HealthTran

Description

Starting with the invention of the automobile and followed by the urban-centric migration of many of modern life's necessities, transportation challenges have created barriers for rural residents. An important example of one such barrier experienced by rural Missouri residents was that related to healthcare access.

Recognition that transportation was inherently connected to improving the well-being of rural Missourians, state, regional, and local stakeholders — including one large Federally Qualified Health Center (FQHC) — who were interested in healthcare-related transportation challenges gathered in 2013. Initially funded by the Missouri Foundation for Health, the outcome of a strategic planning session resulted in the creation of a transportation service. With grant funding secured for a pilot project, the Missouri Rural Health Association (MRHA) took on leadership responsibility for the project eventually named HealthTran.

During the project's 2014-2016 pilot, HealthTran served multiple counties and provided over 4,700 rides at an average cost of $33 per ride. Key to the outcomes were data analyses revealing that for every member hospital using the platform, a $1 investment created over $7.50 in provided healthcare services reimbursement.

Although patient health outcomes were not specifically studied, project leaders and data analysts postulated that having reliable transportation decreased missed appointment rates and contributed to some of the project data detailing decreased hospital readmission rates and emergency room visits.

Original project support was provided by the Missouri Foundation for Health (MFH), the Federal Transit Administration through the Missouri Department of Transportation as lead agency, and the National Center for Mobility Management.

With the pilot project completed, the project's overwhelming success provided motivation to create a sustainable transportation system. HealthTran leaders found that sustainability emerged in the post-grant environment with implementation of a membership structure for healthcare systems, like hospitals and clinics. However, other businesses and rural public health projects have found the model crucial, emphasizing the reality that rural-specific transportation is key to many projects geared to improving the lives of rural Missourians who live in areas where public transportation models do not scale.

Additionally, in the post-pilot environment, a volunteer driver program has emerged as the optimal solution for rural transportation needs. Other success keys include incorporating the principles of Mobility Management and utilizing a rural-specific ride scheduling software as most of the latter are often urban-centric and geared to leveraging public transportation and ride-share drivers.

Eventually, a HIPAA-compliant software was identified that could navigate the rural realities of washed-out bridges and roads too heavy with uncleared snow or too muddy for passage. In addition, this technology could accommodate changes on the healthcare appointment side when ride times needed to flex with moved or cancelled appointments.

The platform also provides a variety of transportation-related data that users can leverage for needs such as economic analyses, healthcare quality measures, and numerous other areas. The software developers regularly work in partnership with HealthTran to make improvements to support growth as well as users reporting needs.

As the model has matured over the past decade, HealthTran is now transitioning from its original home within MRHA to its current temporary organizational home and support from another Missouri agency, Community Asset Builders (CAB). Rebranding is also part of an eventual goal of the model's future emergence as a grant-independent, self-sustaining, stand-alone organization. The partnership between MRHA and CAB, built on the premise of a public-private partnership, is a fundamental part of HealthTran's success.

Services offered

For the rural public needing transportation services:

• Offers rides to healthcare appointments in local and urban locations
• Offers rides to other essential rural activities: banking, groceries, and other needs

For healthcare systems and other new users, HealthTran staff can provide:

• Onboarding steps for new members
• Assists with uploading scheduling platform software
• Provides training for members' staff
• Provides technical assistance if new users self-identify challenges

Note: After training, a membership organization's scheduler can arrange transportation for clients in about 2 minutes.

HealthTran staff additionally provides:

• Virtual monitoring of transportation needs of its members through scheduling software platform
  • For example, unassigned ride management assistance
• Recruitment and monitoring of Volunteer Driver Network
• Some assistance with cost and cost-savings predictions for interested groups exploring the model

• Information to build Mobility Management skills and knowledge to help build rural transportation capacity

Results

Today, HealthTran's outreach supports about 1,700 rural citizens in nearly 45 counties. Volunteer driver numbers fluctuate but in early 2024 number about 20.

Of note: In late 2023, the model was scaled to an urban Missouri location, Jefferson City.

For more on the HealthTran program's initial successes:

• National Academies of Sciences, Engineering, and Medicine, et al. Exploring Data and Metrics of Value at the Intersection of Health Care and Transportation: Proceedings of a Workshop. National Academies Press. November 2016.
• AARP Public Policy Institute. Mobility Managers Transportation Coordinators for Older Adults, People with Disabilities, Veterans, and Other Members of the Riding Public. June 2019.

For more on recent HealthTran model developments:

• Meeting the Transportation Needs of Rural Communities: Lessons That Cannot Be Learned from Urban Transit. TR News the bimonthly magazine of the Transportation Research Board. January-February 2020.
• Federal Funding for Rural Health: Supporting Planning and Development Around a Regional Transportation Need. The Rural Monitor. December 9, 2020.
• Journey to Well-being: Go For A Ride Day and Transforming Rural Transportation. November, 22, 2023. Community Asset Builders LLC. Accessed January 2024.

In this video, HealthTran staff, volunteer drivers, and clients speak about the model:

Challenges

With model maturation, HealthTran leaders indicate that now few challenges exist other than those linked to the volunteer driver recruitment — despite offering volunteer pay, special insurance coverage provisions, and other support.

Replication

Since its 2016 pilot program completion, HealthTran leaders continue to provide informal consultation. To date, this has been requested by individuals and organizations in about 10 states for either similar program start-ups or to inform other programs.

Replication efforts should start with identification of an organization/individual willing to serve as a community's project champion. Additionally, the community stakeholders should connect with rural transportation models because scaling urban volunteer models are often unsuccessful.

Communication should also occur with the specific state/local transportation agencies.

Mobility management awareness is strategic to any new model's success.

Contact Information

Reagan Alewine, HealthTran Director
573-415-6201
reagan@cabllc.com