"If you ask the patients and their families about which direction they would rather go for their health care, most often they'll say, ‘I prefer to be seen in my home. I want to be

taken care of proactively before I end up with a medical emergency that will lead to my having to go to the emergency department.’ " Seeing patients in their home has its advantages for

medical professionals, too. Russell and his colleagues were able to help a diabetic man avoid a medical emergency when they noticed that he wasn't removing the cap from his insulin

injector. For some time, the patient was having trouble managing his blood sugar levels, all because “he was never getting the insulin that he needed,” Russell says. “We never would have

to visit people who have recently received a heart pump (a left ventricular assist device, or LVAD) and relays their care needs to the nearest firehouse, should an emergency call come in.

Russell, on the other hand, visits adults referred from primary care physicians whose packed schedules don't allow for home visits. Many of the patients he and his colleagues care for

don't qualify for home health services and lack support networks at home. A community paramedic helps “bridge that gap” between doctor's visits, Russell says. “I really see it as

being an invaluable tool for the primary care physicians.” Although states from California to South Carolina have had success with community paramedicine programs, the biggest “hurdle”

that's keeping the model of care “from absolutely exploding” is the compensation piece of it, Idaho's Denny points out. Traditional ambulance rides to the hospital and routine

doctor's visits are mostly covered by private or public insurance. Community paramedicine, on the other hand, falls into a gray area. Different communities fund their programs in

different ways. The Alexandria Fire Department, for one, pays for Woolsey's full-time community paramedic position. Others, like Russell, operate through a patchwork of grants. Some

programs, including those in Minnesota and Idaho, have had luck getting state programs and commercial insurers on board with reimbursements. The Centers for Medicare & Medicaid Services

(CMS) does not reimburse community paramedics for home visits or scheduled appointments. But it will begin testing a new program in the spring of 2020 that “will reimburse ambulance

suppliers or providers for transporting patients to alternative destinations (rather than an emergency department) and/or for treating patients in place” when an emergency call comes in, the

agency tells AARP. The aim is for patients to “receive the most appropriate care, at the right time and in the right place.” Still, Wilcox says it's only a matter of time before

insurance companies and other payers get on board with community paramedicine. "If you can take care of these patients less expensively, more efficiently — not in a hospital or clinic —

at the end of the pay period, the health care organization comes out ahead financially,” he explains. In the meantime, the movement toward more at-home preventive care will continue to

grow. "It's not a matter of if, it's a matter of when, community paramedicine really takes hold,” Russell says. “It's something that I don't believe is a fad

anymore. … It enables us to deliver a full spectrum of care.”