Shifting the Paradigm of Healthcare

“He did save my life. I would have never went in for any of it if it wasn’t for him.”

In rural areas, it can be weeks before you’re able to be seen by a doctor. And to see a specialist, like a cardiologist or a neurologist? That can take months. A limited number of doctors and hospitals combined with a large demand creates a perfect storm that leads to a lack of service for those who need it most.

Community paramedicine is a healthcare model that allows paramedics and emergency medical technicians (EMTs) to serve as on-call medical professionals to underserved populations in the community. Programs like this are growing significantly across the U.S. but are seldom funded by public or commercial insurance programs. 

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When Natalie turned 30, she threw a party. Friends and family celebrated, but throughout the night, Natalie grew lightheaded. Her symptoms worsened until eventually, she couldn’t see out of her right eye and she assumed she was having a stroke. Her husband rushed her to the emergency room. Natalie would end up spending almost two weeks in the hospital with meningitis.

After Natalie was discharged from the hospital, staff told her about the Delta County Ambulance District’s Mobile Integrated Healthcare (DCAD-MIH) program. Natalie contacted MIH to request that the team check on her periodically —and it wasn’t long before they found she wasn’t healing the way she should be. Her infection was back.

Natalie describes herself as stubborn. She is confident that if MIH had not instructed her to head back to the hospital, she would have stayed home and tried to heal on her own. They saved her life. And that’s what MIH is doing for residents all over Western Colorado.   

Rural communities like Delta County, Colorado often face gaps in healthcare, and the Delta County Ambulance District has created an innovative solution.

DCAD-MIH founder Reuben Farnsworth has been a seasoned paramedic in rural Colorado for many years. Before MIH was launched, being a paramedic in such a remote area was both rewarding and frustrating. In the Delta County Ambulance District, where he worked, saving lives was a regular occurrence. But Reuben says he also started to feel like a taxi driver for mildly sick patients who called for an ambulance to take them to the emergency room. Not that it was the patients’ fault: With so few doctors, there was a long wait time for acute medical needs, sometimes up to three weeks for symptoms like chest pain. So the choice for rural residents was to wait or go to a crowded rural ER, where they were at risk of catching something else, like the flu or COVID. To compound the issue, many people equated ER visits with taking an ambulance, so they would call 911 and use ambulance services to go to the ER, which would end up costing them thousands of dollars. 

After talking with his chief, Reuben and his team started treating many of the patients they were called out to in their homes. If needed, they would set up a virtual video call with a doctor for medication prescriptions, but otherwise, they found they could treat most people quickly, easily, and much more affordably in their own homes. And that’s how a new paradigm of healthcare began in rural Colorado. Called community paramedicine, the approach is changing the landscape of healthcare.

The DCAD’s Mobile Integrated Healthcare program has turned to a “modern-day house call” system to address gaps in healthcare in a rural area of the Western Slope.
DCAD-MIH founder Reuben Farnsworth discusses logistics with his team.

Reuben and his team have helped countless people in Delta, Montrose, Gunnison, Hinsdale, Ouray, and San Miguel counties, many of whom lack the means or opportunity to seek healthcare. For example, they’ve provided in-home treatment for a man who was traveling hours to Salt Lake City twice a week and helped a patient with a congenital defect who requires infusions. Reuben’s team was able to rerun her infusion line and maintain her gastric tube port, saving her from the alternative of permanent hospitalization.

Dave Jepsen is the MIH paramedic who initially noticed something was off with Natalie’s condition. A gray tint to Natalie’s  skin color prompted him to check for more symptoms. After some tests, Dave knew Natalie couldn’t wait until the following morning to see a doctor — she needed to go to the ER right away.

In-home routine care saves valuable time and money for both patients and medical institutions alike.
 Care from The Delta County Ambulance District’s Mobile Integrated Healthcare program very likely saved Natalie’s life.

That’s the beauty of MIH. Going beyond traditional paramedicine, MIH clinicians perform all the roles of a typical paramedic but with the expanded ability to gather and interpret patients’ labs to share with a treating physician and help the physician guide the patient’s treatment.

“We couldn’t have grown as fast as we have without the investment from Rocky Mountain Health Plans and UnitedHealthcare. Their vision and willingness to jump on board with us in this and say, ‘Yes, we think this is the future,’ [and] their willingness to embrace innovation is what has helped us to thrive and move forward.”

With the support of Rocky Mountain Health Plans, a UnitedHealthcare company, DCAD-MIH is able to provide Medicaid support for those who wouldn’t otherwise be able to afford treatment at an ER, while reducing patient volumes at those facilities. Investments from Rocky Mountain Health Plans’ Prime program fully fund Mobile Integrated Healthcare’s services to Medicaid members. For people like Natalie, MIH is a lifeline to lifesaving healthcare, meeting people where they are and giving them what they need to stay healthy.

Rocky Mountain Health Plans and United Healthcare continue to invest in people-first programs like Mobile Integrated Healthcare, as well as many others throughout Colorado.

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