health crisis calls.
In West Virginia, the Kanawha County Ambulance Community Paramedicine Program was developed to reduce costs from hospital readmissions and frequent emergency room visits. In its first year of operation, the program achieved decreased readmissions and increased Patient Activation Measure (PAM) scores, which indicate increased confidence in participants’ ability to manage their health.
McDowell County EMS in North Carolina implemented a pilot Community Care Paramedic Program, funded by the Kate B. Reynolds Charitable Trust. The program addresses high ED utilizers by 1) providing alternate destination transportation to a behavioral health clinic for patients experiencing a mental health emergency and 2) conducting home visits to identify problems like broken medical equipment or medication issues and addressing them with the patient's primary care provider. An evaluation calculated 125 EMS transports and ED visits were avoided during the pilot program.
The Regional Emergency Medical Services Authority (REMSA) in Washoe County, Nevada, developed an Alternative Destination Transport program to bring low-acuity 911 patients to urgent care centers, detoxification centers, and mental health hospitals. First responders evaluate patients in the field to determine what type of care is needed and then transport the patient to the appropriate facility for care.

Implementation Considerations

Rural communities implementing a mobile integrated health or community paramedicine program should consider funding and reimbursement, statutes and regulations, and duplication of services.

Funding and reimbursement. Under fee-for-service payment models, payers such as Medicare typically only reimburse EMS costs, including ambulance transport, when a patient is taken to an ED. Because community paramedicine programs are often designed to reduce costly and unnecessary transports by treating patients in place or providing transportation to alternate care locations, many of their services may not be reimbursed under traditional payment models.

Many programs are currently funded through in-kind or financial support from ambulance services, hospitals, or grants. However, payers are starting to recognize the financial savings provided by community paramedicine programs. For example, Accountable Care Organizations (ACOs), which operate under value-based payment models, are increasingly supporting community paramedicine programs. Further, some private insurers are beginning to consider reimbursing emergency medical services, even when the patient is not transported during the encounter.

Statutes and regulations. In some states, paramedics are limited by statute to only respond to emergency calls and provide medical services as a first responder. Because of this and other scope of practice regulations, state and local jurisdictions may have difficulty establishing a community paramedicine program. Some states, like Minnesota and Wisconsin, have successfully passed legislation to broaden the scope of practice for paramedics, which can support the establishment of community paramedicine programs.

Concerns about duplication of services. Rural communities should consider the potential overlap between the roles and responsibilities of community paramedicine programs with existing programs and services, such as home health, home visiting, and community health worker programs. Since community paramedicine programs are not "one-size-fits-all," jurisdictions should carefully assess which types of community paramedicine services are most important and tailor their programs to avoid duplication and fill the existing gaps.

Program Clearinghouse Examples

Resources to Learn More

Allied Health Professions Series: Community Paramedics
Document
Explores how states are using community paramedicine to expand access to preventive and non-emergency healthcare. It outlines state-level efforts to train, license, and integrate community paramedics into health systems, especially in rural areas.
Organization(s): National Conference of State Legislatures
Date: 5/2025

Bridging the Gap: A Policy Framework for Sustainable Community Paramedicine in Rural America
Document
Outlines policy and reimbursement barriers to community paramedicine in rural areas, including limitations of transport-based EMS payment models, and offers recommendations to support sustainable program funding and integration.
Author(s): Gorndt, K., Haverly, K., & Syverson, T.
Organization(s): National Rural Health Association
Date: 12/2024

Leveraging Community Paramedicine to Address Rural Health Needs
Document
Outlines how community paramedicine programs can improve rural healthcare access and outcomes, highlighting state innovations, Medicaid integration, and strategies for training, technology use, and program sustainability.
Organization(s): Center for Health Care Strategies
Date: 10/2025

National Association of Mobile Integrated Healthcare Providers
Website
Provides resources to learn more about MIH programs and opportunities to connect with MIH providers to increase community awareness of community paramedicine programs.