Jefferson County public health updates countywide community paramedicine pilot

Jefferson County Public Health and the county EMS division told the Legislature that a pilot Mobile Integrated Health (MIH) program — commonly called community paramedicine — has produced measurable reductions in emergency calls and hospital transports for enrolled patients.

Ginger Hall, a Public Health presenter delegated by Public Health Director Steve Jennings, said the pilot began in October 2022 after planning throughout that year and that local home-care agencies, hospitals and EMS providers participated as partners. Paul Barter, the county’s director of EMS, described operational details.

The program pairs MIH providers from EMS agencies with home-care teams to deliver assessments, medication reconciliation, wound care, blood draws and other nonemergency services in patient homes. Hall said the pilot’s goals were to “increase patient participation in personal health care, decrease unnecessary ambulance transports and ED visits by high utilizers and decrease our hospital readmissions by 50% from the benchmark.”

Public Health provided performance figures to the committee. Hall said year-to-date visits through July numbered 1,023 and that, for a cohort of 77 clients who completed the full monitoring period (six months before, during and six months after participation), the program produced approximately a 50% reduction in 9-1-1 dispatches and roughly a 40% reduction in emergency-room transports. Barter and Hall cautioned those measures are state-calculated and affected by “frequent flyers” who skew averages; after removing three outliers the reductions improved to about 63% fewer 9-1-1 calls and 57% fewer transports for that subgroup.

Hall and Barter described several operational elements: a 16-hour training course for MIH providers; use of the home-care electronic medical record so MIH and home-care staff can read and coordinate notes; a warm handoff protocol where an MIH provider and a nurse do the first coordinated visit together; and a county loaner closet for durable medical equipment. Barter said the pilot started with four diagnostic tracks (diabetes, COPD, heart failure and falls risk) but has since expanded to respond to “if there’s a need, we’ll go.”

Speakers emphasized patient-level outcomes beyond the statistics, including anecdotal cases where MIH visits revealed previously unreported illiteracy that led to medication mismanagement and repeated admissions. Hall said two patients were kept at home for more than two years who otherwise might have been placed in assisted living, attributing the delay to weekly medication setups and respiratory or cardiac assessments delivered through the pilot.

Funding and sustainability were a recurring theme. Hall said the Mother Cabrini Health Foundation-funded pilot pays MIH agencies $80 per visit (covering provider time, travel, mileage and documentation) and supports public-health nurse supervision through the grant, which currently runs to 2026. Public Health and the Home Care Association are working with health plans, Medicare and Medicaid to seek future reimbursement for MIH services. Hall noted a related state Senate bill to make community paramedicine a permanent reimbursable service is in committee in Albany; she said the county’s state legislators have been supportive.

Legislators who asked questions commended the collaboration and asked about staffing and compensation. Hall said participating EMS agencies currently compensate MIH providers and that agencies have a “small pool” to ensure providers do not lose money; one MIH provider in the county works part-time in MIH after leaving 9-1-1 shifts for health reasons, Hall said.

The presentation did not include a formal vote or new county policy; legislators were given the update and had an opportunity for questions. Hall and Barter asked the Legislature to note the program’s results and support ongoing efforts to secure payer coverage beyond the grant period.

Public Health and EMS concluded by asking legislators to remain engaged with state-level efforts to codify and fund community paramedicine.

Hall and Barter’s slides, training summary and the program’s reported caseload and outcome figures were presented to the Legislature; no county budget appropriation or ordinance was adopted during the presentation.

The committee moved on after the presentation to other agenda items including YMCA and audit presentations.