Christopher Montera has more than 32 years of experience in paramedic services, public health and fire service. He has received numerous awards for his service and was named one of the top 10 EMS Innovators of the Year in 2010 by the Journal of Emergency Medical Services. He is the treasurer of the Emergency Medical Services Association of Colorado, Central Mountains RETAC, and was the EMS data specialist for Western Regional Emergency Trauma Advisory Council under contract to serve the State of Colorado. Chris is in the final months of his master’s degree in health leadership.
The Ascent: Vail Health announced this month a commitment of $60 million over the next decade toward improving behavioral health services across the Eagle River Valley. What can you share about that and the work you're doing?
Montera: Eagle County Paramedic Services frontloaded $100,000 to set up a behavioral health crisis response team in the community. That team—which includes Vail Health Eagle County schools, Eagle River Youth Coalition, the Home Center, Mind Springs, Mountain Family Health, SpeakUp Reachout, University of Colorado’s Depression Center and local police departments—got the county to put in another $500,000, and then Vail Health stepped up and gave $60 million, with the idea to raise another $100 million to fully fund what we need in the community.
We now have every leader from the major health organizations and the county commission engaged in discussions about behavioral health and building an infrastructure for what’s best for the community, to include the crisis stabilization model and the co-responder model, plus what we can do to expand more access to care.
With the RAE, in addition to interfacility transport, we also do community paramedicine. Ours was the first paramedicine program in the country. Beginning in 2009, we give paramedics the education to go into the home to do post-discharge patient followup. That includes medication reconciliation, lab draws, fall assessments, immunizations, screening for social determinants of health—they’re just amazing. We try to work collaboratively with other organizations in the community to fit right into that gap between home care and primary care and hospital care.
With the co-responder model, when there’s any type of behavioral health call, we send out a community paramedic with a licensed behavioral health clinician for crisis intervention. Our goal is to stabilize that person in their home whenever possible, and keep them out of the hospital. We refer them to intensive counseling for the next seven days to receive in-office therapy (with Hope Center), and then they are referred to a private therapist.
Last year, we had 321 calls for people who had some sort of suicidal ideation. The co-responder model started in October, and since then the program has decreased transports off the scene by 50 percent. Our goal is to get to 100 percent. It’s definitely a team effort. They really are doing amazing work on the front lines every day.
The Ascent: The paramedicine service there is truly top-notch. What are the top three things that set it apart as a value for the community?
Montera: First, we are community-focused. We’re here to serve. We’re continually trying to find service gaps in the community that we can fulfill or, we find partners to do it.
Second, we’re always patient advocates—for the patient and for the population as a whole.
Finally, we really believe in excellence, and not just in our community efforts, but in the practice of medicine and the way we treat every patient. We want to be respectful. Many times, the patient didn’t choose this. We really try to pursue the idea that while our providers continue to increase their knowledge and skills, they tie that to patient advocacy and a sense of community.
The Ascent: Can you speak to the opportunity to use a program like Rocky Mountain Health Plans' Prime to expand integrated financing and community reinvestment in the dispatch and first responder innovations?
Montera: You have to understand that for emergency medical services, the only time we’re paid is if we transport a patient. But our organization really wants to keep people out of the emergency room and receive focused care where they need it. If we can start saving health plans and patients money, and have better outcomes and experience of care, we’re going to be very successful.
I think it’s important that, if an organization gets a per-member, per-month fee, that you use it to invest in new technology and new ways to innovate for your patient population. We’re not part of Prime yet, but it’s our goal. We think the Prime model would allow us to reinvest those dollars into prevention and new ways to do things in our community that no one has ever thought about.
There will always be people who say, “here, hold my beer and watch this,” that will need emergency transport to a hospital. We can’t fix that. But we can help people who truly have co-morbid conditions and need support in the home. The transport model of just taking them to the ER every time has to die. I want to make that change, not be the person who has to live with the change.