Eagle County Community Paramedic program marks 10 years of service, celebrates ever-expanding reach
EAGLE — A decade ago, the local ambulance district came up with a revolutionary simple idea to improve health care in rural areas — community paramedics.
The idea was to put emergency medical professionals to work in preventative medicine. Unlike traditional medical services, community paramedics come to the patient instead of forcing the patient to come to a doctor’s office. Instead of arriving on the scene of a medical emergency, community paramedics are tasked with checking a patient’s vitals or drawing blood to determine how a prescription regimen is working. The idea is to keep people from needing an ambulance ride.
“One of our longest-running patients in the program used to be a frequent user of the 911 system. By just going to her house once a week and filling her pill box, we have kept her out of the emergency room,” said Chris Montera, chief executive officer for Eagle County Health Services District.
In an age when medical costs are skyrocketing and entities everywhere are interested in cost containment, the community paramedic model has never been as popular.
“Call it luck, call it vision, call it whatever you want,” Montera said. “But in 10 years, I can’t believe how far this has come.”
The Eagle County Community Paramedics program has earned a special designation from the Colorado Department of Health and inspired similar efforts in 22 other states. In 2011, the program decided to write a handbook detailing its operation and offering advice to other agencies that might be interested in launching a program. In October 2011, the handbook went up on the local program’s website. Since that time, it has been downloaded an average of five times a day.
“I have given my Community Paramedics talk more than 200 times,” Montera said.
Over the Memorial Day holiday in 2009, some representatives from what was then the Western Eagle County Ambulance District had to visit Nova Scotia to see an actual community paramedic program in action. There were only a couple of programs running and both were in urban areas. But the group returned home determined that the effort could work in Eagle County.
“We started it and it was hard,” Montera said. At first medical professionals were dubious and there was no licensure process.
But gradually, the local community came to embrace the effort.
“They saw us as filling a gap, not competing with other services,” he said.
But even as the program was finding its way locally, there were still larger institutional issues. Most prominently, there was a licensure issue.
“We were a square peg in a round hole,” Montera said.
Jan Stapleman, deputy director of communications for the Colorado Department of Public Health and Environment, noted that individual counties regulate their emergency medical services agencies. The Health Facilities and Emergency Medical Services Division at the Colorado Department of Public Health and Environment regulates home health care agencies, licenses EMTs and paramedics and defines the responsibilities of each type of agency.
Stapleman said the challenge was to figure out how to license emergency medical services to provide short-term home heath care without encroaching on services provided by traditional home health care agencies.
“Sometimes when you innovate, you find that you are not in line with regulations. But the state finally caught up to what we were doing,” Montera said.
In 2016, the Colorado Legislature passed the community paramedic bill. It invented the Community Integrated Health Care Services Designation and set program standards. Stapleman noted that paramedics must pass a national test to be endorsed as community paramedics. Montera worked with the International Board of Specialty Certification to develop that test and helped write one of the first community paramedicine curriculums, now taught at more than 500 universities and colleges around the world.
“As the first Colorado agency to receive Community Integrated Health Care Services designation, and the first such rural program in the United States, the Eagle County Health Service District now fills a gap in health care services by providing short-term home health care to Eagle County residents,” Stapleman said.
Today, 10 years after community paramedics began work in Eagle County, their role continues to expand. They routinely check in with the parents of newborns, a day or two after they leave the hospital. They work with physicians and patients on at-home alcohol detox. Mental heath care has become a focus in Eagle County and community paramedics work with the Hope Center Eagle River Valley on crisis co-response efforts.
“That’s the power of our program. We haven’t said ‘no’ to someone yet. We want to be there for what patients need,” Montera said.
There are many advantages to bringing medical services to the patient’s home, he continued. It’s healthier for vulnerable patients such as newborns or the elderly and it gives medical providers a better understanding of a patient’s overall environment.
“Plus we take anyone. We don’t care who can pay or not because we don’t charge them,” Montera said.
While the services local community paramedics provide are ever-evolving, their central mission has remained constant.
“We have been great, in America, at teaching people to dial 911. But we haven’t been to great at triaging people to the right place,” Montera said. “Most of the time when get calls from people who don’t have to go to the emergency room, we can get them to where they need to go to get help.”
Ultimately, community paramedics keep patients away from some of the highest cost medical services in the nation — ambulance rides and emergency room visits. But ironically, the program is offered by an entity that depends on ambulance transport for its very survival. After all, Eagle County Paramedic Service’s billing model is based on transport.
But the Eagle County Health Services District, in partnership with Vail Health, continues to recognize the value of dollars saved. The program has received grant support and gets roughly $300,000 per year from the health services district.
That’s a bargain, Montera said.
“On average we figure we save the health care system about $5,200 per patient,” he said.
And while Montera knows that is a great selling point, he said cost-saving is not the biggest reason why community paramedics are so important.
“We just view this as another part of how we take care of people,” Montera concluded. “This about how can we do more with less, and make people healthier.”