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

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.