The Value of Community Paramedicine

Purpose

The information provided demonstrates the value of community paramedicine programs to partners that are addressing their communities' cardiovascular and chronic health needs. The information is not meant to act as technical assistance or an implementation guide.

Two EMS technicians working on a patient laying on a gurney in an ambulance

Emergency department visits and access to care

In the United States, an estimated 40% of emergency department (ED) visits involve patients who could be treated effectively in nonurgent care settings.1 Furthermore, there is an average of 1.2 billion hypertension-related ED visits each year. A 2019 analysis found that 17% of hypertension-related ED visits could be prevented, with a potential health care savings of $2.3 billion annually.2 Many patients with chronic conditions visit the ED because of preventable exacerbation of their condition caused by poor access to primary care, a lack of knowledge about managing their condition, or poor self-management of their condition. Unnecessary ED visits could be prevented by adopting preventive and coordinated ambulatory care that addresses social determinants of health (SDOH). SDOH are the nonmedical factors that influence health outcomes.34 They are the conditions in which people are born, grow, work, live, and age, as well as the wider set of forces and systems that shape the conditions of daily life.4

Community paramedicine fills gaps in primary and preventive care services by coordinating care and addressing SDOH.5 Community paramedics—including emergency medical technicians (EMTs) and other emergency medical services (EMS) providers—provide nonurgent home visits, help patients with chronic disease management, and assess patients to connect them with more appropriate destinations than the ED.67

Social factors and health

Community paramedics can address SDOH by reducing barriers, such as transportation and scheduling issues; improving patient engagement and understanding; promoting patient-centered care; and improving patient satisfaction.5

Community paramedicine can be an essential resource for several populations that have the highest rates of chronic diseases but limited access to critical health care resources.8

People who live in rural areas of the United States have higher rates of preventable death from heart disease and stroke than their urban counterparts.9 Black/African American, Hispanic/Latino, Asian, and Native Hawaiian/Pacific Islander adults also have disproportionately high rates of chronic disease and are less likely to have insurance coverage.10

Chronic conditions, such as cardiovascular disease, increase with age, affecting more than 48% of adults (age 20 and older). About 85% of older adults (age 65 and older) have at least one chronic condition, and 65% have at least two.1112

Because they are members of the communities they serve, community paramedics are uniquely positioned to understand and address the health barriers residents face.3 They can increase access to public health services and comprehensive care for chronic conditions.8

Impact of community paramedicine

Community paramedicine can integrate health care systems and engage health care practitioners, organizations, community-based services, and others with a shared commitment to improve health care access and outcomes and reduce disparities and costs.61314

Community paramedicine can mitigate costs through multidisciplinary collaboration with primary care providers via telehealth, which in turn supports patient communication and engagement.5141516 This collaboration can also increase the use of preventive care, improve medication adherence, reduce hospital readmissions, and prevent the overuse of emergency resources.5141516171819 The improved outcomes can result in cost savings and better return on investment.13171920

Notably, community paramedicine can:

Although early evidence supports the cost-saving potential of community paramedicine programs, long-term economic evaluations of the programs in the United States are needed.13192027232628

Community paramedics’ roles and responsibilities

Community paramedics deliver care that is tailored to the communities they serve and fill gaps in care by expanding access and improving continuity.2028 Community paramedics have the flexibility to operate in diverse settings, including home settings, on-site or at the point of emergency, and in mobile care delivery units.672028

Community paramedics are trained to make health assessments outside of the hospital, generally operate as part of an organized system approach for patient care, can operate at all hours, and have built trust and acceptance within their communities.6781329 Their services include:

  • Primary and preventive care.562328
  • Post-discharge care.56162230
  • Health education and coaching.5142023
  • Chronic disease management.56202331323334
  • Personalized in-home care.82032
  • Public health emergency response (including the COVID-19 pandemic response and opioid epidemic–related emergency care).618323335

In addition, community paramedics coordinate care with clinical and nonclinical providers.562035 Care coordination also allows community paramedics to tailor their care delivery, reduce redundancies in services, and avoid conflicts in service delivery territory.5 Care coordination can be achieved via multiagency collaboration, mobile integrated health, and mobile integrated health-community paramedicine, which are patient-centered mobile resources provided by EMS agencies and other health care entities and practitioners in out-of-hospital environments.

Community paramedics often serve the following populations:

State laws describing community paramedics and their roles

In some states, the scope of practice or roles, responsibilities, and functions for community paramedics are specified in law or regulation.34 Regulatory guidance varies by state, and in many states the legal authority of community paramedics is not well-defined.

Maine law describes community paramedicine as a practice by an EMS provider, in in-hospital and out-of-hospital settings, to provide episodic patient evaluation, advice, and treatment directed at preventing or improving a particular medical condition, as requested or directed by a physician (Code Me. R. tit. 16-163 Ch. 19, § 1).

Colorado law states that community paramedics may provide patient education, resource navigation, initial and follow-up patient assessments, and care coordination. They may also gather laboratory and diagnostic data and have other possible roles (6 C.C.R. § 1011-3:2).

Minnesota law formally recognizes community paramedicine as a profession and describes community paramedics as certified paramedics who meet additional qualifications and standards specified by the Emergency Medical Services Regulatory Board and are certified as community paramedics (Minn. Stat. Ann. § 144E.001, subdivision 5f; Minn. Stat. Ann. § 144E.28, subdivision 9). Certified community paramedics may receive payment for services provided to eligible recipients (Minn. Stat. Ann. § 256B.0625, subdivision 60). Services that are covered include health assessment, vaccinations, post-discharge follow-up, and chronic disease monitoring and education (Minn. Stat. Ann. § 256B.0625, subdivision 60).

Community paramedicine in a rural community‎

To see an example of community paramedicine implementation, read this Best Practice in Action story on the Division for Heart Disease and Stroke Prevention (DHDSP) Best Practices Clearinghouse.

Supporting community paramedicine

Facilitators for implementing community paramedicine programs include:

  • Supporting and collaborating with key partners who may provide (or receive) referral, financial resources, oversight, or direction.562023404142
  • Meeting specific community needs determined by a needs assessment and stakeholders.6202343
  • Communicating and coordinating across health care and community partners, agencies, and regulating bodies.562343
  • Avoiding duplication with existing services.543
  • Integrating with an existing health care system to share health information technology and patient navigation services.52043
  • Educating and training potential workers in the profession and providing opportunities for growth.56202343
  • Evaluating patient satisfaction, safety, outcomes, and costs.202723263643

Challenges to implementing community paramedicine programs include:

  • Lack of sustainable financing for community paramedicine as a health care service and overreliance on discretionary funding (i.e., grants, donations, and short-term retainers).30434142
  • Restricted or vague scope of practice of EMS providers (i.e., restrictions on providing nonemergency or preventive care in home settings, selecting appropriate medical destinations based on patient assessment).30344043
  • State-specific and inconsistent training requirements for licensing/certification and evolving performance standards.3443
  • Lack of standardized curriculum and education requirements at the state and national levels.43
  • Inconsistency in defining community paramedicine programs and the profession.53443
  • Few consistently used and reported metrics to assess patient experience, safety, outcomes, and cost-effectiveness of programs.4344
  • Lack of role clarity among health care providers and extenders regarding community paramedics' unique role in the health care system and public health.543

Integrating community paramedicine and health care‎

Some community paramedicine programs engage nurses and physicians to train community paramedics or to provide medical oversight. Other programs integrate community paramedics into team-based care or engage them to provide home visits.5

Defining community paramedicine‎

There is currently no standardized national definition of community paramedicine, and community paramedics do not hold consistent titles; (they can be referred to as community health workers, primary care technicians, EMTs, etc.).

Moving forward

Assessing and communicating the value of community paramedicine will be necessary to inform decision making and support efforts to expand the field. This will require synthesizing existing evidence on community paramedicine and examining its implementation and impact. To understand the extent of cost savings, cost-effectiveness, and other benefits that result from this work in the United States, economic evaluations will also be necessary.

Resources

Communities that currently implement their own paramedicine programs need more resources, such as assessment of their present reimbursement mechanisms, sample cases of successful programs and lessons learned, and identification of new funding approaches to support programs. Technical assistance resources can be useful for communities interested in establishing and expanding community paramedicine interventions. As interest in community paramedicine grows, standardized core competencies, training, and education curricula are needed to ensure service quality. Addressing these and other program and policy questions can lead to greater use of community paramedicine. Available resources include:

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National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); About the Division for Heart Disease and Stroke Prevention
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