Across North Carolina, EMS agencies are expanding their mission beyond emergency response by piloting Mobile Integrated Health (MIH) and Community Paramedicine (CP) programs. These initiatives have the potential to transform community health, reduce unnecessary emergency department visits, and improve patient outcomes.
Success Story: Durham County EMS
Durham County originally launched a community paramedics program to follow up with opioid overdose patients, providing them with education, access to medication-assisted treatment and detox centers, and Narcan. Today, they’ve expanded to include fall prevention and vaccines for homebound patients, working via referrals from EMS crews, DSS Adult Protection Services, the Duke Outpatient Clinic, and other sources.
They also raise an important question: How do you fund and sustain them?
A New Model of Care for North Carolina EMS
EMS agencies in several parts of the state — including Durham County and other early adopters — are testing MIH and CP models that extend paramedic care into homes, clinics, and alternative destinations such as mental health facilities.
Typical services include:
- Post-discharge follow-ups to prevent readmissions
- Home safety checks for frequent callers or at-risk patients
- Vaccinations and chronic condition monitoring
- Transport to behavioral health or urgent care centers instead of emergency departments
These programs help fill gaps in the healthcare system by using the trusted presence of EMS to reach patients who might otherwise fall through the cracks, driving positive impact for communities, hospitals and public health departments, and most importantly, patients.
The Financial Challenge: How Do Communities Fund MIH / CP Programs?
While such initiatives improve outcomes, they often don’t fit traditional billing models. Most payers, including Medicare and Medicaid, reimburse only for emergency transports to hospitals, not for non-transport services or alternate destinations. Even commercial insurers do not consistently pay for non-traditional EMS services, but can be receptive if it better serves their member and saves money.
That leaves many agencies relying on grants, local funding, or hospital partnerships to sustain their programs. In North Carolina:
- There is no standardized mechanism for billing community-based follow-up visits.
- Payers may not pay for services provided by MIH practitioners (e.g., community paramedics are often not recognized as valid providers of services that advanced level practitioners are approved for).
- Denials are common when documentation doesn’t align with payer definitions of medical necessity or eligible service codes.
For agencies already stretched thin, the lack of reimbursement clarity can make MIH and CP programs difficult to justify financially, even when their community benefit is clear. For the best shot at building a sustainable model, EMS leaders must plan effectively.
5 Questions agencies considering a CP/MIH program must ask:
- What services will your MIH/CP program offer? Options include home follow-ups, chronic disease check-ins, alternative destination transport, behavioral health outreach, frequent user mitigation, and more.
- Which payers will you attempt to bill? Check with other providers and associations if your local Medicaid MCOs, commercial carriers, or Medicare contractors have defined codes or contracts for these services.
- How will you document and code the service? Determine what visits count as “non‐traditional.” Outline how you’ll track them and capture data needed to justify payment?
- Will you have internal financial tracking for cost vs. reimbursement? Model the staffing, vehicles, supplies, oversight, training costs as well as project reimbursement sources so you can forecast the program’s sustainability. Don’t forget to identify cost mitigation.
- How will you engage your community and healthcare partners? Form partnerships with hospitals, primary care, behavioral health, public health, and social services by illustrating the value of the services you intend to provide.
Looking Ahead: Aligning Innovation with Sustainability
North Carolina is one of many states examining a shift toward integrated, preventative EMS care. As agencies across the state evaluate cost-based reimbursement models and supplemental funding options for such innovation, their ultimate success will depend on multiple factors, including clinical excellence, data discipline, and advocacy. By collecting the right data, building strong partnerships, and pushing for payment reform, North Carolina EMS agencies can help to scale and integrate community-driven programs.