Getting the people who overuse emergency services under control has been an uphill battle, but one major health insurer has been teaming with metro-area emergency medical services agencies for over a year to put a dent in the numbers of ER visits by some of its Medicaid members.
During that time, a handful of Albuquerque paramedics have been making house calls through a program designed to reduce hospital readmission rates while helping discharged patients stay on the road to good health.
It seems to be working.
The Community Paramedicine initiative, launched in January 2016 by Blue Cross Blue Shield of New Mexico, has moved from pilot program status to an ongoing service helping more than 1,100 Medicaid members, mostly in the Albuquerque area. The insurer saw an almost 62 percent drop in emergency room visits and a 63 percent decrease in ambulance use by frequent flyers, many of whom live alone, have a limited support network, lack transportation or have a housing situation that's in flux.
Community paramedics from Albuquerque Ambulance and American Medical Response go into the patients homes to check on their overall health issues as well as factors like safety precautions and nutrition, said Kerry Clear, Blue Cross's manager of community social services and coordinator of the program. Blue Cross estimates that the program in its first year saved $1.7 million that would have been spent in the ER.
The insurer is in contract talks with ambulance and fire agencies to expand the program to other New Mexico communities.
Reducing visits to the ER by what the Centers for Medicare and Medicaid Services calls 'super utilizers, typically defined as those who use 911 or visit hospital emergency departments four or five times a year, starts early.
Five nurses employed by Blue Cross assess Medicaid enrollees slated for discharge from a hospital and who may be at high risk for readmission. That includes people being treated for chronic illnesses like congestive health failure, pulmonary disease, asthma, diabetes as well as those recovering from hip replacements.
The assessments may trigger a referral to the paramedic services in the Blue Cross Blue Shield program.
The paramedics are dedicated to the program and do not respond to 911 calls, said Clear.
Shelley Kleinfeld, a paramedic for AMR, visits 10 to 12 patients a week, coaching and educating and taking vitals. She helps clients manage their medications, ensures they are properly using medical equipment and devices, coordinates appointments with primary care providers and looks to see if there is enough food in the house.
If she encounters a minor health issue, shell transport patients with conditions like flu or minor wounds to clinics or urgent care centers rather than to the ER.
Kleinfeld said she likes seeing her career shift from emergency response to proactive response. She said community paramedicine is health care on a grass-roots level, which she prefers. It's nice to interact with someone other than from the back of an ambulance.