Insurer-paramedicine partnership looks to reduce ER admissions

Program helps coordinate care for high-utilizing Medicaid patients
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As a part of an initiative to curb unnecessary hospitalizations and healthcare costs, Blue Cross Blue Shield New Mexico has partnered with Albuquerque Ambulance and American Medical Response to care for high-risk Medicaid patients in their homes, according to the Albuquerque Journal.

The mobile healthcare effort, called the Community Paramedicine pilot program, focuses on reducing the use of 911 calls and emergency department visits as well as adopting better care and follow-up for certain patients. These patients can include anyone from someone suffering from congestive heart failure to a newborn who spent some time in the NICU, the article says.

In the past month, about 50 Medicaid patients have received in-home visits from Albuquerque paramedics a day, and visits can include vital-sign checking and medication review or administering a blood glucose test and making sure the patient has enough food in his or her home. Duane Ross, M.D., and medical director of the insurer's New Mexico government programs, tells the Albuquerque Journal that the true benchmark of the program's success will be fewer visits to the ED and hospital readmissions, but accurate numbers around those benchmarks won't be available for three to six months.

UnitedHealth has had success with a similar program, called HouseCalls, which sends a physician or nurse practitioner on a home visit to Medicare Advantage members. A recent study showed that the program helped reduce hospital and nursing home readmissions. Additionally, Torrance, California's HealthCare Partners Affiliates Medical Group has operated a house call initiative since 2009 for high-risk patients, and after three months, data showed that patients involved were admitted to the hospital less often.

Ross tells the Albuquerque Journal that he saw the potential benefit of a community-based paramedical program to serve a growing part of BCBS' 130,000 members in New Mexico. The article notes that ED visits have skyrocketed in New Mexico with the expansion of Medicaid, which is a costly trend, especially for those with chronic illnesses.

"It's partnerships like this that will improve health care in the community well into the future," he said.

To learn more:
- here is the Albuquerque Journal article

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