It’s said that every system is perfectly designed to get the results it gets. So, we shouldn’t be surprised that our health care system results in fragmented care and inappropriate utilization—we designed it to work that way. Often, the medically underserved have health care needs that go unfulfilled because the system excludes them, either because of eligibility criteria, billing codes, or some other technicality, and that can lead to ER visits that should’ve been primary care visits and 911 calls that could’ve been handled another way. Over the last several months, I’ve spent a lot of time on a taskforce grappling with this issue, seeking ways to serve the patients across Colorado who fall through the cracks in the health care system.
This taskforce was convened by the Colorado Department of Public Health and the Environment to create a public policy framework for community paramedicine and mobile integrated health. Community paramedicine and mobile integrated health care are ways to leverage EMS and Fire Department resources to reach high-risk patients in their homes and reduce over-utilization of the system. By providing basic medical services (checking blood pressure, checking for fall risks, ensuring medication compliance, etc.) and guiding patients to the right resources (behavioral health or primary care appointments), they decrease the burden on the 911 system. These types of initiatives are relatively new, both in Colorado and nationwide. As such, regulations for oversight haven’t been developed, so the state and participating communities have been relying on temporary fixes to ensure patient safety. The health care community as a whole agreed that the time was right for a more permanent public policy solution.
After months of dialogue and research, we developed big picture recommendations for a new vision of health care delivery at the local level: community integrated health care services. We see a future where the existing resources in local communities collaborate more nimbly to respond to individual patient needs—wherever those patients are. Home health will collaborate with EMS, and visiting nurses will collaborate with social workers, just to name a few examples. All our agencies will share patient information and offer appropriate resources, while staying within the bounds of their professional training. Patients will be able to get their needs met in a flexible, adaptable system without facing rigid eligibility criteria issues, and communities will have the freedom to structure their collaborations based on local resources and priorities, which vary across the state.
It’s a grand vision, and one that doesn’t supply all the answers as to how we get there. Our public health regulations still need some changes, as outlined in the taskforce’s final report; however, an articulated vision enables us to develop a plan that will move us toward our shared goals. We all agree that reaching patients outside of higher-acuity facilities will cut emergency room usage, high-cost diagnostics, and hospital readmissions, and could result in significant cost savings for Colorado (PDF). Now that we know where we’re going, it’s time to plan for the journey. I won’t miss our long taskforce meetings, but I’m proud of what we’ve accomplished and look forward to making it easier for communities to meet patient needs in innovative ways.