Lincoln County, MO is a rural community of 60,000 people, spread over 640 square miles on the state’s eastern edge. Residents have long struggled with low access to care, substance use disorders, and chronic health conditions, and in 2019, the Lincoln County Ambulance District (LCAD) started training their first Community Paramedics to address these issues. Five years later, LCAD’s Mobile Integrated Health (MIH) service is an inspiring example of growth, with seven Community Paramedics, several certified community health workers and peer support specialists, and two programs – soon to become three – focusing on specific community issues.

In the beginning, however, it was difficult simply to find a direction. Their first idea – focusing on high utilizers – wound up spreading their fledgling service too thin, as Community Paramedic Vaughn Butler recounts: “It’s easy to identify the high utilizers; it’s kind of a blaring need that services can see and say ‘Here’s a great starting point.’ … The trick to that is high utilizers can sit in any demographic or any need … you can get into the weeds fast with it.” Looking to tighten their focus, LCAD connected with rural MIH grant writers, and grant funding became a key part of their service. As Paramedic Sarah Czarnecki explains: “[With grants] you have to meet certain criteria; you have to concentrate on certain populations.” While the limited scope can be frustrating, Czarnecki takes comfort in knowing that the county’s Community Needs Assessment guides the grant: “If we didn’t have a need in our county or in our area, would we receive funding? No,” she says. “I see it as a win-win.”

LCAD’s first grant focused on substance use disorder, which Chief Administrator Raymond Antonacci – in partnership with Lincoln County Sheriff Rick Harrell – used to build a program to eliminate overdose deaths and provide medication-assisted treatment for jail inmates suffering from opioid withdrawal. The debilitating symptoms of withdrawal become intolerable when suffering in a crowded cell, so Antonacci and his team administer buprenorphine to ease their patients’ suffering – but they also work to build rapport, meeting with their patients to encourage further treatment and helping them plan for after their release. “We’ve seen incredible results,” Antonacci says, recalling one case. “The first day I saw [the patient], he couldn’t hold a conversation or anything, mumbling his words, incoherent … by day three or so, this person was holding a conversation like we are right now … and now we start having conversations with him about seeing a peer support specialist or seeing a counselor. Now they’re making decisions.”

LCAD has also built a grant-based program focusing on chronic health conditions, which has seen marvelous results helping patients receive urgently needed care despite barriers like lack of transport or insurance – in one case within 16 hours, at no cost to the patient. Community Paramedic Butler credits this success to their tenacity in making community connections: “If you don’t know a guy, you’re going to know someone who does, and that’s going to expand. While it might take a lot of legwork for a second or even third time, when you do that fourth, fifth or sixth time, you’ve built a strong connection and found a resource that you can draw upon.”

“Networking is the ‘Integrated’ part of Mobile Integrated Healthcare,” Butler says. “Find those really tenacious employees at your service, the people who like to wear multiple hats, the people who are always asking why, the people who have that drive, and let them go get the answers to your questions … making those phone calls, going to conferences, drawing from other people’s experiences, you’re going to build a network.”

To support their MIH service’s growing need for care coordination, record-keeping, and grant reporting, LCAD purchased the HealthCall platform in late May 2024. In approximately 4 weeks, they were using HealthCall’s automated Clinical Opiate Withdrawal Scale to record their work with substance use disorder, and thanks to HealthCall’s large library of SMART Chart assessments, soon after they were using the service to record interventions, vitals, and even time-tracking reports. LCAD has also added their patients’ previous encounters to the system so that HealthCall’s decision support tools can make that information easily available – and when a grant organization asks for a report, LCAD has HealthCall’s built-in, customizable Report Generator on-hand to generate the documents they need. “[Other groups] are trying to do what we’re doing with seeing patients, but everything is on paper,” says Czarnecki. “And then they have to report data to these grants and build a spreadsheet … I don’t know how anybody does it that way.”

LCAD’s team is also excited to accelerate their care coordination efforts using the HealthCall Care Network. Anyone LCAD connects with – be it a medical specialist, a local hospice, or a corrections nurse – can be added to their Care Network, allowing them to securely share patient data. Each Care Network Member has customized permissions that allow them to view – or even add – notes, documents, medications, assessments, and more. LCAD can coordinate with their Care Network by assigning tasks in the HealthCall Task Manager, with real-time notifications sent when a task is assigned and attachable SMART Chart assessments for collecting standardized feedback. When a paramedic needs to coordinate care in real-time, HealthCall’s built-in video conferencing makes it seamless to get the patient and their care team talking face-to-face – without requiring anyone to download an app.

Paramedic Czarnecki recounts how HealthCall’s features came in particularly handy when helping a patient with extreme mobility issues: “She can’t get up without assistance; she can’t care for herself; she’s completely dependent … we’ve been able to organize her goals and share information with her care team, our community health worker Glenda, who goes in there and documents as well … every time Glenda goes over to see her, she’ll get into HealthCall and say ‘This is great. I can see everything that we’ve done.’”

“We couldn’t do it by ourselves, Glenda couldn’t do it by herself, the pulmonologist couldn’t do it by himself,” Czarnecki says. She recounts how the patient has frequently called 911, and paramedics have been able to start a video conference with members of her care team on the spot. “We can be right there with her in the room. HealthCall has been instrumental with coordinating everything in one spot, all together.”

Lincoln County Ambulance District’s MIH service has grown tremendously, but even so, this is just the beginning. The very day that HealthCall spoke with them for this article, they received a grant to build a third program, this one focusing on maternal health and training. They hope to start a fourth program as well, focusing on special needs patients. As they gain resources and expertise, they’re hoping to work with a wider variety of high utilizers, and to that end, they’re pursuing permanent, grant-independent funding by partnering with local hospitals and hospices. HealthCall is privileged to support them in their work – and excited for what the future will bring.

For more information, please contact:
Sara Bruner
sbruner@healthcall.com
HealthCall, LLC