A Model for Better Community Healthcare
In 2012, REMSA launched a system of community health programs to improve access to the appropriate level of healthcare throughout Washoe County, Nevada. Funded through a $9.1 million Health Care Innovation Award from the Center for Medicare & Medicaid Innovation, part of the U.S. Department of Health and Human Services, the program consisted of three interventions:
Nurse Health Line: a non-emergency phone number that provides 24/7 access to nurse navigators who could assess, triage and refer Northern Nevada residents to health care and community services.
Alternative Destination Transports: paramedics conduct advanced assessments of 911 patients with low-acuity medical conditions and provide alternative pathways of care other than transport to a hospital-based emergency department, including transport to urgent care centers and clinics, a detoxification center, or mental health hospitals.
Community Paramedicine: specially trained community paramedics perform in-home delegated tasks and point-of-care lab tests to improve the transition from hospital to home and improve care plan adherence.
The comprehensive, integrated system created by these three interventions offered new referral and treatment pathways to ensure the safest and most appropriate care for patients with low- acuity medical conditions. As a result, the innovative model successfully achieved the three goals of the Institute for Healthcare Improvement’s Triple Aim: improving the quality and experience of care, improving the health of populations and reducing the per capita cost of healthcare.
REMSA’s Community Health Programs effectively targeted people living in underserved communities, which had the highest utilization rates for the Nurse Health Line and Alternative Destination Transports. These alternative pathways were also very popular with the people who used them. Patients who called the Nurse Health Line and those enrolled in the Community Paramedicine Program consistently reported high levels of satisfaction in follow-up surveys. Over four years, REMSA’s Community Health Programs saved $9.66 million in healthcare payments, compared to $9.06 million in program expenditures. By year four, the programs achieved an 84% return on investment—avoiding $1.84 in payments for every $1 in expenditures.
REMSA’s innovative programs demonstrate the potential to improve the healthcare system by taking advantage of the existing EMS and emergency communications infrastructure. Health care providers, payers and policymakers must come together to make similar programs possible in other communities by reforming reimbursement rules and other policies that prevent EMS and 911 systems from providing effective and efficient care to communities.
To learn more, please download our community health outcomes white paper.