**Evaluate this session**
Commonwealth Care Alliance partnered with EasCare Ambulance Service to create an extensive Acute Care Delivery team utilizing Community Paramedics under a Special Project Waiver with the Office of EMS in the Commonwealth of Massachusetts. Over thirty months, this pilot program was successful in creating Proof of Concept as a safe method of care delivery for the most complex patient populations. Armed with the Proof of Concept and Return on Investment data, CCA’s management team implemented a project to expand the program from the pilot to fully operational statewide care delivery system. This presentation will detail the unique challenges incurred during the process of modeling a successful small pilot program into a large scale operation covering an entire state and servicing the needs of more than 21,000 members, addressing challenges that included medical control, EMR access, and managing multiple care partners.