How innovation spreads across an industry—especially when it comes to technology adoption—aligns along five phases: innovators, early adopters, early majority, late majority and laggards.1 The same is true of toys, cars and healthcare practices.
Mobile integrated healthcare/community paramedicine (MIH-CP) is arguably in an early majority stage now, having been a topic of fascination for years despite few successful long-term case studies. The discipline has a ways to go before it is mature but it’s no longer a novelty.
Indeed, EMS and fire agencies in more locales than ever have the authorization to engage in readmission avoidance, non-transport, and alternate site (non-hospital) transport, and payers like Anthem and states like Minnesota and Arizona have some form of payment for MIH-CP—under one brand name or another (e.g., “Community Paramedicine,” “Treat & Refer,” etc.)
The industry is seeing less-committed programs shake out. At the same time, programs that have taken the time to build a sustainable (even profitable) path forward, using data to demonstrate efficacy and establishing a network of partners to provide both referrals and destinations, are achieving regional significance in light of their success.
But what defines a “successful” MIH-CP program? Endless grant funding? A supportive chief or medical director? A hospital that sees so much value in the model that it seeks to internalize the program as an extension of case management?
Serving the Community
For Tangye Beckham, EMS coordinator and director of Community Integrated Paramedicine for the Rio Rico Medical and Fire District on Arizona’s southern edge, the alpha and omega of a successful MIH-CP program is empathy, since the program’s raison d’être is an unmet community need.
Beckham speaks from experience, having served across the gamut of prehospital care roles, including field medic, flight medic, interim fire chief and nurse: “This is my twenty-fifth year in healthcare. What I think makes me unique to this position is that I have that home health background. When I was in college, I started at the bottom—as a caregiver, all the way up to a CNA [Certified Nursing Assistant].”
But Beckham bleeds purple: In addition to running EMS and Community Paramedicine programs, firefighting is in her blood. Her grandfather was a fire chief in Englewood, Colorado, in the 1910s, and her cousin is a captain at Littleton Fire. She says, “It’s in my family. I love the fire service so much that I would, if I could, do it for free. I feel that strongly about serving the community.”
She also appreciates the challenges—which provides its own motivation—of making it through the day as either a patient or a care provider. In 2012, while working for Air Methods, Beckham fell ill and slipped into a coma for a month. The doctors said, “you’ll never be a firefighter again,” but her thought was simple: “Watch me.” She recovered and “had to learn to walk again. By 2015, Beckham was appointed interim fire chief of the Arivaca Fire District and served until March 2016.
Border towns face unique challenges such as language barriers and profound economic disparities. When she took the reins of Rio Rico’s MIH-CP initiative from Matt Eckhoff, a widely respected consultant and prehospital care innovation advocate—now based in Flagstaff, at the Northern Arizona Healthcare Foundation—Beckham steered the Community Health Integrated Paramedicine (CHIP) program along broad rails: “Where we’re unique is that other [community] paramedic programs are targeting the behavioral health component, opioid abuse, and substance abuse on that side, we’re different because we target not only the behavioral health piece but we also target the chronic illness and disease … [including] individuals with Alzheimer’s, dementia, and Parkinson’s.”
In one of the starkest examples that this author has found to date of an MIH-CP program targeting unmet local community needs, rather than regurgitating one of the widely emulated early, successful programs such as REMSA (Nevada), Eagle County (Colorado), MedStar (Texas) and Pittsburgh—Beckham tunneled through the status quo to find a problem worth solving. It was the “crack” where “socioeconomic status play into an individual’s ability to manage their disease.” The reason? Programs successful in other areas often don’t optimally fit local needs.
According to Beckham, “The individual who would be classified as ‘poor,’ or that live under the poverty level, has access to a lot more services. The individuals who are middle class, where they don’t qualify for state aid, but they don’t make enough to pay for care—that’s a pocket that we deal with a lot. So, when I talked about the Alzheimer’s and Parkinson’s patients, I knew that they need memory care. They know that they need memory care. They can’t afford memory care because a pension won’t cover the cost of memory care even though they’ve worked their entire careers. I had a patient that just moved into assisted living finally, but their pension was $4000 per month; the cheapest assisted living facility for memory care, which is what is specific to Alzheimer’s patients, was $5.500 a month.” So what do they do? “They live alone—that’s what they do. We have many people within our community that are living alone with Alzheimer’s, which is unsafe for many reasons, and they basically cannot afford to pay for memory care facilities and they don’t qualify for the state program, which is ALTCS, the Arizona Long Term Care System.”
Commitment to Care
Beckham ended our interview with a passionate lament that showcased the commitment of an agency chief who has held her ground against elected officials, and blended empathy from years in home health along with a medic’s drive to plow through problems: “If you ask what keeps me up at night, it’s knowing that these people have worked their whole life and they have a pension—and because of that pension they are disqualified from receiving service unless they pay outright for it.”
1. Rogers E: Diffusion of innovations, 5th edition. Simon and Schuster: New York, 2003.