The Quadruple Aim, delivered:

improved quality, lower cost, and better
experience of care 
for patients and providers

A patient in their home.

Commonwealth Care Alliance   (CCA) has earned a national reputation for expertise and innovation in care for people with the most complex health needs – including multiple chronic conditions, physical and intellectual disabilities, and behavioral health comorbidities.


Reducing avoidable ED visits and subsequent hospitalizations is essential to CCA’s success. That need was the genesis of the innovative program that has grown into instED. 


The Pilot Program


From its inception in October 2014, the pilot responded to over 3,500 requests for service. The top service categories included:


  • Respiratory illnesses, including COPD, URI and flu

  • Cardiac illnesses, including CHF and chest pain

  • Gastrointestinal illnesses, including nausea and vomiting/dehydration/diarrhea

  • Infectious diseases, including cellulitis, wound evaluation and UTI 



Excellent Outcomes*


  • 1,494 completed visits in 2019

  • ED visits/IP admissions avoided within three days in 87.6% of cases

  • Avoided ED visits/IP admissions resulted in total cost savings estimated at $2.4 million in 2019**

  • Scored 9.38 on a scale of 1-10, when patients were asked whether they would recommend this service to family or friends


Cited by the Center for Health Care Strategies


In 2016 CHCS analyzed Year One pilot results in "The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance's Pilot Program,"
co-authored by our Chief Medical Officer, John Loughnane, MD. The report found that "accounting for service costs, utilization, and ED diversion rates...the analysis suggests substantial cost savings."


Download the full CHCS report here.

*All figures as of 2019

**Calculations include avoided costs of EMS transport to the ER as well as ED visits themselves. They do not include the cost of potential ED-related hospital admissions – which could conservatively add another 15 to 20% in cost savings.


A link to a paper making the business case for community paramedicine.