WATERVILLE — The Bram Public Policy Lab at Colby College has partnered with the city to research several aspects of Waterville’s development, including ways to support its existing paramedicine program.
The lab “supports interdisciplinary research, immersive learning, and direct collaboration with policymakers, thought-leaders, and lawmakers throughout the country, especially in the state of Maine,” according to the BPPL website.
Nicholas Jacobs, an associate professor of government at Colby, leads the lab, and Nate Bernard organized the collaboration with Waterville.
Jacobs said the lab’s first project focused on the “fiscal picture surrounding community paramedicine.”
Most of the research focused on state-level impacts, since the largest potential savings from paramedicine services come through Medicaid (MaineCare) or hospital reimbursement. For municipal budgets, researchers analyzed the conditions under which a program could break even.
Researchers examined what conditions would make a community paramedicine program cost‑effective — and whether those conditions were realistic. In a report to the City Council on March 3, Jacobs said it was difficult to determine whether paramedicine saves money because there is no definitive way to measure how many 911 calls or hospital visits the program prevents.
Paramedicine — physician‑directed emergency care delivered by paramedics outside a hospital, typically through an ambulance service — serves a wide range of households, most often people who have recently been hospitalized and need a follow‑up visit at home.
A smaller subset of patients are considered “high utilizers,” meaning they use emergency services four or more times in a year.
The “high utilizers” represent the greatest potential for savings. Jacobs and his team analyzed their behavior before and after their first paramedicine visit. During the first three months in the program, high utilizers showed a significant drop in calls to emergency medical services. By six months, however, call volumes had begun to rise again, and the same pattern appeared at 12 months.
“This seems to show that the positive effects of community paramedicine are not permanent,” Jacobs said.
The BPPL team’s main takeaway focused on how much money a community could save by preventing “avoidable” EMS calls. The researchers concluded that if paramedicine can prevent two out of every five calls, the program would have a positive financial impact for the municipality.
Waterville’s paramedicine program is currently funded through an external grant. The program’s costs cover overtime for EMS staff members and some additional equipment. The cost of responding to 911 calls varies depending on reimbursement rates.
Because the program is supported by external funding, Waterville’s paramedicine team could potentially serve other communities.
The program now operates three days a week, but with a full‑time position and additional funding, that schedule could expand. “The city of Waterville could be a leader in the region,” Jacobs said.
Next steps for expanding the program include seeking additional funding.
During a City Council meeting in March, Ira Mandell, a Waterville resident and retired physician, stressed the importance not only of saving money but of improving patient satisfaction and access.
“It’s not all about money,” he said. “In the end, it’s about people.”
Jacobs said he agreed with Mandell’s sentiment, adding that additional grant funding would allow for better data collection, which could help improve patient satisfaction and clinical outcomes.
The Bram Public Policy Lab’s next project with Waterville is expected to be a tree inventory, examining questions of equity and access, beautification and the potential for a wood bank.
“A lot of it is data and numbers,” Jacobs said, “but so much of it is just relationships.”
