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How to prove the value of community paramedicine

The Community Health Needs Assessment is the starting point for launching a mobile integrated health program the hospital will pay your department to run


The Affordable Care Act requires all not-for-profit hospitals to produce a community health needs assessment (CHNA) every three years.

Photo/Birmingham Fire and Rescue

In early 2018, my department’s mobile integrated health program signed a contract with a local hospital to conduct follow-up visits with patients after discharge. For each patient we see, the hospital has agreed to pay our department an enrollment fee, helping us along on our quest for self-sustainability.

Ever since the agreement was announced we have gotten calls from firefighter-paramedics working all over the country who are do the same for their own department’s community paramedicine program.

The question we most often hear is “where do I start?”

What is a Community Health Needs Assessment?

The answer is with your local hospital’s Community Health Needs Assessment.

The Affordable Care Act requires all not-for-profit hospitals to produce a community health needs assessment (CHNA) every three years. In order to maintain their tax-exempt status, not-for-profit hospitals must show that they understand the needs of their respective community and have a strategic plan on how to address those needs.

For anyone in the business of community paramedicine or mobile integrated healthcare, the information found within a hospital’s CHNA provides a perfect launch point to begin collaborative discussions with hospital administrators. Especially if you are looking for the hospital to pay for your out-of-hospital assessment and treatment services.

It worked for the Birmingham Fire and Rescue Service C.A.R.E.S. program. It can work for yours.

How do I find our hospital’s CHNA?

One stipulation under the Affordable Care Act is that each hospital’s CHNA must be widely available to the public. Google makes it easy. Simply type “Community Health Needs Assessment” followed by the name of your local hospital in the search bar.

If your local hospital is a for-profit enterprise or is run by the government, then you might be out of luck. For-profit and government-run hospitals are treated differently compared to the not-for-profit hospitals; meaning they are not required to produce a CHNA.

However, public health departments have been conducting CHNAs for years. And, according to the American Hospital Association, more than 50 percent of all the hospitals in the U.S. registered as not-for-profit in 2018. The odds are in your favor of finding some good information.


Photo/Birmingham Fire and Rescue

What information is in a CHNA?

Some of the information you will find in a hospital’s CHNA includes but is not limited to:

  1. The geographical community served by the hospital.
  2. A list of the community’s needs ranked by priority.
  3. Existing local health care facilities and community resources available to help meet the needs identified.

3 ways to put the CHNA to use

Here are three ways community paramedicine program leaders can put the CHNA to use to serve patients and increase the likelihood of reimbursement for services provided.

1. Geographical community

Hospitals typically identify their geographical community by using the home zip codes of their patients. For us, this was the strongest piece of information to show in support of creating a MIH/community paramedicine partnership between the hospital and our department.

By sharing our department’s run data, we were able to clearly show our strong presence within the zip codes that the hospital’s patients called home.

It only seemed logical that since we were the ones bringing many of the patients back to the hospital in an ambulance, we had the greatest potential to help keep them home.

2. Needs identified

Some of the needs listed within a CHNA can be so large that they almost seem vague. Examples of high-priority needs that I have seen listed in CHNAs include:

  • Access to primary care.
  • Obesity.
  • Diabetes.
  • Cardiovascular health.

Whatever the needs may be of your hospital’s CHNA, you should keep these in mind when presenting your MIH program to prospective hospital partners. If the need is access, you can show how your community paramedics will address issues related to access. If the hospital’s priority is diabetes, then take aim at diabetes.

This may seem deceptive, but it isn’t. Ensuring that community efforts are geared toward meeting the highest needs is the sole purpose of the CHNA. You’re simply using the document as it was intended.

3. Existing healthcare facilities and community resources

Gaining a grip on the available resources within your community can be a never-ending process. Aside from just helping you promote your community paramedicine program to the hospital, the CHNA can provide you with a list of agencies that can help your program be successful. In our community, those agencies include:

  • The Community Food Bank of Central Alabama.
  • Christ Health Center, a federally qualified health center that provides primary care to the underinsured.
  • Cahaba Valley Healthcare, which provides free dental care.

Mobile integrated healthcare is just that. It’s the integration of your agency into the bigger world of healthcare, which, from what we’re learning from the social determinants to health, is ever expanding.

A partnership with a local food bank may help your future patients more often than a free pharmacy.

And don’t overlook the importance of the advocates you recruit with each new partnership. It never hurts to have local community leaders in your corner supporting your mission.

Be prepared but also be patient

Right now is an exciting time to be starting up a mobile integrated health program. With all of the promising news articles popping up from all over the country there is a ton of momentum fueling the drive.

But I’d like to extend a word of warning to those coming from the frontlines of fire-based EMS where things move quickly.

Building a MIH program means you are entering the world of healthcare administration and things here can move at an almost glacial speed.

Depending on the size of the hospital you are attempting to partner with, the chain of command can at times appear a little murky. You’ll meet with one hospital administrator thinking that he or she is the decision maker only to be told at the end of the meeting, “I need to introduce you to my boss.”

As frustrating as this can be, it beats being told “no.” The best way you can ensure you get the invite up the ladder is by:

  • Doing your preparation and homework.
  • Aligning your program to fulfill the needs identified by the hospital’s CHNA.
  • Networking with everyone you can in hospitals and other community programs.
  • Presenting compelling data that will drive a decision from a hospital administrator.

And what better data is there to have in your arsenal than the hospital’s own?

Ben Thompson is a battalion chief in Birmingham, Alabama. In 2016, Thompson developed his department’s first mobile integrated health (MIH) program and shared his experiences from building the program at TEDxBirmingham. Thompson was the recipient of the 2016 Emergency Medical Service Provider of the Year Award and the 2018 Joe E. Acker Award for Innovation in Emergency Medical Services, both in Jefferson County, Alabama. He has a bachelor’s degree from Athens State University in Alabama and is a licensed paramedic. Connect with Thompson through his website