By Hants Williams, director of clinical operations, VirtualHealth.
The buzz around social determinants of health (SDoH) is making waves across the healthcare industry. Linked to roughly 80 percent of overall health, stakeholders are increasingly embracing the opportunity of addressing SDoH in care management workflows.
SDoH are defined by Healthy People 2020 as the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.” Essentially, these elements encompass the non-clinical factors that can promote or hinder a patient’s ability to fully comply with care plans.
Transportation sits at the heart of current SDoH initiatives as a fundamental prerequisite to optimal care. Simply put, if patients cannot pick up their medications or get to appointments, a provider’s ability to impact their patient’s health is minimized. Consider, for example, a recent Connance survey that links 50 percent of re-admissions to factors such as transportation and home instability risk.
In the era of value-based care, the simple act of helping patients access transportation can notably improve the outlook on clinical outcomes and costs. For instance, medication adherence is a focal point of industry efforts to improve clinical outcomes, but if a patient cannot access transportation to pick up needed drugs, the potential for improvement is minimized.
Access to transportation is low-hanging fruit in terms of performance improvement, and providers must get ahead of the transportation challenge to implement successful, sustainable population health strategies. It’s also why forward-looking organizations are addressing this critical element of SDoH by equipping care managers with tools that speed identification of transportation needs and available services.
Understanding the Challenge; Recognizing the Opportunity
Industry statistics reveal that the transportation challenge is significant and is expected to compound in the coming years. Estimates point to 3.6 million Americans missing or delaying medical care because of an inability to get to their appointments.
Understandably, the transportation issue is exacerbated in low-income and elderly populations as well as rural regions where public transportation is scarce. Many patients simply lack the disposable income needed to maintain a reliable source of transportation. In terms of elderly populations or those with disabilities, physical or mental conditions that eliminate or significantly restrict driving as an option create additional challenges.
In tandem with these realities, the elderly population is expected to continue growing at a rapid rate, increasing demand for transportation services. The population of people in the U.S. 65 or older exceeds 50 million for the first time in history, and 85 percent of older adults have at least one chronic health condition such as kidney disease, requiring regular medical care such as dialysis. Notably, 66 percent of dialysis patients rely on others for transportation to their appointments.
The current and coming transportation challenge is sizeable and will require significant resources. Fortunately, the business case for improving the outlook is an easy one to make: A recent study examining non-emergency transportation costs in Florida found that if a mere 1 percent of medical trips resulted in the avoidance of an emergency room visit, the state could save up to $11 for each dollar spent.
Advancing Transportation Strategies
Providers and payers alike are increasingly turning to tools that help identify SDoH needs like transportation in near real-time, allowing care managers to proactively seek out community resources that can help. For example, one state-run managed Medicaid program deployed a care management platform that allows clinical teams to access pre-approved community services and schedule transportation appointments immediately once needs are identified.
With the help of customized algorithms and advanced artificial intelligence tools, drivers can be deployed to patients’ homes in anticipation of needs rather than finding out after the fact that appointments were missed, or medications were not picked up. The efficiency of the analytics platform is critical to changing the dynamic as clinical teams would otherwise be tasked with combing through millions of line items in patient records to identify potential needs.
Advanced solutions allow users to easily monitor transportation requests across all patients or drill down into a single case to manage unique details of each trip, such as advanced authorizations or ensuring the appropriate vehicle has been scheduled to accommodate assistive devices, child seats and companions. Care managers improve efficiency by scheduling recurring trips and tracking specific patient requests or preferences, which can be shared with the transportation vendor and other care coordinators.
Leveraging the transportation functionality, the state-run Medicaid program completed nearly 24,000 transportation entries in 2018. Through advanced analysis, it was able to forecast usage trends across months, time of day and geography to help its clients optimize operations and predict transportation expenditures. For example, the organization can determine which patients are frequent transportation users, which can alert care managers to book multiple provider appointments at once to reduce costs versus on separate days.
Personalized care management and coordination is part of the healthcare industry’s overarching goal of cultivating healthier communities. SDoH indicators such as transportation are critical to these efforts. Forward-thinking organizations are taking hold of the opportunity to improve care management by investing in infrastructures that support greater access to transportation.