The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance’s Pilot Program

Bradley KWV, Esposito D, Romm IK, Loughnane J, Ajayi T, Davis R, Kuruna T
Publication Year: 2016
Patient Need Addressed: Care Coordination/Management
Population Focus: Complex care, Dual eligible
Intervention Type: Best practices, Staff design and care management
Type of Literature: Grey

As complex care programs across the country turn toward innovative workforce developments, mobile integrated healthcare and community paramedicine (MIH-CP) programs are increasingly being implemented and tested. These programs expand the role of emergency services personnel to provide outpatient and primary care-like services in patients’ homes, particularly for individuals who might otherwise visit or be transported to an emergency department (ED). However, because these potentially promising programs are still in their early stages, interest in the cost-saving potential of MIH-CP programs has outpaced the availability of evidence of return-on-investment to date.

To test the value of community paramedicine for its members, the Massachusetts-based Commonwealth Care Alliance piloted the Acute Community Care (ACC) program, an ED-diversion initiative, between 2014 and 2015. With support from the Center for healthcare Strategies and through the Kaiser Permanente Community Benefit-funded Complex Care Innovation Lab, Commonwealth Care Alliance worked with Mathematica Policy Research to assess the business case for ACC. This brief summarizes the business case assessment and illustrates considerations for designing and planning other MIH-CP programs. The accompanying business case tool provides an interactive way to explore how changing cost drivers impact savings projections.

Insights Results

Overview of article

  • Mobile integrated healthcare and community paramedicine (MIH-CP) programs expand the role of traditional emergency medical services personnel to address non-emergency needs and bring outpatient primary and urgent care into patients’ homes. These programs offer potential for reducing healthcare costs, eliminating unnecessary emergency department (ED) use, and shifting service back to community-based and home settings
  • Between 2014 and 2015, the Massachusetts-based Commonwealth Care Alliance (CCA) piloted a community paramedicine program, Acute Community Care (ACC), to serve its members in the Greater Boston area
  • Many MIH-CP programs are still experimental or in early stages of implementation. Accurately assessing them is challenging because typical implementation periods are short, the number of patients served is small, and comparison groups are difficult to identify. Early assessments of cost effectiveness may not fully reflect long-term promise or provide the type of information that organizations and policymakers need to assess sustainability
  • This brief explores the costs and benefits of CCA’s Acute Community Care (ACC) program and assess the business case for expansion to other geographic areas


  • This brief summarizes the following learnings: 1) Defining a reasonable timeframe for assessing existing programs is crucial; 2) Constructing comparison groups is challenging; 3) Calculating savings estimates depends on reimbursement structure; and 4) Business case assessments assume that future programs will be similar to pilot implementation
  • The analysis identified several factors driving ACC cost and savings estimates that provide insights for other MIH-CP programs in designing cost-effective programs. Because CCA receives capitated Medicaid and Medicare payments, any incurred savings will help the organization meet state and federal expectations for incremental decreases in the total cost of care for dual eligible beneficiaries. Although ACC’s business case findings are specific to a capitated environment, they can also guide program design and evaluation considerations for MIH/CP programs with different financing arrangements
  • Overall, CCA anticipates expanding its ACC program into parts of Central and Western Massachusetts. CCA plans to expand the program to these regions with these insights in mind, and to date has hit the necessary volume targets identified in this analysis to generate a return on investment

Key takeaways/implications

  • Conducting robust business case assessments in the growing field of MIH-CP programs is challenging but necessary. These assessments can help individual programs identify cost drivers and improve the chances of long-term success. Robust business case assessments may also, singly or collectively, help to convince payers to provide reimbursement for these potentially valuable programs, paving the way for additional innovation in patient-centered care