The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance’s Pilot Program

Katharine W. V. Bradley
Dominick Esposito
Iyah K. Romm
John Loughnane
Toyin Ajayi
Rachel Davis
Teagan Kuruna
Case Example
December 2016

This resource describes an analysis of a Massachusetts-based MIH-CP program called Acute Community Care (ACC), a pilot program of the Commonwealth Care Alliance. It assesses the business case for expansion to other geographic areas.

  • MIH-CP programs expand the role of emergency medical services personnel. In such programs, paramedics provide outpatient urgent and primary care–like services for patients who might otherwise visit an emergency department (ED).
  • Under the pilot program, patients diverted from the ED had lower average costs than those not diverted on a patient-episode basis (per patient savings were $791 for a seven-day period, $3,677 for a 15-day period, and $538 for a 30-day period).
  • To assess MIH-CP programs, an appropriate time frame is crucial; achieving net savings in less than 12 months may be unrealistic.
  • Modifications of various attributes could yield different financial outcomes for other programs. For example, a 10 percent increase in patient volume would increase savings by 18 percent, and a 2.5 percent increase in the average ED diversion rate would increase savings by 5 percent.
  • Estimating savings depends on reimbursement structure. Commonwealth Care Alliance is an integrated delivery system and able to retain all ACC program savings. MIH-CP programs that depend on reimbursement from other stakeholders may have a more complex equation.
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