How do you cut down on costly ambulance trips to the ER? Alameda County has a plan

Calling 9-1-1 for a medical emergency typically leads to a trip in an ambulance to a nearby emergency room.

Research shows that many times patients don’t need that level of care. And whether the ambulance ride was necessary or not, you are likely to get stuck with a big bill.

Now, Alameda County wants to change that wasteful practice so ambulance providers are more accountable for providing an appropriate level of care.

The county’s emergency services agency on Friday unveiled its vision as it begins the search for its next ambulance provider for all areas of Alameda County – outside of the cities of Berkeley, Piedmont, Alameda and Albany. The new contract would start in 2026, when the county’s current contract with Falck US expires.

“This is kind of cutting edge,” said Lauri McFadden, director of Alameda County Health Services’ Emergency Management. The effort comes as public officials have been grappling with national conversations about mental health, policing, and our health care system.

Offering an exclusive coverage contract allows the county to ask for more from its ambulance service provider, said McFadden, whose office has been working on the new framework with EMS providers and other stakeholders for several years.

“What we found is this one model of taking everyone to the hospital just wasn’t sustainable,” she said.

The county will require its next provider to develop an “appropriate tiered system” for their responses, offering things like at-home telehealth appointments when appropriate, instead of just transporting people to the hospital. The contract comes at no cost to the county, because ambulance services are funded by the revenue generated from billing patients and their insurance.

“We are looking to be more innovative in helping people get the right care at the right place, and that involves potentially a dispatch clinician, a nurse practitioner, or perhaps a doctor… rather than going to the hospital and waiting hours and hours and hours,” McFadden said.

In Alameda County, like the country as a whole, there is a patchwork of emergency services, public and private. In some places, Berkeley, Piedmont, Alameda and Albany, the fire departments handle ambulance transports. Other places, like the rest of Alameda County, offer an exclusive coverage contract, in exchange for more input and choice over how those services are provided, and guaranteed service.

Some municipalities allow private ambulance companies to compete for emergency calls, a system that can lead to poor service for historically underserved communities that are overlooked in favor of calls for help from places with more income and better insurance coverage.

Colleen Chawla, director of the Alameda County Health Care Services Agency, said public education will be a big part of the challenge.

“It’s really going to be a culture change,” she said, “to have people think about emergency response, not just as an ambulance arriving as fast as possible, but as the right response for what you need in the moment.”