Community Paramedic - PSOW 2015

1. Community Paramedic
Paramedic Systems of Wisconsin
September 24th, 2015

2. DHS/MDH
Hospitals
EMS Medical Directors
Primary care
Home health
Hospice
Public health
Affiliated clinics
FQHC's
CHC Look-alikes
Commercial & Gov’t payers
State EMS board
SNF/Transitional care
Geriatrics
Partners

3. Improving Care, Health & Cost
 Effective Community
Paramedic programs
inherently support the Triple
Aim framework to optimizing
health system performance

4. Primary
Achieving Triple Aim Goals: CP – Connecting the Dots

5. Primary Care Focus
PROVIDERS ARE UNDER INCREASED
PRESSURE TO CONTROL COSTS
•Reduce ED utilization
•Reduce admissions and readmissions
•Expand primary care
•Encourage health care home usage for
complex patients
•Community benefit plan - broad goals to
improve population health
Patient Care
Payer source
Primary Care
Referral
Community
Paramedic

6. POPULATION-BASED, PERSON-CENTERED
 Community Paramedics meet
the need for acute medical
care.
 They also collaborate to
identify patient needs and
develop methods for
matching resources with
those needs to support the
overall health of people and
their communities.

7. The Value of CP in Accountable Care
Enabling
Legislation,
Credentialing
Reimbursable
CP Practitioner
Services
Identified
Implementation –
Stakeholders
ED Utilization
Hot Spotting
Patient
Primary Care
Plan, Medical
Home
● Linking Primary Care & EMS

8. CP: ACOs
How ACOs work
 Doctors, hospitals, and other health care providers who volunteer to work together in an
ACO are able to access medical records to help coordinate care.
 Providers also receive data from Medicare (medical history, medical conditions,
prescriptions, medical visits) to be better able to improve care and manage financial risk.
 When an ACO succeeds in both delivering high-quality care and spending health care
dollars more wisely, it will share in the savings it achieves for the Medicare program.
 Several models of ACOs exist across the Country…

9. Health Care Financing Models
 Fee-for-service payment is reimbursement for specific, individual services provided to a patient.
 This model involves payment for specified care coordination services, usually to certain types of providers. The
most typical example of this is the medical or health care home model whereby the medical home receives a
monthly payment in exchange for the delivery of care coordination services that are not otherwise provided and
reimbursed.
 Pay for performance can be defined as a payment or financial incentive (e.g. a bonus) associated with achieving
defined and measurable goals related to care processes and outcomes, patient experience, resource use, and
other factors.
 Episode or bundled payments are single payments for a group of services related to a treatment or condition that
may involve multiple providers in multiple settings.
 The comprehensive care or total cost of care payment model involves providing a single risk-
adjusted payment for the full range of health care services needed by a specified group of
people for a fixed period of time.

10. Hospital Stars Rating
 The healthcare industry is under intense pressure to boost the transparency of
quality data and provide information consumers can use to make more
informed decision about their care.
 CMS first applied star ratings in 2008 to nursing homes. Last year, the agency
rolled out similar programs for home health providers, large group practices
and dialysis facilities.
 The survey asks patients about factors such as the responsiveness of hospital
staff to their needs, the quality of care transitions and how well information
about medications is communicated. The survey is sent out within a few days
of discharge. It also asks the patient about the cleanliness of the hospital and
whether the patient would refer the hospital to others.

11. Why a Hospital would use a CP
 Hospitals are at risk for up to 4.5% of their total Medicare payments based on
readmissions (3%) and value-based purchasing (VBP) measures (1.5%). All-cause
readmissions are measured for patients discharged with MI, heart failure and
pneumonia diagnosis related groups (DRGs). In October 2014, COPD and hip and
knee replacements were added to the list of DRGs. The three-year trend for most
hospitals has seen increasing readmission penalties.
 CMS added the metric of Medicare spending per beneficiary (MSPB). This
evaluates the average spent by Medicare for the three days preadmission, during
the inpatient stay and for 30 days post discharge. If the MSPB is higher than the
state or national average, the hospital may face additional financial penalties. For
some hospitals, the financial incentive to reduce high readmission penalties may
outweigh the actual payments they receive for the admission.

12. Partners for EMS in the CP World
 Integrated Health Care Systems
 Home Health Care
 Hospice
 Hospitals and Payers trying to control utilization
 Long Term Care

13. Engaging Potential CP Payers
 The realignment of fiscal incentives within the healthcare system has created an
environment that encourages providers and payers to work together to right-size
utilization.
 Providers and payers are often unaware of the true value EMS agencies can bring
to their patients through proactive and innovative patient navigation services.
 To work in the new environment, you need to become well-versed in healthcare
finance, specifically as they relate to the partners to whom you’ll be proposing. Be
sure you know things like readmission rates and penalties, value-based purchasing
penalties, HCAHPS scores, MSPB and other motivating factors you can use to help
build the business case for your CP program.

14. ACO Models Nationally
Medicare Shared Savings Program The
Shared Savings Program will reward ACOs that
lower their growth in health care costs while
meeting performance standards on quality of care
and putting patients first
Advance Payment ACO Model (35) intended
to help smaller ACOs have the capital to invest in
the infrastructure
Pioneer ACO Model (23)
a shared savings payment policy with generally
higher levels of shared savings and risk for
Pioneer ACOs than levels currently proposed in
the Medicare Shared Savings Program; moves
from a shared savings payment model to a
population-based payment model
Advance
Payment
ACOs
Pioneer
ACOs

15. ACO: CP Value
MEDICARE ACOMEDICAID ACO
 Withholds
 ER 5%
 Medical Home-Care coordination
payments for managing complex
chronic conditions
 Improve financially on Medical
Assistance reimbursement
 Avoid Withholds
 Increase Patient Satisfaction Scores
 Quality Measures
 Reduce avoidable readmissions
 Opportunity to share in the savings
produced
Opportunities for CP to impact the ACO achievement of Triple Aim Goals:
Improved Patient Care, Enhanced Patient Experience, Reduced Cost of Care

16. A high-level look at a a functioning Community Paramedic Program and its support of Accountable Care
ACO: CP in Action
Year 1 and 2: Over 16,500 CP patient visits
 Referrals from ED/PCP/CC/HH
 Enhanced diabetes management
 ‘Hub’ huddles increase continuity of care
 Charting & In-basket Epic messaging: real
time with provider for follow up/guidance
 Lab contact for analysis and direction
 CC’ing all charts to care coordinator and
PCP
 Closed loop communication with patient and
family
 Link additional community services into pt
goal setting process
 CP follow up upon D/C can increase
information relay to PCP
 D/C lab review and med compliance offers
decrease risk of re-admin
Patient Populations
 Polypharmacy
 High ED utilization
 Anti-coagulation patients
 Not quite homebound: ineligible for HH
services
 PCP feels it would help pt to have
additional resources
 HCH patients needing services
 Continued wound care needed
 CP Clinic in Chem Dep facility
 Bariatric patients
 Surgical follow-up

17. North Memorial CP Medicaid Demo
High-risk patients served by North Memorial are getting
home visits from community paramedics, who help them
avoid the emergency room by providing care in
coordination with their doctor’s offices and clinics. North
Memorial uses data from the Department of Human
Services to identify those who are most at risk and
includes them in its groundbreaking community
paramedic program.
Bonus Payments of: $800,000, $1.5 million in year 2.

18. Initial Data Review-Population

19. Public to Commercial Reimbursement
● Medicaid-approved CP services paved the way for Commercial Payer
interest
● Fee schedule base with the introduction of risk
● Shared savings settle up
● Total Cost Of Care (TCOC) opportunity

20. CP Payment & Delivery Modeling
● Community Paramedic solutions span health care finance,
government reimbursement modeling and care delivery innovations.
● In the brave new world of PMPM, capitation and shared savings for
total cost of care, and a drive for the premium dollar, CP offers new
solutions across the continuum of care and types of services….
 Fire
 Hospital
 Private Systems
● From initial 911 call to primary care integration

21. CPs = Accountable Care Partners
●Viable option for improving the experience of
care, improving the health of populations and
reducing per capita costs of health care
● Bridge existing health care gaps, avoid
duplication
● Reduce the cost of overall health care
expenditures
● Reduce stress on vulnerable patients and
improve care coordination
● Reduce hospital readmissions and emergency
department utilization and avoid penalties

22. Introducing:
The Community Care Connections Program
● Support clinical care by closing the loop with your patients once they’ve been
discharged.
● Communicate more effectively with your patients by enhancing your “frequency of
touch” with them: when, where and how they wish to be contacted.
● Shape the engagement strategies that drive targeted behavioral change.
● Reduce unnecessary healthcare expenses and inefficiencies in care management
practices.
● Improve the results of chronic condition and disease management programs.

23. The Community Care Connections Program
● The use of two-way mobile, online and email
communications
● Fully secure tools, HIPAA-compliant services
● Campaigns that inform and engage patients to
drive compliance with post-discharge and
ongoing care management services
● Permission-based mobile channels drive up to
95% opt-in rates and less than 3% opt-outs

24. Patient Surveys
Streamline your surveys:
• Lower costs vs. paper systems: pay only for
completed surveys
• Real time reporting can be customized
quickly
• Improved response rates let you survey more
of your patients
Sample survey:
• Text “EMS SURVEY” to 30123
Sample reporting:
• http://lil.ms/p09

25. Community Care Connections Addresses
Readmission Issues
1. 50% of Medicare patients don’t have ongoing access to a physician
2. 30% of readmissions occur as a result of improper medication management
Medication
Monitoring
Patient Education
About Disease
Established
Physician
Relationships

26. Questions
Contact:
Buck McAlpin
Buck.McAlpin@NorthMemorial.com
(763) 213-2645