Transportation is Medicine: How Hospitals are Solving the Transportation Puzzle to Improve Transitions of Care

Jan. 8, 2020
Why is transportation so challenging to get right? The difficulty lies in creating a consistent and reliable patient experience across diverse transportation models and systems.

Every day, thousands of people wake up unsure whether or how they will make it to a medical appointment. An estimated 3.6 million Americans miss or delay medical care each year because of transportation issues, according to  the National Academy of Sciences. Especially vulnerable to transportation barriers are the elderly, disabled, and low-income groups, who suffer from much lower emotional and physical health than other groups do.

Removing barriers to access for these vulnerable populations, then, impacts the outcome of treatment for the most complex, high-risk and high-cost patients. As health systems double down on removing waste and lowering costs by addressing social determinants of health, many are recognizing that transportation assistance for their most costly patients is good medicine.

The challenges health systems face in making this social medicine more widely available to patients are profound, from enterprise-wide budget controllership and implementation challenges to workflow alignment. But there is reason to hope that a better transportation future is right around the corner where the right ride is arranged for the right patient at the right time.

Signs of progress can be found in places like Penn Medicine in Philadelphia, a large academic medical center that has been arranging rides for patients from their homes to appointments and from the hospital to home. The initiative has contributed to reduced costs related to patient transportation in the outpatient setting and driven an average six-hour reduction in length of stay for patients qualifying for service within the inpatient setting.

Similarly, Virtua Health, a five-hospital network in Southern New Jersey, implemented a system-wide transportation assistance policy in 2018 that has generated increased patient satisfaction, improved bed turnover, a greater-than 50 percent reduction in the average cost of rides––from $42 to $20––and a significant reduction in primary care no-shows. Overall, Virtua reports up to a seven-fold return on investment from its transportation program.

Similar successes can be found across the country in health systems and health plans that have elected to help make transportation for patients affordable and easy.

The long road to better transportation

Getting here hasn’t been easy or fast. Transportation’s essential role in providing access to care for vulnerable populations was first recognized in 1965, when Medicaid identified transportation as an assured benefit. Over the years, states have evolved how they manage Medicaid transportation, but the solutions they have deployed share many faults.

The most common model involves centralized, call center-based, low-technology brokers that primarily focus on managing utilization and costs while consistently underperforming on – or failing to properly track – measures of patient experience, responsiveness to emergent needs and overall care adherence. This traditional model disempowers care managers and social workers on the ground who are best positioned to help patients with their day-to-day needs.

Hospitals have also started creating transportation programs based on new OIG Safe Harbor guidelines that took effect in January 2018. In addition, Medicare Advantage plans have created transportation benefits in response to new CMS rules for 2020 that allow plans to include supplemental benefits in the medical loss ratio.

These programs fill crucial gaps that traditional Medicaid benefits do not address: same-day and next-day needs such as emergent visits or hospital discharges, those who are elderly and need assistance with mobility, but do not qualify for Medicaid, and those who might have temporary or longer-term disabilities, but also do not qualify for Medicaid.

For health system leaders, this emerging transportation landscape is complex, and not only because of evolving programs or the entrance of services like Uber Health, Lyft Concierge, or Ford GoRide. The complexities run much deeper: Care managers and social workers often spend more time than needed as transportation dispatchers, rotating between different phone calls and web portals outside of their usual workflows, instead of working on the clinical needs of their highly complex patient populations.

Solving the transportation puzzle

Why is transportation so challenging to get right? The difficulty lies in creating a consistent and reliable patient experience across diverse transportation models and systems such as public transit agencies, app-based ride-hailing services, wheelchair-accessible vehicles, and more. Add in the fluid dimensions of geography, time, and weather, coupled with inevitable changes, cancellations, and other uncontrollable life situations.

However, the tools available to help are evolving quickly to meet the need. Technology now exists to capture real-time, event-based trip status and GPS location via API-enabled integrations with transportation provider dispatch systems so patients know in real-time that their ride is on the way.

Technology also can enable convenient digital pass distribution and payments for public transit, which is a cost-effective and environmentally sustainable form of transportation. This approach links both public and private providers of transportation in an integrated service.

The latest technologies can make patient communication accessible whether they have a smartphone or a landline, whether they speak English as a preferred language or not, and whether they navigate rides independently or with a caregiver. Lastly, technology can also enable the automatic detection of disruptions—such as a driver running late or waiting at a pickup spot for longer than usual, which might imply a risk of a no-show—and enable timely human or automated interventions, which can mean the difference between a missed appointment and a positive outcome.

Small differences in system design can mean the difference between a poor experience that leads a patient to disengage from care, and a good experience that fosters trust and better health outcomes. On the scale of hundreds of thousands of experiences per day, nationally, the quality and reliability of the system coordinating the interactions of all of these stakeholders––patients, family members, drivers, dispatchers, care managers, clinicians, and administrators––matters a great deal.

If transportation is medicine, then health system leaders share a responsibility to ensure the technological advances emerging in mobility—including increasingly connected transportation networks and even autonomous vehicles—get translated into meaningful outcomes for low-income, elderly, disabled, and other vulnerable populations.

Together with committed providers like Penn Medicine and Virtua Health, health system leaders have the opportunity to turn transportation from a pain point and cost center into a differentiated and strategic asset to ensure access to care for their patients.

Imran Cronk is founder and CEO of Ride Health, providing smarter transportation for every patient need.

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