How Community Health Workers and Community Paramedicine Improve Population Health

Paramedics visiting diabetes patients to check vital signs and make referrals.  Community health workers assigned to teams in medical homes and accountable care organizations to educate overweight patients on healthy eating and exercise habits.

These may not be the roles that paramedics or community health workers have traditionally performed. But with new incentives created by population-based payment methods, providers are increasingly looking at ways that community-based practitioners can provide basic health services to their patients. Growing evidence suggests that expanding these types of alternate staffing can help improve population health while reducing cost.

How states are expanding the roles of both of these types of health care workers was one of the topics discussed this month at Reforming States Group (RSG) meetings held around the country. The meetings were attended by representatives from 37 states, three Canadian Provinces, and Australia.

Community paramedicine is an evolving field that involves paramedics in more than emergency care and transport. Its use in rural areas, especially, is reducing emergency room visits and filling gaps in health care delivery by reducing the burden on primary care physicians.  Another way it’s being used is to improve access to appropriate care for patients who are “super-users” of the 911 system.

Community health workers, trusted members of the community who focus on outreach, education, and informal counseling, contribute to improved health care outcomes for the underserved populations they serve.  Evidence has shown that these workers’ peer-to-peer relationship with patients improve outcomes in such areas as childbirth, chronic care management, and diabetes. There is growing interest in bringing the skills of these workers to specific condition-focused initiatives or patient-centered medical homes.

Presentations at the RSG meetings focused on the evidence, experience, and practice of implementing expanded community health worker and community paramedicine programs.  Experts described the types of providers and training involved, emerging strategies, and promising practices. RSG members spoke frankly about the challenges and best practices in developing legislation and policies to act on this evidence, the catalytic role of payment reform, and the inevitable scope of practice disputes that arise.

The topic was selected by the RSG and developed by RSG members and Milbank Memorial Fund staff.  To learn more about the evidence and experience of community health workers and community paramedicine, go to the Reforming States Group Resource Library and search for “paramedicine.”