1 Exploring Data at the Intersection of Health and TransportationCalACT 2017 Spring Conference and Expo April 24, 2017 Eric Ziering, Cambridge Systematics Pinch-hitting for Sarah Anderson, Cambridge Systematics Moumita Dasgupta, Amherst College September 2016

2 How Does Lack of Transportation Affect Healthcare3.6 Million Americans miss or delay medical care because they lack appropriate transportation to their appointments (2005)1 3rd most commonly cited barrier to access health services for the elderly (2004)2 2 Fitzpatrick, A., Power, N., Cooper, L., Ives, D., & Robbins, J. “Barriers to Health Care Access Among Elderly and Who Perceives Them.” American Journal of Public Health. 94(100). page 1793. 3 Grant, Roy et al. “Transportation Shortages are Barriers to Child Health Access.” Children’s Health Fund 1 Access to Health Care and Nonemergency Medical Transportation Two Missing Links. By Richard Wallace, Paul Hughes-Cromwick, Hillary Mull, and Snehamay Khasnabis, 2005. 7% of children (10% in rural) in low income homes miss or do not schedule a medical appointment because transportation is inaccessible (2011)3

3 Case Study: Family Health Center Worcester, MAFHC – Provides primary care and social services to traditionally underserved and culturally diverse populations networked with 600 community health centers nation wide How big is the problem in Worcester? 80% Prebooked appointments in earlier visits 182,544 Population of Worcester (2013) 85, ,000 patients visits per year 10% of Worcester households are below poverty line 15% Rate of missed appointments

4 Survey Research Results How do Patients get to the FHC?51% of respondents mentioned they had some type of transportation problem

5 Reasons for Transport ProblemsCan’t walk Bus is unreliable Many reasons for transportation problems, cost is just one of them….. Taxi is too expensive Assistance required 86% are interested in scheduling a ride to the FHC at the same time they are scheduling their doctor’s appointment

6 Medicaid / Mass Health In FY 2014 there were 1.2 million Mass Health beneficiaries with transportation benefits Only 3.4% used transportation benefits, of that 2.3% used the demand response benefits (PT-1) In Worcester the average cost per PT-1 trip was $ and a total of 842,079 one way trips were taken in FY ‘14 The FHC has aprox. 85,000 patient visits per year, on average only 1,995 used the PT-1 benefit, leaving 83,005 round trips to be planned by patients Mass Health has provision for reimbursement of the travel expense for an appointment Only 0.2% submitted a request for reimbursement and half of which were denied.

7 What is the FHC Cost for Missed Appointments?FHC has approx. 800 missed encounters /month at $154 per person/visit $1,478,400 per year loss to FHC solely on missed appointments 51% missed their appointments due to transportation $739,200 per year loss specifically related to transportation problems Hidden cost questions …. What % of missed appointments are not re-booked? What critical needs were not served / revenue not received for folks on the FHC waiting list? Cost of emergency room visits due to these missed appointments? Other operational cost of unproductive FHC staff time? What % of missed appointment are for real transportation barriers vs. perceived transportation barriers? What is the cost of appointments not made at FHC due to barriers to access?

8 FHC Proposed SolutionsSubsidize specific transportation options for target patients….. Providing WRTA one day passes to 180 FHC patients will cost FHC $158,130/year or only 10.7% of the total $739,200/year in losses due to transportation related missed appointments Fixed route pass will not solve all the transportation challenges identified Provide dedicated transportation access…… 82% of respondents said they would use a dedicated FHC shuttle if available Operating a dedicated FHC shuttle services was cost prohibitive and unsustainable Provide better access to transportation information at the time of appointment booking…. 51% of respondents missed appointments due to transportation; 59% of respondents did not use any kind of technology when trying to figure out transportation options Improve appointment booking (less overbooking, fewer missed appointments); solve more than one transportation challenge; sustainable and affordable; provide more options; remove technology barriers; provides opportunity for new data collection

9 Transport => Medical SchedulingThe patient calls-in to schedule their doctor’s appointment AND their ride at the same time Solution could evaluate across any or all: Fixed route Paratransit Community / faith based TNC (Uber/Lyft) Carpool Volunteer Taxi Walk/bike Amtrak

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12 Planned Solution Start with 1-Click: an open-source multi modal demand response trip planner. Built using VTCLI One-Call / One Click grant program funds. Integrate trip plan results with medical schedules: There are only a few major providers of health care scheduling software - only a few interfaces needed An open-source technology solution is lower cost and more flexible than an operational solution, and will provide new data that can be used to target investments in transportation that will provide the best out comes for that specific community Provide examples: Maybe in an dense urban area; need to get people off of the public paratransit provider and onto another option Maybe in a rural area you want to get more people into the paratransit system and you want your Health care center to invest some of those lost dollars to make that happen Maybe that….

13 Potential Benefits Increased CollaborationGreater access to information Raise awareness about new options and increase the likelihood of finding a mode of transportation that works. Increased Collaboration The Smart Transit idea can get health care providers and transit providers talking….what are the mutual benefits that can come out of local/regional partnerships….. Intelligent appointment scheduling Health centers think about the ‘total appointment time’ when scheduling. Make transportation part of the process. Better Manage Demand Response Ridership Use the data and customer interface to suggest the alternatives that work best for the community, better manage the challenges facing demand response ridership in the region Again come up with some good challenge examples Better health outcomes Studies show that increased access to preventative healthcare will create better health outcomes for individuals, especially vulnerable populations.

14 Example of ImplementationJacksonville Transportation Authority – Ride to Wellness Grant Connect TransPortal (1-Click) with Epic Medical software, at eight UF Health locations Train call center staff to deliver transportation information – or bookings – at time of medical scheduling Conduct a pilot and evaluate impacts: improved health outcomes for target population? Reduction in missed appointments? Shifts to fixed route services? Project begins mid-2017

15 Exploring Data at the Intersection of Health and TransportationCalACT 2017 Spring Conference and Expo April 24, 2017 Eric Ziering, Cambridge Systematics Pinch-hitting for Sarah Anderson, Cambridge Systematics Moumita Dasgupta, Amherst College September 2016