How to Support the Growth of Community Paramedicine

EMS World recently profiled several community paramedicine programs and the difference they are making in their communities to provide the right care in the right place at the right time for patients who don’t need and aren’t best served by an ambulance trip to the emergency department (ED).

Community paramedicine is a healthcare model where EMS staff operate in expanded roles in primary healthcare and preventive services, delivering care in the community, in many cases without a need for transport to overcrowded emergency EDs. Rural areas can benefit from this service for patients facing transportation issues and long distances that impede their access to medical care.

But in the absence of reliable access to reimbursement for community paramedicine and its close partners, treatment in place and mobile integrated healthcare (MIH), these models are forced to rely on alternate funding such as grants, contracts, local subsidies, sales and property taxes—or else risk closure.

Traditionally, EMS was built on the foundation of transportation, said Steven Kroll, MHA, EMT, an EMS consultant and Associate Advisor with Cambridge Consulting Group in Wayne, Pennsylvania. “That’s where our payment model comes from.” EMS lives in the U.S. Department of Transportation, and its institutional history has been hard to change.

The biggest barrier to community paramedicine has been lack of payment, because the payment models for EMS are not built around helping people stay in their own homes, he says. In most cases today—including for Medicare—there is just no reimbursement for EMS services unless they include transport to the ED, which raises real questions about sustainability for this innovative service.

“We see where patients live,” Kroll said. “We see things that they don’t see in the doctor’s office, or in the hospital. So, we think, hey, what if we were to come out here more often and try to help this person avoid that next episode of difficulty breathing that’s going to put them intubated and in the intensive care unit. Or avoid the diabetes crisis that is going to put them in the hospital.”

Innovators have been doing this, and it has been accepted in many communities, becoming part of the culture of EMS, he said. “We have this new title, community paramedic, but you don’t necessarily need to be a community paramedic to do community paramedicine.”

Where Are the National Solutions?

In the early days of the COVID-19 pandemic, a payment policy called the Emergency Triage, Treatment and Transport (ET3) model was launched by the Center for Medicare and Medicaid Innovation with the aim of improving outcomes through Medicare reimbursement to ambulance providers for services other than ED transport. At the end of 2023, CMS shut down the pilot, citing lower than expected participation and projected interventions by EMS agencies.

But it was not without its lessons learned, says Justin Duncan, CEO of Washington County Ambulance District in Potosi, Missouri, and chair of the Economics Committee for the National Association of Emergency Medical Technicians. A Booz Allen analysis of the ET3 pilot identified average net savings to Medicare of $537.51 per participating emergency patient.

Two bills currently in Congress also offer new hope for supporting community paramedics and treatment in place. H.R. 2538, the Improving Access to Emergency Medicine Services Act (introduced by Rep. Mike Carey, R-Ohio, and others) would create a pilot program to test allowing Medicare to reimburse EMS agencies for treatment-in-place services, permitting patients to be cared for in their own homes and/or transported to an alternate destination when a trip to the ED is not necessary.

H.R. 4011, the Community Paramedic Act of 2025 (introduced by Reps. Emanuel Cleaver, D-Missouri, and Kelly Armstrong, R-North Dakota), would expand the scope of rural health grants issued under Section 330A of the Public Health Services Act to pay start-up costs for MIH and community paramedicine grantees, including hiring personnel, purchasing equipment, and paying for staff certification courses and public outreach.

Together these bills could open new doors for community paramedicine, but the current political atmosphere in Washington, D.C. poses significant questions about their ability to prevail. Duncan calls this legislation a first step down the pathway to coverage for MIH and community paramedicine. “If the patient doesn’t go to the ED, we would still have a way to get paid by Medicare.”

What’s the Problem?

“There is a belief that EMS traditionally just responds to emergency calls. Even within the healthcare system, people believe that an ambulance’s role is to get somebody to the hospital where they can start getting real care,” said James McLaughlin, who directs the MIH team and community paramedics for Ute Pass Regional Health Services District in Woodland, Colorado. The way ambulances have traditionally been reimbursed ties in to that belief system.

Treatment in place and MIH are great ways to control emergency medicine costs upstream and to make sure that patients get the right care at the right place at the right time with the right resources. “But we have to get beyond the biases that say ambulances are only for taking people to the ER, when that’s just not true,” he said.

Ute Pass Regional viewed behavioral health as the area with the greatest opportunities for community paramedicine to make a difference, McLaughlin said. “We got our providers some additional training in motivational interviewing and trauma-informed approaches to mobile crisis response.”

This program worked with community resources and behavioral health hospitals to divert patients away from the ED and get them set up with supportive resources in their homes or, when appropriate, at alternate destinations.

“We’ve been so successful with community paramedicine that the demand for our behavioral health and substance abuse disorder, mobile crisis response, and urgent care services became so great that we no longer had the residual capacity to meet the need. And then we were able to justify outside funding to support the program’s growth.” McLaughlin said.

Bigger Answers

While waiting for Congress to act on the current bills to support community paramedicine, what can EMS advocates do to advance this innovation and its ability to address the larger challenges facing emergency medicine? One thing is to make sure that EMS is driving clinical research studying emergency medicine, McLaughlin said. “There need to be studies designed by paramedics, driven by paramedics, to show that the work we do does has positive impact on access to care and a positive impact on outcomes.”

Other countries, including Australia and England, are more likely to be doing such research, he says. “They have prerequisites for training and education that set people up to have roles in designing and implementing research studies, asking the right questions, and making sure they have a seat at the right table.”

“I believe in quality and in clinical quality metrics,” Duncan said. His agency has adopted metrics such as the Healthcare Effectiveness Data and Information Set, a widely used set of performance measures developed by the National Committee for Quality Assurance, which federal health centers are required to follow. “What we wanted to do was to measure our MIH patients compared to local clinics; and we knocked it out of the park, because of the ways we removed barriers to their care.”

Connections and a Scalable Platform

The EMS community may not be holding its breath waiting for Congress to act on the community paramedicine legislation. Meanwhile, some state-level initiatives are proposing their own programs test these non-transport models at the state level. A pilot launched earlier this year by the company Paralign Health proposes to mobilize existing community paramedics and MIH resources and connect them with payers.

That means creating a scalable platform that allows health plans to refer their highest utilizing, most vulnerable patients for preventive care in the home while making sure providers are paid for providing this service.

Leading the charge is Aaron Molloy, Paralign’s founder and CEO and an EMT himself. Molloy recently spoke at the 2025 Missouri EMS Conference & Expo in Branson and found a lot of interest among EMS agencies. Paralign has also sparked interest in other states, including Florida, Montana, Maryland, Texas, Minnesota, and Kansas.

“My job is 95% aligning the stakeholders,” Molloy said. His pitch to insurers is a 4 to 1 return on investment from community paramedicine. “They’ll see the benefit almost immediately.”

What’s permitted or required for community paramedicine varies widely from state to state. If fee-for-service is not possible, value-added contracts or the purchase of a fixed number of visits might be, he says. Paralign aims to mobilize 250 community paramedics per year into its network, each making 800 to 1,000 visits per year.

Community paramedicine has the potential to be an anchor for the patient who uses the emergency department for routine medical care, Molloy said. “This is a new front door to mental health and other local community resources. Community paramedicine can stabilize the patient and help them be more integrated with primary care providers. It’s the eyes and ears for the primary care physician,” he said. “In small towns and rural communities, it has the power to change the very fabric of rural health care delivery.”

This also means generating data that could demonstrate its value and using the data to continue advocating with state, local, and federal policymakers to see community paramedicine’s ability to move the needle. Molloy believes that through affiliation with Paralign, health plan funding can become a cornerstone of the diverse range of funding sources for community paramedicine programs, along with subsidies, grants and tax revenues.