Exploring Data and Metrics of Value at the Intersection of Health Care and Transportation

1. Health & Medicine Division ● Transportation Research Board Exploring Data and Metrics of Value at the Intersection of Health Care and Transportation Research Advisory Council July 2016

2. Key Facts • Project sponsored by FTA • Staffed by Health and Medicine Division and Transportation Research Board • Workshop, commissioned paper, literature review • Planning committee members: 5 health sector, 5 transportation

3. The Charge A two-day workshop examined community level data relating to building partnerships between health and transportation providers, including identifying data from health care providers, existing measures, and other information relevant to measuring the value of the relationship and partnerships between public transit services and health care and to calculate the return on investment.

4. The Premise and the Problem • The cost to medical providers of missed appointments and/or hospital readmissions is huge. If these numbers can be reduced through improved transportation access, a positive return on investment can be estimated. • The problem. Few are doing systematic accounting for both sides. What institution should collect the data and do the analysis? Privacy issues.

5. The Planning Committee

6. Workshop Highlights • Policy and social context creating momentum: • Affordable Care Act, Medicare Access and CHIP Reauthorization Act (Children’s Health Insurance Program -- Community Health Needs Assessment and Health Improvement Plan), health system transformation • Beyond narrow focus on health care savings--larger focus on value is a complex undertaking , but crucial • Funding for enabling services (e.g., transportation) often episodic and disease-specific • Not a new conversation; we’ve been talking about coordination for decades, but there is new energy in seeking solutuions. Integrated models – from health care to transportation

7. Workshop Highlights: Enviro Scan • 70 interviews with individuals representing the following sectors: • brokerage, consulting/technical assistance, consumer/consumer advocacy, foundation/funding, health services, human services, research/academia, transportation services, veteran’s services • Challenges creating health and transportation partnerships and measuring ROI/value: • defining return on investment, funding, missing information & data, technology, geography, NEMT destination and service gaps, cross-sector collaboration

8. Workshop Highlights: Enviro Scan • Solutions & opportunities • Grants • Shared learning • Start small and go slow • Let patients tell the story • Take the care to the patients • Customer experience • Sharing resources, increasing revenue • Sharing data, analyzing solutions

9. Workshop Highlights • Workshop was like a wedding (transportation & health care) • Recognition of relationships that exist – we could now show the world that we’re talking, but conversation needs to continue • Surfaced shared values: person (patient, traveler)-centeredness; focus on quality of life matters • Need common measures: ways to measure things in people’s lives that make for better living • 2 sectors need to start measuring the same things; partly for accountability—that people’s needs are met

10. Workshop Highlights • National: 3.6 M Americans miss or delay non-emergency medical care because they lack transportation (FTA’s Acting Administrator Carolyn Flowers) • Local: 51% of missed appointments at Worcester Family Health Center are due to transportation barriers • Needs and solutions range widely from one region/jurisdiction to another • Crucial to include customers in troubleshooting and finding solutions

11. Workshop Highlights • Importance of community health workers in helping patients navigate not only health care services but addressing health-relevant social needs (e.g., transportation. A RELATIONSHIP must be built.) • Some benefits of transportation services are hard to measure (addressing social isolation, meeting other health-related needs) • How do we take mobility on demand into the future—to meet needs of getting to health care, to work • Cross-departmental interactions crucial to help address need

12. Workshop Highlights: Next Steps • Research ideas for TRB’s Cooperative Research Program • Need research proposal(s) that span the transportation and health care sector (TCRP and others), both long-term and short-term opportunities • Needs assessment of all federal agencies and what is being done • Need to surface learning models and pilot sites across the nation – need to identify effective service delivery models that work well and could be spread and scaled.

13. Workshop Highlights: Data • What data is being collected by partnerships and brokerages across the country? • Population health data can help connect the dots on the populations of need and what partnerships can help • Refine objectives of a common data set for transportation and health care • Some ongoing surveys may be willing to consider adding transportation questions: National Core Indicators (NCI) and NCI for Aging and Disabilities; (National Association of State Directors of Developmental Disabilities Services); National Health Information Survey conducted by CDC. • Non-disclosure agreements and accessing HIPAA data – need guidebooks and examples, a wiki to help people navigate

14. What is Going on Now • Under the “Rides to Wellness” initiative FTA has issued planning grants, demonstration grants, and a study of missed medical appointments due to lack of transportation. FTA is Also funding the National Center for Mobility Management (APTA, CTAA, Easter Seals) to provide technical support and outreach. • The FAST Act requires that the Interagency Coordinating Committee on Accessibility and Mobility reconvene and establish a strategic plan

15. More information Staff: Alina Baciu, Health & Medicine Division abaciu@nas.edu Steve Andrle, Transportation Research Board sandrle@nas.edu Meeting web page (video, slides, background readings) http://www.nationalacademies.org/hmd/Activities/PublicHealth/TransitandHealthcare/2016-JUN-6.aspx Or Go toTRB.Org., past conferences, June 6, 2016