A Pandemic Gives Telehealth a New Purpose With Community Paramedicine

Putting Community Paramedicine to Work

In Pueblo, CO, Parkview Medical Center launched a partnership with the Pueblo Fire Department to create Directing Others to Services, of DOTS. The hospital-funded community paramedicine program, which identifies and provides home-based care for frequent flyers, has halved 911 calls – all but eliminating unnecessary transports – and saving the health system thousands of dollars.

“What we’re finding is that people aren’t connected to resources in their community,” says Kelly Firestone, Parkview’s community Risk reduction coordinator. “We find the barriers that exist in their lives and we break through those barriers.”

Firestone, who visits the homes of recently discharged patients identified as ideal candidates for DOTS, sees many different barriers to care, from transportation issues to an unhealthy or challenging home life.

“These problems aren’t being fixed in the emergency room,” she says.

Kelea Nardini, Parkview’s assistant vice president of quality and post-acute care, says the program helps these patients find the resources they need to maintain a healthier lifestyle at home. That often includes access to primary care providers, pharmacies and social workers, and soon will include telehealth access to substance abuse counselors, mental health counselors and other care providers.

“We’re a community-based care transition program, with the emphasis on community,” she says. “We take care of our community.”

They point out that DOTS, which was launched in 2015, was originally intended to last just three months, but they found that each patient’s needs are very different and have to be addressed as such – one person might need just one or two visits, while another might need frequent check-ups for six or nine months.

“We know these people, and who does what they say they’re going to do?” Firestone says.

Pueblo Fire Chief Barb Huber says the program slowed down a bit when COVID-19 surfaced just because no one knew how to manage it in the midst of a pandemic. They quickly realized, however, that the program would be even more important to seniors and those with ongoing care needs who couldn’t venture outdoors or were scared of doing so.

“The message is critical right now that people still do need to take care of themselves,” she says. “They still need to see their doctor. And we have a program here that is a critical part to the community because it serves that need.”

Giving Mobile Integrated Health a National Platform

While the pandemic has allowed more communities to experiment with mobile integrated health programs, it has also highlighted the challenges those programs face – particularly around federal recognition and funding.

The Centers for Medicare & Medicaid Services recognized that need when it introduced the Emergency Triage, Treat and Transport (E3) payment model in late 2019. CMS had planned to enroll some 200 healthcare providers, including health systems and EMS providers, in the program, to study how connected health tools could be used to reduce unnecessary 911 transports and improve care coordination for Medicare beneficiaries.

CMS put a hold on that program when COVID-19 took over, but some say it was flawed from the start, and needs to be redesigned.

“Is this really a value-based care model?” asks Jonathan Feit, co-founder and CEO of Beyond Lucid Technologies, a develop of mHealth technology for EMS providers. “They focused on the how but left out the why, which is the most important part.”

Feit, whose company has been partnering with communities across the country to improve EMS response and care coordination during the pandemic, says federal support has focused on the idea of better managing transportation for patients.

“That’s a travel-based model,” he says. “They want to know where I took you instead of why I took you there or how did I do.”

Feit says CMS has to understand the root causes for shifting transports away from the ER, and that delves into examining what factors lead up to a 911 call and what healthcare resources can be used to avoid those calls and better serve patients after they’ve made the call.

“They have to recognize that EMS is not just a first responder but an extension of the health system,” he says.

With COVID-19 closing or restricting many hospitals and clinics, many health systems and EMS providers have practically been forced to look at other ways to help patients in need of care. If the ER is filled with coronavirus patients or closed, there has to be an alternate route to care. That’s where mobile integrated health comes into play.

“COVID-19 is a catalyst,” Feit says. “The virus has forced people to challenge their assumptions in ways that they’ve never done before.”

That, he says, may lead to further refinements in the mobile integrated health model, and maybe even scrapping the E3 program in favor of a better model, based on lessons learned from COVID-19.

Feit sees syndrome surveillance and chronic care management as community paramedicine 2.0. On the horizon, he says, will be a model – community paramedicine 3.0 – that addresses and even bigger need in healthcare: mental health and substance abuse.

“This is a wake-up call for healthcare,” he says.