“I don’t know where I would be without it,” Toth said of the paramedic team when Williams went to his house one afternoon earlier this month to check on his vital signs.

Williams is part of a Grand Rapids-based health management program built around paramedics, nurses and social workers called Tandem365. The mission is to offer support in the homes of more vulnerable residents, most of them older people and they are all more prone to serious illness and frequent hospitalizations.

Result: Much less Patient teams end up in the emergency department than a comparative group of residents who lack such support.

In southeastern Michigan, an Huron Valley ambulance based in Arbor provides similar results with an emergency response system that treats many patients on call 911 at home rather than delivering them to an ambulance hospital. According to Huron Valley records, in 2020 her paramedic program received just over 3,000 calls from 911 ─ and was able to treat more than half of them (1,569 patients) at home rather than deliver them to the hospital.

The average ambulance charge in Michigan is estimated at almost $ 1,300. In contrast, a visit by the Tandem365 paramedic team costs about $ 200.

In addition to saving money, paramedic programs free up frequently overcrowded emergency rooms for more critical medical cases, allowing many vulnerable patients to be treated where they are most comfortable, at home. But despite the positive results, there are fewer than a dozen such networks in Michigan.

According to advocates, this is mainly because basic Medicare ─ federal health insurance for people aged 65 and over ─ and most private insurance plans will not pay for paramedic services that do not involve hospital transport. Tandem365 is a notable exception, as its patients are covered by two insurance plans that pay for its costs.

“I think the potential of public paramedics is huge,” said Angela Madden, executive director of the Michigan Ambulance Association, a trade and advocacy organization representing 70 ground-based ambulance agencies in Michigan.

“But the biggest hurdle to expanding this is the lack of insurance that will pay for it. This is very important for its sustainability. “

Dominic Palon, executive director of the Michigan Association of Health Plans, a nonprofit with the Lansing Health Insurance Industry, said the biggest hurdle to broader health insurance coverage is the lack of accurate data for every program that shows it works.

Captain said that in this new area the programs are very different in how they work, which can make it difficult for insurers to decide whether to fund them.

“If you’ve seen one (joint paramedical) program, you’ve seen one program,” Polona told Bridge Michigan.

“If you have a program and it’s evidence-based and you can demonstrate that it works, then insurance is easier to cover,” he said.

According to Christine Cool, coordinator of paramedics at the Michigan Department of Health and Human Services, the cost of launching public paramedic programs creates a second hurdle to their expansion.

The state requires 150 to 200 hours of approved training for a community paramedic, costing $ 2,000 or more, to be borne by an ambulance service or paramedic. This training is improved in accordance with the state requirements for basic medical practice.

“Programs have a hard time sending paramedics through the educational component. Everyone wants (community health care program), but no one pays for it, ”Cool said.

In Ann Arbor, Huron Valley Ambulance launched its joint paramedical program in 2015, after creating its own training program for its paramedics. At around $ 2,400, the 160-hour course requires 40 hours of clinical training in a hospital, a 36-hour internship on paramedic calls, and coursework that includes exploring how factors such as poor housing, stress, and lack of transportation can affect outcomes. patients. The HVA pays the cost of training paramedics from their salaries who wish to become public paramedics.

But the program survives only thanks to “several hundred thousand dollars” in annual grants from the nonprofit parent organization Huron Valley, based in Ann Arbor Emergent Health Partners, which owns and operates six ambulance services in 14 counties in southern Michigan. This includes Jackson’s ambulance, which also runs a public medicine program in Jackson County.

“If you (redirect) 911 calls (for paramedics), that’s where you lose money. More than 50 percent of the calls are Medicare patients, and Medicare doesn’t pay for it, ”said Jason Fair, emergency care project manager in the Huron Valley, Bridge.

One Michigan health analyst said the insurance gap reflects a deep and long-standing mistake in how most emergency care is funded – to reward ambulance services just for trips to the emergency room.

According to Samantha Ivan of the Center for Health Transformation and Research at the University of Michigan, a nonprofit think tank on health policy, this payment model cannot recognize a small but consistent piece of 911 calls that can be safely treated at a patient’s home. .

And because community paramedics spend more time in the patient’s home, they can often identify other forms of social care that will help patients with health problems, saving even more trips to the emergency room.

“If a paramedic comes into a person’s home who can’t cure a chronic illness, it’s probably because they don’t have a vehicle,” Lovan said. “If they don’t have food security, they can connect them to the food pantry. The paramedic can serve as a liaison with NGOs that can help. ”

In an ambulance in the Huron Valley, which covers Washton County and parts of Wayne and Auckland, dispatchers are trying to identify 911 calls that are most appropriate for the medical and obstetric department. This may include problems with urinary catheters, nausea, vomiting or shortness of breath associated with asthma.

With asthma calls, Fair from the Huron Valley said, a paramedic may find that a patient has run out of medication to treat.

“A community paramedic will contact an ambulance doctor, and the doctor will write the script, and the paramedic will call him and even go to the pharmacy and bring him home,” Fair said.

On vomiting, the Huron Valley Fair said, “We see that many of these calls can be eliminated with some fluid administered by a paramedic and medication. The paramedic can do this, call an ambulance and discuss a treatment plan.

“You spent an hour and a half in the patient’s home compared to a few hours in the emergency room.”

In the last 18 months of the pandemic, Huron Valley paramedics have delivered more than 1,900 treatment of ciliated monoclonal antibodies for COVID-19 in patient homes across the service area.

“These are patients you don’t want in the emergency room,” Fair said.

In western Michigan Tandem365 comes to public paramedics from the other side.

Unlike the ambulance in the Huron Valley, it does not call 911.

Instead, it sends paramedics from Life EMS Medical Service of Grand Rapids (supported by nurses and social workers) on regular home visits to high-risk patients to prevent avoidable ambulance trips and hospitalizations. Tandem365 has about 1,100 patients with an average age of 77 in Kent and four other Western Michigan counties.

Patients are identified by medical records for frequent hospitalizations, which are often accompanied by multiple chronic diseases. It is one of the few paramedic networks covered by insurance, as Priority Health Insurance Company and Blue Cross Blue Shield of Michigan offer coverage that is paid for through their additional Medicare health plans.

Phil Fennema, director of operations at Tandem365, cites a typical patient: an elderly man with congestive heart failure, a common disease in this age group that often leads to fluid buildup in the limbs and, if left untreated, hospitalization.

“One of the main factors in the development of congestive heart failure is sodium in the diet. We had a patient who ate a pack of hot dogs a day, thinking it was low in sodium. His congestive heart failure was completely uncontrollable. ”

Fennema said nurse Tandem365 discovered his dietary habits by peeking into his fridge and confirming his favorite food.

“According to our recommendations, he stopped eating salty foods and dining in the microwave,” Fennema said.

Janet Scovel, director of health care management at Priority Health, said the insurer continues to fund coverage through Tandem365 for a simple reason: evidence suggests it is working to reduce hospitalizations and ambulance travel for its patients.

“It is definitely worth the investment, not only to control costs but also to improve the quality of life of our members and their families. This is a win-win situation, ”Scovel said.

Earlier this month, paramedic Alex Bergnan went on a trip to pick up a urine sample from 64-year-old Nora Hals, a receptionist who lives alone in a suburban apartment in Grand Rapids. Her number of health problems include congestive heart failure, liver cirrhosis and high blood pressure.

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