Integrating Community Paramedics into the Cancer Care Team

This blog post is the fifth of a seven-part series highlighting the achievements of the 2021 ACCC Innovator Award winners before their in-depth sessions at the ACCC 38th [Virtual] National Oncology Conference. You can learn more about the innovations being recognized this year and the people who pioneered them by joining us live in on November 9-10, 2021.

Effectively managing oncology patients’ treatment-related symptoms is a challenge many cancer programs and practices face. To prevent patients with cancer from having to access the emergency department (ED) or hospital throughout treatment, oncology providers want to be able to provide timely care for adverse reactions or symptoms. Presbyterian Healthcare Services in Albuquerque, N.M., is leveraging its existing relationship with community-based paramedics to address patients’ treatment-related symptoms in their homes.

Through a partnership with Albuquerque Ambulance Service, a local community paramedic group that is a division of Presbyterian Healthcare Services, Presbyterian enables qualifying patients with cancer access to certain clinical interventions and wellness checks in their homes from a specialized paramedicine oncology team. The goal of the program is to reduce patient utilization of the ED and reduce inpatient admissions by addressing some patients’ treatment-related symptoms at home.

The idea for the program arose in 2018 during a regularly scheduled strategy meeting of the Presbyterian Healthcare Delivery System leadership. Present at the meeting was Scott A. Kasper, MS, vice president and chief at Albuquerque Ambulance Service at Presbyterian Healthcare Services, and Michele Goodman, RN, BSN, MBA, vice president of Cancer Care Services at Presbyterian Healthcare Services. "When I heard Michele talking about reducing ED utilization, I immediately thought that while most of our work is for the health plan to reduce cost, we can certainly work with a clinical division to address these concerns,” Kasper explains. “When I asked what patient needs were being unmet, I learned it was things like providing hydration, pain management, and nausea control. In the world of paramedicine, that's easy. We do that every day.”

Presbyterian Healthcare Services is a fully integrated healthcare system that incorporates inpatient, outpatient, and community-based clinical delivery services as well as a commercial health insurance plan. Kasper explains that because of the relationships created through this integrated network, Albuquerque Ambulance Service’s Mobile Integrated Health Team can offer services aimed at providing outstanding clinical care in a model designed to prevent hospitalizations. This service model can also decrease the costs of care passed along to the health system’s health plan, whose members include a majority of the covered lives in the Albuquerque metropolitan area.

ED Care in the Home

The Mobile Integrated Health Team was assembled quickly after the idea was born, bringing together Albuquerque Ambulance Service (represented by Kasper, its medical director, two managers, and seven full-time community paramedics) and Presbyterian Cancer Care (represented by Goodman, the cancer center’s medical director, two medical oncologists, nurse educators, nurse leaders, and other non-clinical staff).

With Kasper leading the Albuquerque Ambulance Service team, Goodman’s team began working to make the services feasible for patients. "We identified several patients who we thought would be interested in this opportunity and got universal agreement," she says. "Patients really like the idea of staying in their homes, especially for things that don't require travel, so that's where we started. We then identified the competencies that would be required of the paramedics to be able to deliver this care.”

The team created a plan to educate the paramedics on what they needed to know to ensure they understood the complexities of cancer care and the common treatment symptoms patients with cancer may experience. As part of the education initiative, cancer care expert nurse clinicians joined the paramedics during their first set of appointments.

“There was a ton of learning happening, and great collaboration,” says Goodman. Kasper says his team welcomed their new role. “Our paramedics felt integrated with the cancer care team. They don’t feel like they are just ancillary technical providers, but that they are part of the cancer care continuum.”

To establish workflows for receiving referrals, Kasper’s team created treatment algorithms and plans for traveling to patients’ homes. This included working with the New Mexico Department of Health to draft waivers that would expand the Albuquerque Ambulance Service's scope of practice and allow Kasper’s team to be reimbursed for their services. Presbyterian Healthcare Services' health plan covers 65 percent to 70 percent of its oncology patients. Because both teams had experience working within the scope of the plan, the groundwork was already laid for the project.

Since its implementation in April 2019, the Mobile Integrated Health Team has provided 652 home visits to 169 patients with cancer in need of rehydration, electrolyte replacement, symptom management, and/or lab services. With the success of the program, Presbyterian Healthcare Services is looking to expand its scope of available treatments to include injections such as darbepoetin alfa, pegfilgrastim-sndz, pegfilgrastim, and pegfilgrastim-jmdb to prevent complications (e.g., anemia, neutropenia) in patients currently undergoing chemotherapy and/or radiation regimens.

Kasper recommends that cancer programs and practices looking to build similar programs not box themselves in with traditional definitions of patient service. “We're fortunate to be an integrated healthcare system that includes both clinical delivery services as well as a health insurance plan, which allowed us to easily advocate for this service,” says Kasper. “But people who are not in that situation can still demonstrate to managed care organizations the cost-savings and patient satisfaction of a program like this one. There may be different barriers, but I’m a believer that barriers are simply there to challenge our creativity in identifying innovative solutions.”

Attend the ACCC 38th [Virtual] National Oncology Conference to gain in-depth knowledge about the creation and implementation of Presbyterian Healthcare Services' Mobile Integrated Health Team and its success at treating patients’ treatment-related symptoms in the comfort of their homes.