How a few paramedics are giving some people in the hardest circumstances a chance to feel better — and helping change our state’s health care system at the same time.
CHALLENGE In less than a decade, ambulance calls to the Harbor Light shelter had more than doubled, to an estimated 1,500 per year in 2014 — causing immense expense and often inadequate or inappropriate care for many of the approximately 500 people who come to the shelter every day.
ACTION A team of Hennepin County community paramedics spends Friday through Monday at the shelter, building relationships with visitors and helping them get access to the medical care they need — reducing 911 responses to the shelter by 30 percent in just two years.
SUPPORT Although the shelter serves many people who are not their members, Hennepin Health, a plan run by MHP, funds the community paramedics’ work at the shelter to provide better care for people and lower expenses for the community.
THE WORK AHEAD The community paramedics do vital work at Harbor Light, but they are just four workers at one shelter in one city. To make humane and effective use of our health and emergency resources statewide, we need many more community paramedics serving many more people.
Metropolitan Health Plan supports community paramedics at the Harbor Light Center
If you’re down on your luck and not feeling good, you want Mike Molitor in your corner. “I think that everybody has a right to feel better,” he says simply.
Four days a week you can find Mike at the Harbor Light Center, the Salvation Army’s shelter for people who are homeless in downtown Minneapolis. Along with three other community paramedics — Dennis Combs, Dave Johnson, and Scott Lindbergh — Mike helps the people who come to the shelter get the medical care they need. These community paramedics — paramedics who are specially trained and certified to build relationships with patients and help them maintain their health — have been working out of Harbor Light since 2014. By talking with people at the shelter about their health problems and helping them navigate the health system, the community paramedics have reduced the need for first responders by 30 percent.
Amber Brown, deputy chief of Hennepin County Emergency Medical Services, ticks off a list of the community paramedics’ accomplishments. They’ve seen consistent reductions in 911 calls to the shelter, she says. Twenty-five percent fewer ambulances are crossing the city to get there. Most dramatically, the number of times the Minneapolis Fire Department has had to respond to the shelter has decreased by 30 percent a year.
Amber explains why these statistics matter. At Harbor Lights, she says, many people have serious medical conditions — but don’t have good ways of getting access to care to manage them. So they called 911. “Many people would call because they were out of medication, or because they had just got into town and needed to be hooked into the health system,” she says. But for most issues, the E.R. is simply the wrong setting to get people the help they need.
By building relationships with people at the shelter, the community paramedics can find better ways of helping them. Today, people at Harbor Light are just as likely to seek out the community paramedics as they are to dial 911. “At eight o’clock, when the shelter opens, there are people who come looking for us,” says Dennis Combs, one of the community paramedics. “‘Can you help me with this? Can you get me an appointment tomorrow?’ Yes we can. We navigate people through whether to go to the clinic, to the hospital, to the E.R., to urgent care. We help people understand where to get access to the help they need.”
In so doing, the community paramedics’ work has benefits that transcend the shelter. Every time a fire truck or an ambulance doesn’t go to Harbor Light, it can respond to an emergency somewhere else in the city. Every time someone at the shelter can get a medical problem taken care of without a trip to the emergency room, the hospital’s staff can help someone else who needs them. And every time the community paramedics can help someone on the spot, without activating the costly and complicated machinery of first responders and hospitals, our whole community saves money — and people in need feel better, faster.
The community paramedics insisted on this when they teamed up with Hennepin Health to serve people at Harbor Light. “That’s one of the things that’s great about them,” says community paramedic Dave Johnson. “They’re willing to fund something that’s innovative, something that will help, regardless of the benefit to them.” Julie agrees. “Our support of the community paramedics saves costs for a lot of people that can’t necessarily be traced to somebody’s bottom line,” she says. “But collectively, as a community, their work helps us all. We’re taking health care resources that aren’t being used wisely, taking a little bit of it, using it much more wisely, and having much more for everyone we want to help. And we love to help.”
The paramedics’ presence at Harbor Light is supported by Hennepin Health, a managed care organization that serves low-income residents of Minnesota’s most populous county. But by supporting the community paramedics at the shelter, Hennepin Health isn’t just caring for its own members, says clinical program manager Julie Bluhm. “We’re thinking not just about reducing medical costs, but about reducing costs our community is accruing overall — in corrections, and the shelter, and the need for first responders. Hennepin Health funded the program because it’s the right thing to do. A significant percentage of the people at Harbor Light are our members,” she says. “But we have not limited the community paramedics to serving Hennepin Health members. They serve everyone.”
For everyone involved in the community paramedics’ work, it’s helping that matters most. Tamiko Morgan, M.D., former medical director of Hennepin Health and current Commonwealth Fund Mongan Fellow at Harvard University, describes the program in deeply personal terms. “I don’t ever want anyone to feel that they don’t matter,” she says. Visitors to the shelter know they matter to the community paramedics they see there. “Our job in health care is to take care of people,” says community paramedic Scott Lindbergh, “regardless of their economic or social status. I go to the shelter and watch people. The people who come in at eight o’clock when the doors open — any one of them could be me.”