Visiting medics prevent problems

North Memorial's community paramedic program is expanding to provide more at-home, nonemergency support to people who might otherwise call 911 for costly and avoidable ambulance rides.

A UCare health plan grant is extending the reach of the Twin Cities program to include Faribault, Forest Lake and Princeton. Leaders said the program in its first six years has produced measurable results, including lower costs by helping people avoid intensive medical services they don't need.

Many patients with nonemergency concerns call 911 because the health care system doesn't present them with obvious alternatives, said Dr. Peter Tanghe, medical director of the program. "That's part of the problem we're trying to solve. We have had sort of one solution for a thousand problems."

Community paramedics are often dispatched after colleagues on emergency scenes notice that patients have problems beyond their immediate injuries. Doctors and nurses might request visits as well if they suspect patients have problems at home that are worsening their medical conditions.

The state Medicaid program pays for visits to its poor and disabled members. Visits generally aren't covered by private health insurance, though, so North EMS has used its own investments and UCare grants to keep the program running.

North EMS leaders said the investment will hopefully pay off in the future, as health insurance plans switch from paying per procedure to paying for efficient care that improves patient health while lowering costs.

Studying community paramedic visits in the first half of 2018, North Memorial found no cost savings during that time period. But in the second half of 2018, the costs of patients who had received those visits declined by $1,969 per member per month. North EMS leaders said this might reflect less usage of the ER because medics referred these patients to primary care doctors and instructed them on how to safely take their medications.

"We find a medication error on almost every visit that we go out on," Tanghe said.

Medics have eagerly sought to join the program, completing the required additional training and then alternating shifts between traditional ambulance runs and community visits, said Shannon Gollnick, North Memorial's director of ambulance operations.

The change of pace gives medics a chance to help people beyond stabilizing them in emergencies and running them to hospitals, he said. "They like to take care of people."