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Mapping Out a Partnership


View a video interview with Christopher Montera below this article.

In 2003, Christopher Montera, EMT-P, now chief of the Western Eagle County Ambulance District in Eagle County, Colo., was working as a planner under a Centers for Disease Control and Prevention (CDC) grant in bioterrorism. At the time, he was the only planner under the grant who had any emergency medicine background in public health. “I didn’t have a good enough handle on, or respect for, what public health had done, until I did that job,” he says. “After that time, I had an idea that we needed to take EMS and public health and somehow bring them together.” He did some reading and thinking about how such a partnership might look, but he still didn’t have a clear road map of how to proceed.

Five years later, while attending a national EMS conference, he heard a presentation that forever changed the way he thought about healthcare delivery in Eagle County. What’s more, the presentation also spurred the idea of how he could finally approach the EMS/public health partnership and make it work.

“I saw this presentation on community paramedics and thought about the idea that they could be an answer for rural issues and rural healthcare in the U.S.,” says Montera, who’s been interested in EMS since his teens and a paramedic since 1999.

A Glimmer of an Idea Takes Hold
He took the idea back to his community in Eagle County, and as chief, started working with the local public health department, which he’d worked with while employed as a planner for the CDC. Still, the path of how to specifically make such a partnership a reality remained elusive.

“We had it simmering in the background, but we could never really make it take off,” he says.

Then in February 2009, Montera found himself part of a consulting team helping to bring together 10 ambulance agencies in Colorado. As part of the process, he interviewed interested parties, such as the area’s local service directors and county commissioners. He asked about their biggest challenges and noted their answers.

“A service director in one of the counties said he needed to pay people; he needed paramedics,” Montera says. “Then, I was talking to a county commissioner one night, and she said, ‘I have all this money from the state to do public health and primary care, but no one wants to move here.’ That night it all came together.”

Montera realized that he could deploy his paramedics, who were highly trained and already part of the healthcare system, into the area’s rural communities. He could take his paramedics and, with the help of the public health department, make them community paramedics.

Once he knew the idea had legs, he began moving forward. He went to Nova Scotia, Canada, to take a look at its system, which had been up and running for a while. He met with dozen of leaders of community organizations, primary care practices, physicians and nurses.

“If anyone would talk to me about it, I would talk to him or her,” he says. “I got their ideas of what they thought healthcare could be and what they thought this program could do, for them and our community.”

Community Paramedics Becomes a Reality
All of that groundwork helped solidify what the partnership could become. “Since July 2009, we’ve been working tirelessly at this thing called community paramedics,” says Montera. More than $600,000 has been raised for the five-year pilot project. “Our most recent grant was $50,000 from a foundation in Colorado to buy a mobile I-stat lab and a vehicle for our community paramedics to travel in. People are coming on board with the idea.”

The central theme of the community paramedic program is to take an Eagle County paramedic in his or her current role, and without changing the scope of practice, change what he or she does every day. This would include post-hospital discharge follow-up, fall prevention, blood draws and medication reconciliation.

Montera has engaged and aligned the local hospitals and medical providers, along with public health, into a new healthcare model. The program has allowed for increased access to healthcare, streamlined medical and public health services and decreased healthcare costs overall.

“All of this is provider driven,” says Montera. If a physician thinks his or her patient might be a good candidate for the program, a standardized form is filled out, which the patient signs so their patient record can be accessed. “They fax all of that information to our office, and a coordinator sets an appointment with that patient,” says Montera. “Then we send the community paramedic out.”

Within the first 20 visits made by community paramedics, one life was saved and a hospitalization was averted.

“The community paramedic role has turned and become the eyes and ears of the physician at home,” says Montera. “The physician orders it, the community paramedic goes out to the home and does the visit, the paramedic comes back, writes a report on what they did, and we get that report back to the physician within 24 hours.” This process ensures continuity of care with the physician and the patient, and the patient keeps the physician as their primary care doctor. Patients who don’t have primary care doctors are referred to one through Eagle County’s health network.

Carrying the Program Forward
For other communities interested in starting a program of their own, Montera welcomes the opportunity to share what he knows.

“It’s not cookie cutter, but we’re going to give you the template and tools so that you can go back and find out what you need in your community so that you can do for your community,” he says. “We want to make it replicable for other communities.”

Recently, the state of Colorado has told Montera that his community paramedic program is required to hold a state-issued home health license, which Montera welcomes.

“As a home health agency, we will be able to tell Medicare, Medicaid and the insurance companies that we can see patients that they may have traditionally paid for in another setting,” he says. “It’s all making us focus on what healthcare is for Eagle County.”

Currently, Eagle County employs 17 paramedics. This past summer, 12 were sent through the program for training. The county hired two of them to fill the role of community paramedic. “My goal is to have all of our paramedics doing it, and, someday, that it become the daily work for all paramedics,” Montera says.

To document the program, Montera and his team have created a how-to manual. “We’ve also hired [someone who has] a master’s in public health to be our researcher and collect our data,” he says. “We have measurable outcomes that we want to see after the five-year pilot is over, and from that standpoint, I think we want to make sure we have someone from the outside evaluating our process.”

Montera knows all about collecting and evaluating data. A one-time chief of administration for an ambulance service, he was the state of Colorado EMS data specialist for the system that captured more than 1.5 million records for more than 120 ambulance services throughout the state. “When I started, we had zero records in the system,” he says. “We started with nothing and developed this program by getting everyone on the same page. It was quite an accomplishment.”

An Enthusiastic Response

As for the response to his community paramedic program, Montera couldn’t be more pleased. “The response is better than I could have ever imagined,” he says. “We have people that I didn’t think would want to come alongside us to help us, and they have.”

He’s had help from the local fire department and the Health and Human Services Agency. He attributes this generosity to people’s willingness to step up and take care of the community—Montera’s goal all along.

“It’s about what’s right for our community, what’s right in taking care of people every day, and maybe lessening some of their suffering,” he says. “Maybe we can support them in having a healthier life and to take ownership for their own healthcare.”

Beyond that, Montera thinks this program is one way he and his generation can give to the community and make a real difference in people’s lives. “It’s not my thing; it’s our community thing,” he says. “I could have never envisioned what it’s becoming.”

Please view the interview with Christopher Montera that took place at EMS Today.


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