UCHealth Emergency Medical Services has partnered with Larimer County and Rocky Mountain Health Plans to provide a service that saves taxpayers’ money and reduces emergency room visits and readmissions.
In September 2015, UCHealth approached Larimer County Community Corrections to help tackle LCCC residents’ high use of ambulance services and UCHealth’s emergency rooms, and to better manage medical needs within the correctional facility.
LCCC reported more than 332 medical events from March to December 2015 that required transport, either by ambulance or by the facility’s staff, to the ER.
“We were going frequently to pick up patients who didn’t necessarily need emergency care,” said Julie Bower, paramedic for UCHealth EMS. “Many of these people were using the ER as their primary care.”
The solution: a once-a-week clinic hosted by UCHealth EMS at the correctional facility. The first clinic started September 2016.
“We see first those who have been to the emergency room the week before,” Bower said. “We go over their discharge paperwork, review their case and see if they understand, are following instructions and have filled prescriptions. Then we communicate that visit with their case manager at the correctional facility.”
Each visit takes about 5 to 15 minutes and includes a full set of vitals and a health exam. The EMS team spends about one hour each in the men’s and women’s units.
LCCC has a residential facility that averages about 290 clients a day. These people are transitioning out of prison prior to being released on parole, or they have been sentenced to the correctional facility as an alternative to prison.
“There are people who are coming into this program who have not been taking care of themselves and need to learn how to live again without being high,” Bower said. “We are spending a lot of our visits educating on urgent vs. emergent and proper utilization of an emergency room — both to the residents and the staff.”
Bower serves as triage — making sure each patient receives an appropriate level of care. For residents who have acute issues but don’t need emergency care, Bower can schedule a virtual visit with a physician through the clinic’s partnership with Rocky Mountain Health Plans. This also helps patients become established with a primary care provider in the community.
LCCC resident ER visits decreased 25 percent from September 2016 to January 2017 compared with the same time period the previous year, and ambulance use dropped 41 percent. During that same time, LCCC’s utilization of staff transports to the ER increased by about 11 percent, demonstrating staff’s increased understanding of when an ambulance is necessary, said Joe Ferrando, assistant director of LCCC. It amounted to about $80,000 in savings, he reported.
The program was recognized as a success for the county, and in May, the Board of Larimer County Commissioners awarded it with the 2017 Innovation Grand Prize Award, an award given to employees who show ingenuity, creativity and improve process for the county through resourceful, groundbreaking or novel approaches.
Because the population at the correctional facility is always changing — residents stay between 90 days to nine months or more — the need for the clinic’s services won’t be going away, Bower said.
A flu shot clinic was also added this year and in the coming year, the clinic will be held earlier in the flu season to provide protection against the virus that causes the flu to even more residents.
The Affordable Care Act’s expanded Medicaid coverage for nondisabled adults without dependent children, a category that many correctional facility residents fall into, helps with clinic costs.
“How we run the clinic may change as our UCHealth EMS community paramedics program evolves,” Bower said.
Community paramedics is an additional community program provided by UCHealth EMS that allows paramedics to make house calls to at-risk residents throughout Larimer County, helping them with such things as medication reconciliation, health exams, home safety checks and vaccinations. It allows people to stay in their homes and also has decreased unnecessary visits to the emergency room, but currently, patients, most of whom are elderly, have to be referred through the UCHealth Aspen Club. However, new legislation may change that and allow the program to be expanded, which could then benefit the LCCC clinic program by allowing UCHealth EMS an expanded scope of practice, which in turn will help even more people at the correctional facility avoid the ER.