Healthy You Healthy Hennepin

Norma Young interacts with her community paramedic

Proactive Paramedics

December 2015

Once a week, usually on Tuesdays, a community paramedic visits Norma Young’s apartment in Minneapolis’ Steven’s Square neighborhood. The medic helps Norma set up her 21 medications for the week ahead and monitors her general health and vital signs. But it’s friendly chit chat that’s at the heart of each 60-90 minute visit.

Norma has rheumatoid arthritis and congestive heart failure, and for years she bounced in and out of hospitals and rehabilitation centers, racking up thousands of dollars in medical bills. But last year, doctors at Hennepin County Medical Center (HCMC) decided to try a different approach.

First, they implanted a sensor inside Norma’s pulmonary artery and equipped her with an in-home CardioMEMS™ device. With it, Norma no longer makes frequent trips to HCMC or waits to seek care until she experiences heart failure symptoms. Instead, she measures her pulmonary artery pressure each day from home, simply by reclining on a special pillow. While Norma lies still, monitors inside the pillow transmit readings from the implanted sensor to a computer box next to her bed. The box then sends the readings to her HCMC doctors.

HCMC also started sending community paramedics to Norma’s apartment. “My community paramedics do everything that I’d normally do at a doctor’s office or in a hospital,” Norma says. “Plus, I stay out of the hospital. And this way, I’m in charge of taking my medications. I’m in charge of my health.”

My community paramedics do everything that I’d normally do at a doctor’s office or in a hospital. Plus, I stay out of the hospital.
Norma Young

 

This homecare isn’t just less costly and more convenient than going to a clinic or a hospital, it can also be more personal. “My community paramedics feel like family,” Norma says. She rattles off their names: Amber, Angela, Dennis, Matt. “I love them all. They’re my kinfolk. Whoever thought of this idea was smart.”

A community paramedic is an advanced paramedic or emergency medical technician with an expanded role. In addition to emergency response and transport functions, community paramedics offer primary and preventive care and other services that reduce patients’ need for clinic and hospital visits. Services include health assessments, immunizations, vaccinations, chronic disease monitoring and education, lab specimen collection, medication compliance checks, hospital discharge care, and minor medical procedures.

Community paramedics help patients manage their medications
Community paramedic badge on uniform
Patient's CardioMEMS device

 

Community paramedicine is an emerging healthcare profession, one that was enacted into law by the Minnesota state legislature in 2011 to meet the needs of underserved communities and counter rising healthcare costs. In 2012 further legislature allowed community paramedic services to be Medicaid reimbursable. A number of health care systems have since expanded or initiated a community paramedic program, including North Memorial Medical Center, Allina Health, HealthEast, Tri-County Health Care, and Essentia Health. HCMC’s program launched in 2013.

In addition to conducting home visits, Hennepin County community paramedics are also a presence at Minneapolis Salvation Army Harbor Light Shelter, the state’s largest adult outreach facility.

Between 2010 and 2014, 911 calls to Harbor Light increased 22 percent. By embedding community paramedics there four days per week, Hennepin County hopes for a 10 percent reduction in emergency medical services and a 10 percent reduction in total cost of care. The initiative launched in March 2015 and so far it’s exceeded these goals; comparing third quarter 2015 to third quarter 2014, emergency medical 911 calls to the shelter have decreased 31 percent.

The community paramedics at the shelter credit their success to the relationships they’ve built. Instead of calling 911, “Call our cell phone or come find us,” they remind residents, security guards, and homeless advocates.

A typical case in point: Soon after the program launched, a community paramedic was on-site when an asthmatic shelter resident, who had recently been discharged from the hospital, began wheezing. “Normally someone would have called 911 about him,” the paramedic remembers. “Instead they called me.” After showing the resident how to properly use his nebulizer and inhaler, his wheezing subsided. Crisis averted. Calm achieved. Costs contained.

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