In the year before being admitted to the CONNECT Community Paramedic program in Allegheny County, Penn., one Pittsburgh-area patient with uncontrolled diabetes called the 9-1-1 system 40 times. Half the time, he refused to go to the ED, resulting in the local EMS agency not receiving payment for the frequent responses. The patient joked that the medics always gave him dextrose and woke him up in the back of the ambulance before he got to the ED, so there was no need to go to the ED every time.
Thanks to the CONNECT program, the patient and the frustrated EMS providers now have an alternative.
About the Program
Established in September 2013, the CONNECT Community Paramedic Program is a two-year grant-funded program unique among other community paramedic programs in many respects. The program was the brainchild of the Allegheny County EMS Council (ACEMSC), which represents all 45 EMS agencies in the county, and the University of Pittsburgh’s CONNECT program.
The CONNECT program is a collaboration between the city of Pittsburgh and its bordering 36 municipalities in the urban core of Allegheny County. The partnership started with discussions to address the financial burdens facing many of the community EMS agencies that exist in the county. Soon, they agreed that a community paramedic program could both benefit vulnerable patients and demonstrate the ability of paramedics to provide more than medical transportation to local health systems. The group believed that, if successful, the program could help establish a sustainable revenue stream for participating agencies in the future.
The collaboration successfully obtained funding from two leading health insurance providers in the county, and partnered with the Center for Emergency Medicine of Western Pennsylvania (CEM), whose Emed Health program has been operating a small community paramedic program for approximately 10 years.
In addition to their partnerships and funding streams, the program is unique in that it isn’t operated by any of the individual EMS agencies directly. The program is run as a countywide resource team, not unlike regional hazmat or critical incident stress management teams.
CONNECT community paramedics work one or two days per week and follow 4-5 patients enrolled in the program.
How the Program Works
All CONNECT community paramedics live or work in Allegheny County, so they’re familiar with the area. All but one of the 12 community paramedics are hired as casual employees of CEM, working one or two days a week and following 4–5 patients enrolled in the program.
Referrals can come from any of the EMS agencies in the county, or from any of the 15 hospitals in the area. This system is seen by many as a potential model for community paramedic programs in regions where local EMS agencies are too small to offer a single provider-based program to local hospitals, health insurers or other potential customers.
For this particular patient, the major focus of the community paramedic intervention was to help him understand the relationship between skipping breakfast and his frequently low blood sugar level. The paramedics also helped him obtain his preferred glucose testing strips and encouraged him to test his blood sugar level multiple times a day.
Thanks to the unique treatment plan implemented by CONNECT paramedics, it was discovered that the patient started calling 9-1-1 much less frequently. By taking the patient to an endocrinologist, encouraging him to more effectively inject his insulin and teaching him proper diabetes management, the EMS system and local hospitals saved a substantial amount of time and money.
A CONNECT medical director meets with the team of community paramedics to review various issues regarding the CONNECT program.
Rather than believing he couldn’t control his blood sugar, the patient became better able to manage changes in his blood sugar level without relying on the paramedics.
Using national Medicare averages, the patient’s healthcare expenses for transports and ED visits in the year prior to his enrollment in the CONNECT program totaled $40,560.
In the 12 months since his enrollment in the program, the patient’s expenses dropped to a total of $3,636, generating a 91% savings in avoidable healthcare costs. In those months, he called EMS just three times, resulting in two transports to the ED.
Now, the patient is better equipped to manage and control his diabetes and local EMS agencies are freed up to handle other high priority calls.