Initiatives

Missouri Rides to Wellness

The purpose of Missouri’s Rides to Wellness (R2W) initiative is to Link-Engage-Sustain, building upon the existing HealthTran and MoRIDES mobility management / transportation coordination models. Since 2013, MRHA has been piloting a demonstration in south central Missouri, known as HealthTran (see below), that has resulted in improved health care access, improved transportation coordination and improved patient outcomes. MoRIDES is a referral service that coordinates affordable rides for people with transportation challenges, particularly senior citizens, individuals with disabilities and those with low-to-moderate incomes. Mobility managers help locate transportation options to help individuals get to work, medical appointments, shopping and more.

The national Rides to Wellness effort is primarily related to finding and testing promising replicable public transportation healthcare access solutions that support increased access to care, improved health outcomes and reduced healthcare costs. Missouri’s R2W initiative brings interested local partners and state leaders to the table for continued dialogue and planning to advance that national efforts and to improve Missouri’s rural public transportation to improve health outcomes.

Missouri’s R2W planners utilize Design Thinking principles learned from the training received through the 2015 Design Challenge that was initiated and funded by the National Center for Mobility Management. Components of the business plan resulting from the Design Challenge serve as the foundation of R2W’s strategic growth and development. The Design Thinking principles will be used to identify additional partners to bring to the table to assure continued emphasis on improving and expanding mobility management services in Missouri.

To learn more about Missouri Rides to Wellness, click here:

HealthTran

HealthTran is a healthcare access solution to improve patient health outcomes and reduce costs through healthcare and public/private transportation partnerships.

Overview

Administered by the Missouri Rural Health Association (MRHA), HealthTran is part of Missouri’s broader Rides to Wellness initiative. HealthTran’s service area encompasses a 10-county rural, high poverty area in south central Missouri. HealthTran partners include three hospital/health systems, three community health centers, one private practice clinic, two ambulance districts, two regional public transportation systems, one hospital transportation service, and three city public transportation systems.

Fundamental Tenets:

  • Patient-Centric – patient health and needs are first and foremost; how patients can be transported from point A to point B with the least amount of disruption, discomfort and cost in a dignified manner through qualified and quality-conscious transportation providers.
  • Healthcare Access – increased healthcare access through innovative partnerships between healthcare providers and public and/or private transportation providers that ultimately improve patient health outcomes.
  • Quality Data – data that supports advocacy for inclusion of transportation costs in the overall cost of healthcare treatment and/or disease management; data to support increased funding for public transportation infrastructure.

HealthTran funding has been provided by the Missouri Foundation for Health, National Center for Mobility Management (Design Challenge), and Missouri Department of Transportation (FTA Section 5310 Mobility Management). MRHA is presently developing a HealthTran dues structure to sustain existing services and to expand services beyond its 10-county region. Data gathered since services became operational in August 2014 demonstrate that with transportation, patients exhibit an increase in adherence to appointments, resulting in improved patient outcomes/maintenance, particularly for chronic conditions; i.e., behavioral health, therapies, wound care, etc. Healthcare providers value HealthTran because it reduces provider down time, keeps hospital and emergency department (ED) beds filled with appropriate care patients, and assists with care management of patients to improve overall health outcomes. Longer term, HealthTran hopes to demonstrate a reduction in preventable hospital readmissions. Healthcare providers already agree that the cost of transportation is minimal compared to the savings associated with appropriate care in the appropriate setting.

Ambulance providers are a unique source of transportation for this model. HealthTran was approached by the ambulance districts because their emergency vehicles were being occupied with low-acuity patients, who when transported to the hospital ED were not reimbursable. Additionally, ambulances were unavailable when a true emergency occurred.  To help address the issue, the districts purchased non-emergency vehicles to transport patients through HealthTran, allowing ambulances to be available for emergency calls.  This is critical in a rural area where ambulance districts have limited ambulances to cover expansive square miles. Additionally, public transit providers are seeing increased ridership for services outside those provided by HealthTran as a result of increased community awareness.

HealthTran is being evaluated by an independent third party evaluator. Data from August 2014 through February 2016 has been compiled and analyzed.  Results indicate that 40% of riders have mobility concerns, i.e., require a walker, wheelchair or escort. Over two-thirds of riders are age 50 and older. The primary health issues are chronic conditions. The majority of HealthTran participants do not have a vehicle, and distance to care is a significant barrier to accessing healthcare services. Most riders require multiple trips, not just one.  The majority of the population served by HealthTran has an annual income of less than $15,000.  Data from the largest hospital provider is also being compiled and analyzed to determine the impact to the hospital and its rural health clinics.

While the emphasis of Section 5310 funding is the elderly and disabled, HealthTran also serves the low-income with matching funds. The primary target population of HealthTran is individuals with disabilities, elderly, and low-income persons. Elderly is defined as individuals age 65 and older.

HealthTran demonstrated in its initial pilot and first year of Section 5310 Mobility Management funding that the provision of public transportation, along with service coordination in the clinical setting and between clinical visits, generally increases client adherence with appointments, counseling and care plan goals; reduces preventable hospitalizations and reduces utilization of hospital emergency departments for ambulatory sensitive conditions such as wound care, therapies, uncontrolled diabetes, and hypertension. In one instance, a leg amputation was avoided. While it is still relatively early in the life cycle of the project, early data analysis indicates that HealthTran has been both cost effective and shown to improve poor appointment adherence rates with healthcare providers. Data analysis further indicates HealthTran has had a positive effect on participants’ health outcomes. Because of HealthTran, healthcare providers have realized increased billable visits and collections for healthcare visits that would otherwise have been “no show” appointments.

Assignment Protocols

Fixed Routes First – Unless a client has special needs, HealthTran seeks to use fixed route public transportation to transport our clients to and from their medical appointments. Only when a regularly scheduled service will not meet the client’s need, will a HealthTran Coordinator implement an alternate regime.

We Use Local Transportation Service Providers – Private or local transportation providers are used when other options for non-emergency medical transportation or public transportation have been exhausted. HealthTran contracts for transportation services primarily from local and regional public transit providers and ambulance district providers offering these non-emergency transportation services.

HealthTran’s Hours of Operation – HealthTran offers transportation coordination and referral services Monday through Friday from 7 a.m. to 5 p.m. Transport services are provided seven days per week, with some 24/7 hour coverage, utilizing a combination of public transportation, local, private, and medical transport providers. Same day service is limited at this time.

Medicaid Referrals – Individuals with Medicaid coverage are referred to Medicaid non-emergency medical transportation providers.

Dual Eligibility – If a client is dually eligible for Medicaid/Medicare, the client will be served by HealthTran if they cannot access Medicaid Non-Emergency Medical Transportation in a period that meets their healthcare need.

Partnerships

Regional Planning Commissions – HealthTran’s current service area encompasses two regional planning councils, Southwest Missouri Council of Governments (SMCOG) and South Central Ozark Council of Governments (SCOCOG), with seven of HealthTran’s ten existing counties located in the SCOCOG region.

Local Partnerships – The Missouri Rural Health Association operates HealthTran, with funding support from the Missouri Foundation for Health and Missouri Department of Transportation, in coordination and cooperation with the following organizations:

  • Burton Creek Clinic
  • City of West Plains Transit
  • Cox Health System/Skaggs Memorial Hospital
  • Jordan Valley Community Health Center
  • Licking Bridge Builders Transit
  • Missouri Public Transit Association
  • Missouri Ozarks Community Health
  • OATS
  • Ozark County Ambulance District
  • Ozarks Medical Center (OMC)
  • SMTS
  • South Howell County Ambulance
  • Southern Missouri Community Health Center
  • Texas County Memorial Hospital

The Missouri Foundation for Health is a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

To learn more about HealthTran, click here: