Delivering care: Essentia’s community paramedics program brings high-quality care to patients’ homes

Brendan Krupich recognized a need among folks plagued by chronic health conditions who are more susceptible to hospitalization. How could Essentia Health better serve those high-risk patients, he wondered. Turns out the answer was to bring care directly to their homes via a unique community paramedics program.

"There is this vulnerable population that just so happens to need this kind of care," said Krupich, who manages the program for Essentia. "That's why we're here."

As an Accountable Care Organization, Essentia is driven to enhance access to expert and compassionate health care while reducing costs and preventing unnecessary visits.

Those objectives form the foundation for our community paramedic services. Essentia's program started in 2014 and is one of the most established in the nation. It exemplifies our commitment to preventive care and thinking outside the box to meet the needs of our patients.

Here's how it works: At the request of a health care provider, Essentia sends a certified community paramedic to a patient's home following a hospital stay, or to treat a wide range of health care needs. These include conditions like heart disease, chronic obstructive pulmonary disease or congestive heart failure, but the list goes much deeper. Community paramedics work closely with the medical team to provide high-quality — and timely — care at home and prevent health concerns from deteriorating.

It's a novel and effective approach for patients who have an increased risk of hospitalization. The goal is to keep them safe and limit readmissions. Patients say it's easier, more convenient and more comfortable to recover at home. This also helps to preserve hospital capacity for the most critically ill patients. Workforce challenges at skilled nursing and long-term care facilities are creating discharge bottlenecks at many hospitals, which can limit the number of available beds for others in need of care.

Krupich helped launch the program in 2014. It started in Fargo-Moorhead and has since spread to Ada, Brainerd, Deer River, Detroit Lakes and Duluth. Additional expansion is planned for communities across Essentia's service area.

Community paramedics report to EMS medical director Dr. Chris Anderson and associate medical director Dr. Brandon Drazich, who approve all patient visits. Collaboratively, they devise a care plan, with constant communication among a team that also includes vital assistance from Essentia's remote patient monitoring and nurse care line colleagues.

Aside from the more common conditions treated, services provided by community paramedics include discharge follow-up and home-safety assessments; wound care; vitals monitoring; lab work; electrocardiograms; and education.

They do it all, says Dr. Anderson, an emergency medicine physician at Essentia Health-Fargo. Beyond medical conditions and treatment, they encounter a variety of requests, from assistance with sourcing nutritious meals for those suffering from food insecurity, to help navigating MyChart and even daily tasks like snow removal.

"I refer to them as a bit of a Swiss Army Knife," he explained. "Their skill sets are broad and they often work under the radar because their patients interact with practitioners less frequently once the community paramedic establishes a relationship."

Hospitalizations and/or emergency room visits decline among patients who engage with Essentia's community paramedic services. That was the objective all along, to improve health outcomes via preventive care in a way that makes the most sense for vulnerable folks — by bringing care to them.

"We've been so reactive to emergencies, rather than proactively looking at the root causes" of injuries and illness, Krupich said.

Now, Krupich and his counterparts travel to patients' homes and help them manage those chronic conditions. Beyond providing care, they also aim to educate so that patients are better equipped to take ownership in their care plans.

"Essentia's community paramedics play an indispensable role in reducing cost of care by decreasing ED and hospital admissions," Dr. Anderson said. "Our community paramedics often develop lasting relationships with their patients, which allows patients to better understand and participate in their own care."

Community paramedics deliver more than just expert care; they deliver peace of mind. Simultaneously, they are addressing social determinants of health in a bold way to improve the health and well-being of an at-risk population.

At Essentia, community paramedics have specialized training in primary and preventive care.

This program is another way for Essentia to carry out its mission of making a healthy difference in people's lives.

"The number of patients we've been able to impact, the 'thank-yous' we get from patients and providers, the patients who feel like we've added years onto their life or we've kept them out of the hospital … that gratitude is really, really neat," Krupich said. "It's exciting and rewarding."

IN THE NEWS: KBJR in Duluth aired this story recently about one patient who has benefited greatly from Essentia's community paramedics program.