Health at home with community paramedicine

Published October 26, 2018

In Greenville County, South Carolina, most residents have health insurance and regular access to a doctor, according to county records. But, like in many communities across the U.S., some residents face obstacles to staying healthy. Those may come down to social determinants of health, like poverty, access to regular healthcare services or even a lack of transportation. To get the healthcare services they seek, some go to the emergency room. 

Communities across the nation are exploring ways to help residents get the care they need before calling an ambulance. Here’s how one community is addressing social determinants of health to help vulnerable patients get healthier.

Starting with data

One of the largest networks of hospitals and providers in the area, Greenville Health System, decided to dive into the data around frequent emergency room visits and 911 transports. They cross-checked hospital records and first responder data. And they found that a small number of residents were calling 911 repeatedly for non-emergent issues and going to the emergency room.

The reason, says Jennifer Snow, director of accountable communities for Greenville Health System, was simpler than they thought. “It wasn’t because they were experiencing a real emergency, but because they didn’t have a primary care physician, or even a car.” Many had no health insurance at all, or the money to pay for a doctor’s visit.

Developing the approach

To address the problem – and the underlying causes –the Blue Cross and Blue Shield of South Carolina Foundation helped fund a partnership with Greenville County Emergency Medical Services (EMS) and the health system to test a new approach: training paramedics to help patients who use emergency services repeatedly for non-emergent issues how to manage health conditions at home connect them with the resources to stay healthy, such as a primary care doctor.

“We’re investing in something that benefits the economically disadvantaged but has an impact on the whole healthcare system,” says Erika Kirby, head of BCBS South Carolina’s Foundation. Kirby says the approach improves the health of the population by addressing the needs of the most vulnerable. And, she says, the program has freed up two additional ambulances to respond to emergencies.

Community paramedics trained to make house calls

The organizations helped establish a new curriculum in community paramedicine at nearby Furman University. A trained community paramedic can arrange to visit a patient at home to check vitals and review medications. They can scan for safety hazards and other clues to a patient’s well-being. 

“We define it as an evolution of what first responders are known for,” says Kirby. “They have the ability and a trusted presence in their community that they can, in a more proactive manner, help these individuals get the right level of care at the right time.”  

Follow up visits from social workers and community healthcare workers can help address some of the social determinants of health contributing to a patient’s poor health.

How Greenville County's Paramedicine Program works: Patients are referred to the community paramedicine program through a variety of avenues, a community paramedic schedules a visit to conduct an initial assessment, including reviewing medical history, checking vitals and ensuring medications are in order; a social worker can then help navigate the next steps with his or her care, including making the connection to mental health resources; a community health worker can address underlying social determinants of health most responsible for a patient's poor health, such as lack of transportation, access to healthy food or an unsafe environment.


Monitoring results: better health, fewer ER visits

To measure the success of the program, BCBS South Carolina Foundation is ultimately looking to see if people are healthier and getting the care they need, says Bree Bess, an analyst with the BCBS South Carolina Foundation. She says the community program is starting to make a difference:

  • Patient hospital admissions have declined by 19 percent, meaning that individual patients are receiving the follow up care they need to prevent being admitted.
  • Community paramedicine teams have helped decrease ambulance transports by 44 percent.
  • Emergency department visits have decreased by 25 percent, meaning that patients’ needs are being met at home, or through a connection with a primary care doctor, before conditions worsen.

Based on these early results, says Bess, “We believe this model could work in other places.” She says the Foundation’s initial contribution got the program off the ground, but it’s now self-sustaining. 

Blue Cross and Blue Shield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.