Are Community Paramedics the Solution to Patient Management?

It all started with a simple goal: reduce 911 call volume by reaching patients with chronic conditions before their situation becomes an emergency. Before they call 911. Before they have to be readmitted to the hospital.

But now, the Montgomery County Hospital District’s (MCHD) Community Paramedicine program has grown into something much more. It is a lifeline for patients who just need someone looking out for their best interest—making sure they have access to fundamental human needs like food, housing and medical care. The Community Paramedicine program works to find unique solutions to common healthcare barriers.

How Community Paramedics Bridge the Gap

“A common problem we encounter with our patients is a lack of funding,” says Morgan Clark, MCHD Community Paramedic Case Manager. “Sometimes it’s as simple as gathering the necessary paperwork, so (patients) qualify for our county healthcare assistance program. Other times, it’s navigating governmental aid like disability assistance or veterans’ benefits. We’re willing and able to jump through the hoops to help them get access to insurance.”

Since the implementation of the program, Community Paramedicine has enrolled more than 800 patients, and that number is growing—thanks to a partnership with a local hospital-based clinic. CHI St. Luke’s The Woodlands Transitional Care Clinic refers all unfunded patients to the Community Paramedicine program, in hopes they are able to connect these patients to adequate medical coverage. To date, the MCHD Community Paramedicine program has been able to secure insurance for 67 percent of referrals, at no cost to the patient.

“The partnership with the community paramedic case managers has been a cornerstone of the success of the Transitional Care Clinic,” said Anthony Stock, Hospitalist and Nurse Practitioner at CHI St. Luke’s The Woodlands.

“We owe that to a true multidisciplinary collaboration in providing care to high-risk patients.”

Nivea Wheat, MCHD Community Paramedic Case Manager, agrees.

“To be able to have that much success for our patients in just the 14 months we’ve been working with St. Luke’s is incredible,” she said. “Because of that success, we’re looking to expand our services to more people in the community. But, the best way for people to benefit from our services is from referrals. We need physicians, clinics, and hospitals to recognize the need for this service and pass the information along to those who need us most.”

Aside from connecting patients to a payor source, Community Paramedicine also prioritizes quality of life for these patients. They focus on finding resources in the community to provide everything from food, clothing, and safe housing—to assistance with household expenses and income. MCHD’s case managers will work to set the patient up with a primary care physician and educate them on the health literacy applicable to their unique situation. No situation that applies to the patient’s overall well-being is ignored, even if they just need help with an outstanding utility bill.

“We have had success with our goals because we are in the community. We have had face time with many of the local resources, which helps when trying to access them for the patients. All of our community paramedics have had field time as 911 paramedics, so we don’t do well taking ‘no’ for an answer. We will find a way to ensure the best outcome for our patients.”  

Promoting Mobile Integrated Healthcare

Another aspect that has arisen since partnering with CHI St. Luke’s The Woodlands Transitional Care Clinic is MCHD’s Mobile Integrated Health (MIH) initiative. This program deploys specially-trained 911 responders to manage a patient with a chronic illness like congestive heart failure or chronic obstructive pulmonary disease in the comfort of their own home. The goal is to keep them from being readmitted to the hospital, until the Community Paramedicine program can follow up or until an appointment with their physician can be made. As MCHD’s referrals from the Transitional Care Clinic have been inpatient less than 30 days prior to referral, the goal is to empanel them with medical coverage and help be the stopgap for readmission in the 30-day window.

The Community Paramedicine team strives to take a holistic approach in patient treatment by revealing underlying causes or social determinants affecting a patient’s optimal well-being.

“Wound care clinics could also be an excellent referral source for the Community Paramedicine program,” said Ms. Clark. “A lot of patients in wound care clinics often have other medical conditions that may exacerbate a wound or prevent it from healing. Having access to a Community Paramedicine program with MIH responses or resources assistance can increase compliance with treatment plans and decrease readmissions to the hospital. Sometimes just having someone there to remind you to take care of yourself can make all the difference.”