Paramedicine program brings back house calls

Copyright © 2016 Albuquerque Journal

Several times a week, Amy Kettleson pulls up to a home in Albuquerque to check in on the resident. Kettleson is a paramedic for Albuquerque Ambulance Service, but she drives a sport utility vehicle, not an ambulance, and instead of taking patients to an emergency room, she’s there to make sure they stay out of one.

Scheduled house calls may seem like a throwback to an earlier era, but they’re an essential part of a small, mobile health care effort called the Community Paramedicine pilot program, which was launched in January by Blue Cross Blue Shield New Mexico. The goal is to reduce use of 911 calls and emergency departments, and foster better care and follow-up for certain patients.

Amy Ketteleson gets ready to roll to an appointment with a Medicaid client involved in the Community Paramedicine pilot program. (Marla Brose/Albuquerque Journal)

Amy Ketteleson gets ready to roll to an appointment with a Medicaid client involved in the Community Paramedicine pilot program. (Marla Brose/Albuquerque Journal)

The insurer has contracted with Albuquerque Ambulance and American Medical Response to care for high-utilizing Medicaid patients in their homes as part of an initiative to curb unnecessary hospitalizations and health care costs. About 50 Medicaid recipients received visits from paramedics in the past month, ranging from a person suffering from congestive heart failure to a baby recently discharged from a neonatal intensive care unit.

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During one recent visit, Kettleson checked a patient’s vital signs and reviewed the list of medications. On other visits, she might do a blood glucose test or see if a person has enough food in the house or do a home safety evaluation.

Kettleson and other Albuquerque Ambulance staffers involved in the community paramedicine program are not responding to 911 calls.

The paramedics make contact with Blue Cross Centennial Care members in their homes, usually within 48 hours of a referral, said Dr. Duane Ross, medical director of the insurer’s New Mexico government programs. Hospital personnel and the insurer’s care coordination staff identify the members who may benefit from an in-home visit, said Ross.

Ross would not say how much the program costs or how much it might save but said Blue Cross Blue Shield will evaluate its effectiveness over the next three to six months.

“It’s partnerships like this that will improve health care in the community well into the future,” said Ross.

ER visits have skyrocketed with the expansion of the Medicaid program in New Mexico. “It’s a (bad) habit built up over time” by many Medicaid recipients, especially those with chronic medical problems, Ross said.

The ideal benchmarks for the program will be fewer visits to the ER and hospital readmissions, said Ross. “We’ll know within a few months if we are meeting or falling short” of these goals, he said.

Similar community paramedicine partnerships have been launched in other parts of the country, but the pilot program is new to Albuquerque and the Blue Cross system. Ross saw the potential benefit of a community paramedicine program to serve some of Blue Cross’ 130,000 Medicaid members in the state.

“We haven’t hit capacity,” said Ross.

Community paramedicine, which involves chronic disease management, follow-ups on hospital discharges, health teaching and counseling, is distinctly different from traditional emergency medical services, said Jeff Kinney, deputy chief of Albuquerque Ambulance, a division of Presbyterian Healthcare Services. “We are really excited about this,” Kinney said.

He didn’t know how many patients potentially would be served, but he said the company is preparing to offer the program to other insurers with Medicaid clients.

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