The new report, Transportation and Health Access: Rides to Wellness Community Scan Project, conducted by Health Outreach Partners, describes the scope of the problem of transportation barriers to health care and its financial impact due to missed appointments. Based on a national survey with community health centers, findings show no-show rates ranging from 11-30%, but that the reasons for missed appointments are not being tracked. By addressing transportation barriers, there is greater potential for financial benefits for health centers that are also likely transferable to other health care providers. The Missouri Rural Health Association and Community Asset Builders were contributors to the report, which includes six profiles of communities – one of which is Missouri’s HealthTran initiative – who are taking action to address barriers and decrease loss of revenue.
Last week, HRSA announced the fiscal year 2017 Access Increases in Mental Health and Substance Abuse Services (AIMS) awards. AIMS funding provides more than $200 million to 1,178 health centers to increase personnel, leverage health information technology, and provide training to support the expansion of mental health services and substance abuse services focusing on the treatment, prevention, and awareness of opioid abuse, and their integration into primary care. AIMS awards will support health centers in all 50 states, the District of Columbia, American Samoa, the Federated States of Micronesia, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands.
Award recipients are invited to view a brief video on the AIMS technical assistance website highlighting the awards and important information for award recipients.
Our Missouri pilot project showed that free trips to the doctor pay off for everyone
In 2014, Leo Haralson’s big toe turned black, a casualty of his battle with diabetes. A veteran and a former software developer for the U.S. Navy, he had insurance through both Medicare and the Veterans Affairs Department, so getting good health care shouldn’t have been a problem. But after the toe was amputated, he developed an infection that spread to his bones. Haralson needed daily oxygen treatments at a hospital to halt the infection.
Haralson and his wife, 65, motorcycle enthusiasts originally from Wisconsin, had retired to southern Missouri, seeking a warmer climate and a home in the middle of the country so they could drive off in any direction. They built their dream home on the outskirts of the town of Mountain View, named for its commanding view of the Ozarks. But his wife could no longer drive, and with his foot in bandages, Leo couldn’t either. The hospital was 30 miles down Highway 60 from his home, and the local transit provider has bus service only on Wednesdays. Without a way to get to the hospital every day for a month, Haralson faced losing his leg—and his ability to live independently.
Transportation comes up in virtually every conversation about rural health care, particularly in the past few years as hospital closures have increased the distances many patients need to travel. Missouri has closed three hospitals since 2010, victims of cutbacks in reimbursement from insurers and the government. Distances patients must travel are increasing.
As policymakers look at ways to improve the health of rural Americans, it’s becoming increasingly clear that transportation is a critical missing link between patients and providers.
The problem isn’t necessarily a lack of rides; many places, like Missouri, have a variety of transportation options for people who can’t drive. Medicaid provides some non-emergency transportation for eligible patients. Some local communities run van services, particularly for seniors. The Southern Missouri Transportation System and OATS, a nonprofit transit company, provide van services, as well. And there are medical transportation services including emergency ambulances.
But all of those systems have problems and gaps. For Medicaid, rides must be ordered five days in advance, and cannot include secondary stops, even just to visit a pharmacy to fill a prescription after the doctor visit, without prior approval. Van and bus services run once or twice a week on fixed schedules and routes that may not match a patient’s appointment times. And ambulances are expensive.
There’s a bigger problem, too: The current system puts the burden of navigating those options and schedules on patients, even as they are struggling with illness and symptoms like pain, confusion and fatigue. In Missouri, we have found that when getting a ride isn’t simple and affordable, patients will forgo care. And that means that their conditions can worsen until they become acute and result in an ambulance ride to the ER instead—the most expensive option of all.
Clearly, the existing system doesn’t work well for anybody. Patients are overwhelmed and often give up. Doctors and hospitals lose time and revenues because of “no-shows.” And ambulance companies are transporting patients who didn’t know whom else to call—and then don’t get paid if an insurance company or Medicaid decides it wasn’t an actual emergency.
As a health care consultant and the executive director of the Missouri Rural Health Association, I helped develop a program to test whether there was a better way. We got seed money to hire a “mobility coordinator” who could arrange rides for patients who needed them. Our program, called HealthTran, trained clinic and hospital staff to ask patients at the time they made appointments whether they needed a ride. And if they did, they alerted the HealthTran coordinator who would contact them, assess their transportation needs and figure out a cost-effective solution.
Leo Haralson was one of HealthTran’s first patients. In his case, the coordinator determined that because of his infection, he needed private rides from his home in Mountain View to Ozarks Medical Center in West Plains, 30 miles away. She arranged 70 rides for him at a cost of $6,000. That wasn’t cheap, but it paid off. The hospital benefited by being able to bill Medicare $13,000 for the oxygen treatments and avoiding penalties for a hospital readmission. Medicare saved the cost of a leg amputation and possible transfer to a nursing home.
Here was how it played out at one hospital system: In just 17 months, HealthTran provided 2,470 rides for patients receiving services, at a cost of just over $66,000. Including staffing, the total cost of coordinating and paying for transportation was approximately $95,000, an average of $33 per ride. These patients resulted in over $730,000 in payments to the hospital and its clinics. In short, for every $1 invested in transportation, the hospital earned $7.68 in reimbursement.
The return on investment in transportation is so strong that it can pay off even for individual doctors. A missed appointment means missed revenue, loss of provider productivity, patient rescheduling and most likely a sicker patient. If 20 percent of scheduled appointments are missed on a weekly basis, and the average charge for that primary care visit is $150, a provider who typically sees 20 patients per day will miss out on $3,000 each week (or 1 entire day’s worth of revenue), while staffing costs remain constant. At $225 per visit for specialty care, the provider misses out on $4,500. Over the course of a year, the health care provider is missing out on $156,000 to $234,000. Considering the average cost of a ride for these patients at $33, the annual cost of paying for transportation and mobility coordination would be about $45,000. This is a $3.46 to $5.20 return for every $1 invested in transportation.
And that doesn’t even consider the improved patient outcomes and those long-term savings to the health care system.
Perhaps the biggest payoff is that it helps senior citizens like Haralson and people with disabilities to live successfully in homes of their own rather than move to nursing homes or assisted-living facilities, placements that can erode their health and cost the government and other insurers much more money in the long run. If Haralson had required a leg amputation, that would not only have cost Medicare and Medicaid upward of $1 million, but left him disabled and likely forced to move to a nursing home. Instead, Haralson was able to continue to live at home and fend for himself. These days, he’s spending his retirement helping deliver meals to homebound seniors in his community.
So, why aren’t more hospitals offering no-cost transportation to their patients? One reason is that well-intentioned federal regulations have created unnecessary hurdles. In an effort to avoid a practice known as “self-dealing,” hospitals are not allowed to directly provide transportation to patients. While there were a few instances in the past of hospitals unfairly profiting by providing transportation between nursing homes and hospitals, the practice was not widespread. Still, the rules designed to eliminate that practice now make it difficult for providers to take on the transportation problem directly. That’s why the HeathTran model offers a solution: By using an outside coordinator to make the arrangements, HealthTran helps hospitals maintain an arms-length relationship from transportation services.
In theory, driverless cars could someday address some of the need for medical transportation. But I’m skeptical that will solve the problem for most patients because a key factor in health care is human interaction. Many patients who need transportation are seniors, or have a disability that can make it hard to get to and from their front door and the vehicle without assistance. At least in Missouri, and I would venture to say in many other areas of rural America, people need a human connection—a person in the community, familiar with the community—to connect the health, transportation and payer systems in a way that makes good, common sense. And besides, we can’t wait for a driverless future. Patients in rural America need a solution now.
Missouri’s HealthTran was designed to bridge the transportation gap between patients and providers in a way that works for all sides. Rural America needs more of these solutions. If we can’t make it easier for rural patients to get to and from their homes and their doctors, the whole country will pay for it down the road in greater medical costs and poorer health outcomes.
Suzanne Alewine is a health care consultant and executive director of the Missouri Rural Health Association.
Community Asset Builders, LLC reached a significant milestone in July 2016, celebrating 15 years of business. The company has grown from the dreams of co-founders Doris Boeckman and Suzanne Alewine, to a company that has supported more than 150 organizations through project-specific and retainer contracts, and generated more than $235 million in grant revenue for customers. As part of our celebration, we are excited to share, “15 Years of Taking Clients Beyond Their Potential,” a document that captures our journey throughout the years and summarizes the wonderful relationships that have been established to improve the health and well-being of individuals in Missouri and throughout the United States.
“It gives me great pride in joining Suzanne and our employees, clients and business partners in celebrating our company’s 15th anniversary. We have come a long way since the business first started in 2001 and we are very excited about our future as we continue to seek innovative solutions and services to meet the needs of our customers,” said Boeckman.
Community Asset Builders readied itself for growth by focusing on its core tenets:
- Serving as a voice on community development and asset building for the communities and organizations it serves with state and national organizations;
- Increasing access to financial resources through grant writing and fund development;
- Providing technical assistance and planning services so clients can more effectively utilize their resources;
- Strengthening peer networks among clients to increase opportunities for collaboration and shared learning; and
- Challenging public and private funding sources to invest more robustly in communities where clients are serving vulnerable populations.
Our ability to engineer solutions based on the specific needs of customers has helped the company to continually grow over the past 15 years, and offers promise for future growth.
In December 2017, the Department of Health and Human Services awarded over $50 million in funding for 75 health centers in 23 states, Puerto Rico and the Federated State of Micronesia. Community Asset Builders provided technical assistance to Compass Health, Inc., and Douglas County Public Health Services Group, Inc. (dba Missouri Ozarks Community Health), funded in Missouri, and Rosa Clark Medical Clinic, Inc., funded in South Carolina.
“We expect this competitive New Access Point funding to provide health care to more than 240,000 additional patients, ” said Dr. Mary Wakefield, Acting Deputy Secretary at HHS. “These new health center sites will contribute significantly to the health of families and communities across the nation.”
Health centers are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary health care services. Health centers also often integrate access to pharmacy, mental health, substance abuse and oral health services in areas where economic, geographic or cultural barriers limit access to affordable health care services.
“For millions of Americans, including some of the most vulnerable individuals and families, health centers are the essential medical home where they find services that promote health and diagnose and treat disease and disability,” said Health Resources and Services Administration (HRSA) Acting Administrator Jim Macrae. “One in 13 people nationwide rely on a HRSA-funded health center for their preventive and primary health care needs.”
Nearly 1,400 health centers operating over 9,800 sites provide care to more than 24 million people across the nation, in every U.S. state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the Pacific Basin. Today, health centers employ nearly 190,000 people.
To learn more about HRSA’s Health Center Program, visit http://bphc.hrsa.gov/about/index.html.
To find a health center in your area, visit http://findahealthcenter.hrsa.gov/.
HHS awards $156 million to health centers to expand oral health services. Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced nearly $156 million in funding to support 420 health centers in 47 states, the District of Columbia and Puerto Rico to increase access to integrated oral health care services and improve oral health outcomes for Health Center Program patients.
A total of 20 awards were made to health centers in Missouri, amounting to $7,467,586 in funding through December 2017. Community Asset Builders provided technical assistance and grant writing expertise to 13 health centers (12 were awarded funding) and is pleased to congratulate all of Missouri’s awardees.
This funding enables health centers to expand integrated oral health care services and increase the number of patients served. With these awards from the Health Resources and Services Administration (HRSA), health centers across the country will increase their oral health service capacity by hiring approximately 1,600 new dentists, dental hygienists, assistants, aides, and technicians to treat nearly 785,000 new patients.
“Oral health is an important part of our overall physical health and well-being,” said Secretary Burwell. “The funding we are awarding will reduce barriers to quality dental care for hundreds of thousands of Americans by bringing new oral health providers to health centers across the country.”
Oral health problems can be a sign of illness elsewhere in the body. Additionally, lack of access to preventive and routine dental care for underserved populations can result in dental conditions requiring more costly emergency dental treatment.
“HRSA will continue to explore ways to further integrate oral health services within primary care settings, and increase awareness of the connection between oral health and overall health,” said HRSA Acting Administrator Jim Macrae.
Today, nearly 1,400 health centers operate approximately 9,800 service delivery sites in every U.S. state, D.C., Puerto Rico, the Virgin Islands and the Pacific Basin; these health centers employ more than 170,000 staff who provide care for nearly 23 million patients. In 2014, health centers employed over 3,700 dentists, more than 1,600 dental hygienists, and over 7,400 dental assistants, technicians and aides. They served about 4.7 million dental patients and provided nearly 12 million oral health visits.
To view the list of the awardees, visit http://bphc.hrsa.gov/programopportunities/fundingopportunities/oralhealth/fy16awards.html
To learn more about HRSA’s Health Center Program, visit http://bphc.hrsa.gov/about/index.html
To find a health center in your area, visit http://findahealthcenter.hrsa.gov/
HHS Awards over $260 Million to Health Centers Nationwide to Build and Renovate Facilities to Serve More Patients – Today, HHS Secretary Sylvia M. Burwell announced over $260 million in funding to 290 health centers in 45 states, the District of Columbia, and Puerto Rico for facility renovation, expansion, or construction. Health centers will use this funding to increase their patient capacity and to provide additional comprehensive primary and preventive health services to medically underserved populations.
Community Asset Builders provided resource development and grant writing assistance to five of the eight awardees: Community Health Center of Central Missouri, Family Health Center of Boone County, Missouri Ozarks Community Health (Douglas County Public Health Services Group), Myrtle Hilliard Davis Comprehensive Health Centers, and Northwest Health Services.
In preparation for the 15th anniversary (July 2016) of Community Asset Builders, LLC (CAB), we will be featuring a past or present client each week. Our first highlight is Katy Trail Community Health.
Regional Health Care Clinics, Inc. dba Katy Trail Community Health joined CAB as a community health center retainer client in 2005 and was rewarded with a Health Resources and Services Administration (HRSA), Bureau of Primary Health Care, New Access Point (new start) award for Pettis County, Missouri in 2006. In years to come, CAB was able to secure new access points for Morgan and Saline Counties and wrote and secured $2.9 million in ARRA Facility Improvement Funding in 2009 for construction of Harbor Village in Benton County. Harbor Village houses the Area Agency on Aging program, known as Care Connection, Pathways Community Health and Katy Trail Community Health. The co-location of services improves access to care and promotes service integration. CAB also secured capital funding to purchase Katy on the Go, a mobile unit that provides mobile primary care and oral health services to schools in Katy Trail’s service area.
CAB also provides support to Katy Trail in completing HRSA, Bureau of Primary Health Care, Service Area Competition (SAC) applications for ongoing federal base funding for the health center. Past awards have also been secured from the Office of Rural Health Policy, including Network Planning funding, a Rural Health Outreach grant award, and a Small Healthcare Provider Quality Improvement grant award. CAB has also secured capital funding and service expansion grants to support health center growth and operations.
Katy Trail has benefited from an estimated 85% grant success rate, generating more than $17 million over 11 years, with a return of nearly $100 for every dollar invested. In addition to resource development and grant writing services, CAB conducts annual strategic planning with Katy Trail’s leadership and board of directors.
We are proud to be a partner in Katy Trail’s growing success!
Doris Boeckman, co-founder of Community Asset Builders and MRHA Rides to Wellness Director, is presenting about Missouri Rides to Wellness and HealthTran for the panel presentation, Moving Towards Health Equity: Success and Challenges. Co-panelists include Nancy Kelley, Director for Expanding Coverage, Missouri Foundation for Health and Sara Gentry, Policy Director, Missouri Health Care for all.
The featured speaker for the event is Robert Murphy, MEd. Mr. Murphy currently leads Maryland’s discipline reform, dropout prevention, and alternative programs efforts at the Maryland State Department of Education. He has been instrumental in reducing Maryland’s number of suspensions by 50% over the last 8 years thus reducing Maryland’s dropouts over the past 7 years. He just completed developing the regulatory guidance for changes in Maryland’s Discipline regulations and the new State Code of Discipline Policy that was adopted by the Maryland State Board of Education in July of 2014. Mr. Murphy also has been named by the Governor Martin O’Malley to the Maryland Juvenile Justice Coordinating Council.
The target audience for the conference is health care providers, public health professionals, health policy makers, community advocates, academic researchers, health departments, other governmental agencies, legislators, non-profit and for-profit organizations as and the business community with an interest in eliminating health disparities.
It is not too late to register! Conference fees are only $50. The conference is packed with information and learning objectives to help you 1) assess current efforts that address health disparities in Missouri and develop strategies to meet specific patient/client needs; and 2) identify strategies to build inclusive communities, schools and health care systems.
For more information or to register, follow this link: http://medicine.missouri.edu/cme/healthy-lives—healthy-communities.html
Joe Lopez, Director of Strategic Growth and Development for Community Asset Builders, LLC (CAB), will be the lead team member for all three new accounts. Joining the network of peer organizations being served by CAB are Helias Catholic High School and The Helias Foundation (Jefferson City, Missouri), and Concord Christian School of New Hope International Church (Concord, California). Each of these organizations will receive professional assistance with planning and fund development in 2016 to develop new and augment existing resources.
Helias Catholic High School is a co-educational high school of the Diocese of Jefferson City which seeks to educate and strengthen the whole student – mind, body, and soul – within the strong tradition of Catholic secondary education. Welcoming Catholic and non-Catholic students alike, Helias seeks to provide a strong education in a safe environment for students who will further their education in college, trade school, the armed forces, or the workforce. The Helias Foundation, Inc. supports Helias Catholic High School to enable Helias to offer a quality, affordable Catholic education to the students of Central Missouri.
New Hope International Church ministers to people from every imaginable ethnic background. The membership includes Hispanics, African Americans, Asians, Europeans, Caucasians, and many other ethnic groups who freely worship together. Concord Christian Schools aid children in their academic, spiritual, and character development. Concord Christian Schools was started in 1972. All of the classrooms are designed and supplied with a wide variety of learning essentials and educational resource materials, each unique and creating a learning environment for each child to succeed and excel.
Welcome to the CAB network!