This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

People usually associate paramedics with emergencies, CPR, and high-speed ambulance trips to the closest hospital with sirens shrieking. But that image is shifting. 

Across Michigan, communities, health care plans, physician groups, and health care systems are embracing a more proactive new model: community integrated paramedicine (CIP). CIP employs paramedics to perform basic, non-emergent, clinical tasks on site in people’s homes. CIP’s goals include reducing hospital admissions and readmissions; decreasing emergency room visits; and extending health care access to populations lacking the insurance coverage, transportation, or ability to establish healthy relationships with their own primary providers. In other words, CIP can help address the health care disparities that are rampant within Michigan’s communities, especially among people with income challenges.
Kristine Kuhl.
“Community paramedicine can fill gaps in the existing health care system,” says Kristine Kuhl, Michigan Department of Health and Human Services (MDHHS) community paramedic coordinator.

CIP can improve outcomes, build community relationships, and reduce health care disparities. MDHHS' goal for CIP is to build infrastructure that moves the modality into the Michigan Emergency Medical Services System’s standardized structure. The Michigan Health Endowment Fund has provided grant funding for the state to carry out that process.

In February 2020, we reported that nine agencies in eight Michigan counties were using CIP to reduce costs and improve outcomes for their communities’ residents. Some utilized a mobile integrated health model, sending paramedics on planned visits to educate and assist people at risk of medical emergency or hospital admission. Others followed a community paramedicine  model, where paramedics interface with the 911 system to respond to low-priority 911 calls with the goal of reducing hospitalizations.

“Community paramedicine programs are starting to show their worth. We’ve seen it around the country and the world even,” says William Brodin, Northwest Regional Medical Control Authority specialist. “The benefits are reduced health care costs overall, better access for health care, and helping fill out the gaps of the health care systems.”

Brodin is involved with community paramedicine programs in Kalkaska, Green Lake, and Missaukee County. He notes that the program in Kalkaska has saved Kalkaska Memorial Health Center about $15 million over a three-year period.
Mike Berendsohn, EMS director at Kalkaska Memorial Health Center, with a smaller vehicle often used for community paramedicine work.
“It’s a small community hospital, nothing big. They reduced readmissions, reduced the amount of visits by frequent users of the health care system, reduced stays and admissions,” Brodin says. “They also provided health care access to some of those in Northern Michigan who are a long way from a lot of things, including health care facilities. Sometimes, especially during the winter, it’s difficult for [home health care to reach] patients who have a hard time with mobility. The community paramedicine programs up here help bridge those gaps.”

Likewise, a community paramedicine program operated by St. Joseph Mercy Oakland Hospital, Bloomfield Township Fire Department, and Star EMS has resulted in a 70% reduction in hospital readmissions. A 2016-2018 Washtenaw County study of Emergent Health Partners' CIP pilot program found that out of 2,000 patients seen, 53% were treated in place and could stay home, resulting in a $2 million to $2.5 million savings – approximately $500 each for hospital transport and $1,500 to $2,000 each in emergency room charges.

Currently, 17 community paramedic programs are up and running in the state. Three more will be on board by January 2022. Two more are anticipated to launch in early 2022, including in the Marquette-Alger counties region, which will be the first in the Upper Peninsula. And more are on the way. Brodin also works with the Munson Healthcare Paramedic Training Program, where certified emergency medical technician can advance their certification to include community paramedicine. The 11-week program includes online instruction, book work, and hands-on clinical experience.
 
“They are actually going out and practicing community paramedicine skills with home health care workers, hospice staff, different case management areas, community mental health, and some of the primary health care providers,” he says. “They learn how each interacts with the health care systems and formulate where the gaps are, and offer, ‘This is how we can help and here’s my number. Give us a call.’”
 
Community paramedics can visit patients who are back home after hospitalizations or surgeries. They can help them understand and follow their care plans more closely, reconcile their medications to rule out contraindications and ensure proper dosages, and check for sepsis, proper wound healing, oxygen levels, or water-weight gain. During the visit, they can do home safety checks for smoke and carbon monoxide detectors, trip and fall hazards, and dangerous clutter. They may also take a peek at the kitchen to make sure the refrigerator’s working and that patients not only have access to healthy foods, but also the ability and means to prepare them. Community paramedics can also drop in on patients who haven’t been hospitalized but are living with chronic conditions like congestive heart failure, COPD, diabetes, or substance use disorder.
Andrew Brown.
“Community paramedics can help high-risk, high-utilizing patient populations, who are going to be older; have one, two, or more comorbidities; and have been seeking care through the emergency department or other means,” says Andrew Brown, vice president of stakeholder integration for Medstar, southeast Michigan’s largest EMS and mobile health provider, serving Bay, Clinton, Eaton, Genesee, Ingham, Lapeer, Macomb, Oakland, and Wayne counties. “Community paramedicine programs are really geared towards augmenting the health care system so those patients don’t have to seek care. Community paramedics can go out and see these patients and tend to the minor needs in their homes and mitigate their need to be seen in a facility.”

Community paramedics can take vitals, check weight gain, listen to lung sounds, draw blood for the lab, or run diagnostic tests like electrocardiograms. They are also trained to administer IV fluids to treat dehydration, replace Foley catheters, change ostomy bags and dressings, and provide wound care.

CIP can be particularly relevant to Michigan’s aging population, especially in rural areas of the state where hospitals and physicians’ offices can be hours away. For example, after surgery, an older adult may need extra help understanding and following a care plan, managing medications, or keeping follow-up care appointments.

“We have also started working with the Veterans Administration, looking at how to utilize EMS,” Kuhl says. “Paramedics already ask if someone has served. We are looking at how to utilize community paramedicine to take that a step further, to take the time to establish safety mechanisms for suicide prevention. … 911 paramedics may not have time for those extended conversations.”

In Michigan’s rural areas, where pregnant women may live hours from the nearest physician or maternity facility, community paramedics will soon be acting as a liaison between the OB/GYN and the expectant mother to make sure she is on track and has the resources she needs for a healthy pregnancy. Community paramedicine is also a highly effective means of tackling Michigan’s opioid epidemic.

“The community paramedics have a level of trust and sometimes existing relationships with the people who deal with substance abuse disorder,” Kuhl says. “They are not unfamiliar faces. We have noted that those suffering with substance abuse disorder are pretty open to community paramedicine intervening and helping them either directly or connecting them to a warm hand-off to the appropriate resources.”

The COVID-19 pandemic has also been a driver for community paramedicine. Crowded hospitals and the need to socially distance have made routine trips to the doctor’s office or a hospital’s urgent care department far less available. Some community paramedics connect patients with providers via videoconferencing during home visits. Others step in with basic clinical services that had been relegated to physician offices and health care facilities. For example, Medstar paramedics provide in-home monoclonal antibody infusion treatments to people diagnosed with COVID-19 and living with chronic obesity, hypertension, kidney disease, COPD, or diabetes. The aim is to reduce the severity of their symptoms and help them avoid hospitalization. After giving the 15- to 30-minute IV infusion, the paramedic remains to monitor the patient for an hour afterward.
Medstar Mobile Health Paramedic Nicole Plauman demonstrates an in-home monoclonal antibody IV therapy setup.
“Community paramedicine advances care into homes and into the community rather than physicians’ offices or hospitals. The pandemic has really escalated the integration of this model,” Brown says. “These programs are only going to benefit the health care delivery model within the state and the communities we serve. This is going to be the new way that EMS provides medical help.”

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Northwest Regional Medical Control Authority photos by John Russell. Medstar photos courtesy of Medstar. Kristine Kuhl photo courtesy of MDHHS.