Non-Emergency Medical Transportation Plan for Lake County

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  ___________________________________________________________________________________________________________________


                                               Developing a

      NON-EMERGENCY
MEDICAL TRANSPORTATION PLAN
      FOR LAKE COUNTY
_______________________________________________________________________________________________________________________



              CalACT Spring Conference Presentation – April 2011
                Terri Persons, Lake County/City Area Planning Council
                      Heather Menninger, A-M-M-A Transit Planning


                                                                                                                          1
                Lake County NEMT Plan
             Non-Emergency Medical Transportation
_______________________________________________________________________________________________________________________




 What we did and why
 Defining the case for coordinated NEMT
  program
 Recommended program elements
 Current initiatives



                                                                                                                          2
3
                    Lake County/City APC
                      NEMT Plan Goals
________________________________________________________________________________________________________________________




 For Lake County residents –
  Improve mobility
  Improve access to medical care
   by improved NEMT services
  Promote public safety
  Be sustainable

                                                                                                                           4
                Lake County NEMT Plan
                                             Approach
_______________________________________________________________________________________________________________________


          Identify existing conditions & context
      1.       Health care conditions: primary care development, service gaps, care
               coordination
      2.       Public transportation: services and funding
      3.       Published studies on NEMT cost/benefit
          Document NEMT need
      1.       Countywide household survey- 33,000 residences
      2.       Agency survey-200 organizations
      3.       3 Public workshops, intercept surveys
      4.       Key stakeholder interviews
          Analysis and Plan Development

                                                                                                                          5
                Lake County NEMT Plan
                                             Approach
_______________________________________________________________________________________________________________________


          Identify existing conditions & context
      1.       Health care conditions: primary care development, service gaps, care
               coordination
      2.       Public transportation: services and funding
      3.       Published studies on NEMT cost/benefit
          Document NEMT need
      1.       Countywide household survey- 33,000 residences
      2.       Agency survey-200 organizations
      3.       3 Public workshops, intercept surveys
      4.       Key stakeholder interviews
          Analysis and Plan Development

                                                                                                                          6
                             Key Findings:
       Countywide Household Survey
 3%    well-distributed response – 1,052
 households; 1,890 persons                                                 Lake County NEMT Household Survey
                                                                  In What Town or Community Do You Live, Is Closest to You?
                                                                                             N=1583 Individuals

                                                            50%                                      45%               45%


                                                            40%

                                                            30%
        Lake County NEMT Household Survey
         Individuals Responding by Age Group                20%
                   N=1829 Individuals                                                  10%
                                                            10%
                     48%
                                               Ages < 15    0%
 50%
                                               Ages 15-64               South County         North Shore/East County         West County/Mountains
 40%                                    26%
                                22%            Ages 65-74
 30%                                           Ages 75 +
 20%      4%
 10%
 0%
            Lack of Transportation
                                                             48% of respondents age 65 and older



                                                                                                                                                     7
     Key Findings: Household Survey
                                     Accessing Health Care
_________________________________________________________________________________________________________

How do people report getting to health care?
                        Lake County NEMT Household Survey
           How Do Family Members Travel to Medical Appointments?
                                              N=1890 Individuals

                                Drove self                                          67%

     Driven by relative who lives with me                         26%

  Driven by a relative who lives elsewhere              11%

                             Transit / bus             8%

                                     Walk         3%

                                Dial-a-ride      3%

                                      Bike       2%

                                  Taxi cab       1%

                                          0%                20%         40%   60%         80%




                                                                                                        8
          Key Findings:
       Accessing Health Care
Missing medical appointments…
                                     Lake County NEMT Household Survey
                Why Did You or Family Members Miss Medical Appointments in the Past Six Months?
                                                     N= 1890 Individuals


                     I / we didn't miss any appointments                                  60%

                                    Lack of transportation              12%

                  Health improved, felt better, felt worse         5%

                               Forgot about appointment            5%

                        Private matter / personal reasons      4%

                       Could not get off of work or school    1%

                           Don't know / don't remember        1%

                                                         0%             20%   40%   60%




                                                                                                  9
                     Key Findings:
              Accessing Health Care
Missing medical appointments…
                                                     Lake County NEMT Household Survey
                                Why Did You or Family Members Miss Medical Appointments in the Past Six Months?
                                                                     N= 1890 Individuals


                                     I / we didn't miss any appointments                                  60%

                                                                                        12%
- More likely originating on                        Lack of transportation

                                  Health improved, felt better, felt worse         5%
North Shore
                                               Forgot about appointment            5%

- Trips intermittent and one-           Private matter / personal reasons      4%

time for some                          Could not get off of work or school    1%

                                           Don't know / don't remember        1%
- Trips continuing for others                                            0%             20%   40%   60%




                                                                                                                  10
                     Key Findings:
              Accessing Health Care
Missing medical appointments…
                                                     Lake County NEMT Household Survey
                                Why Did You or Family Members Miss Medical Appointments in the Past Six Months?
                                                                     N= 1890 Individuals


                                     I / we didn't miss any appointments                                  60%

                                                                                        12%
- More likely originating on                        Lack of transportation

                                  Health improved, felt better, felt worse         5%
North Shore
                                               Forgot about appointment            5%

- Trips intermittent and one-           Private matter / personal reasons      4%

time for some                          Could not get off of work or school    1%

                                           Don't know / don't remember        1%
- Trips continuing for others                                            0%             20%   40%   60%




          Scale of need modest – 12% of responding individuals, among
          representative respondents.

                                                                                                                  11
      Key Findings: Household Survey
                         Accessing Health Care
_________________________________________________________________________________________________________


Who is missing appointments due to lack of
 transportation?               -Youth most likely
                                                                              to miss medical
                   Lake County NEMT Household Survey                          appointments due
        Missed Medical Appointments Due to Lake of Transportation
                                                                              to transport.
                        By Age and By No Insurance

30%
                                                                              - Seniors least
                  23%                                          Ages < 15
                           16%                                 Ages 15-64
                                                                              likely to miss
20%                                               13.3%        Ages 65-79     appointments due
                                    7%       6%
                                                               Ages 80+       to transport.
10%                                                            No Insurance

                                                                              - Responding non-
 0%
                    Lack of Transportation                                    senior adults and
                                                                              those with no
                                                                              insurance more
                                                                              likely to miss.
                                                                                                      12
    Key Findings: Household Survey
                         Accessing Health Care
_________________________________________________________________________________________________________

Appointments scheduled by age group and
 those without insurance – past six months
                                                                      Lake County NEMT Household Survey
                                              Quartile Distributions of Number of Medical Appointments Made In Past Six Months,
                                                                  by Age Group and by Reporting No Insurance
  Youth - fewer                       90


  appointments,                        80
                                                                                      84


  smaller range.                                                                                                           Q1
                                       70
                                                                                                                           Minium
   Seniors younger                    60                                                               60
                                                                                                                           Median
                                                                                                                           Maximum
  and oldest -                                                      53
                                                                                                                           Q3


  greatest range of #                  50
                                                                                                             N= 1,588 Individuals
                                                                                                             reporting they received
  of appointments,                     40
                                                                                                             health care
                                                                                                             N= 55 individuals reporting
                                                                                                             no heatlh insurance and
                                                                                                             receiving health care
  No insurance                        30


  adults - fewer                       20                                                                                         20

  appointments,                                   15
                                       10
  smaller range.                                                                      4                  5
                                                  3                 3                                                             3
                                        0
                                             Ages <15         Ages 15-64        Ages 65-74         Ages 75+            No Insurance - All   13
                                                                                                                             Ages
    Key Findings: Household Survey
                         Accessing Health Care
_________________________________________________________________________________________________________


Within Lake County –
       Countywide majority of trips to Doctors’ offices –
        63%


Out-of-Lake County -
       25% of households report out-of-county
        destinations




                                                                                                     14
    Key Findings: Categorizing NEMT Needs
          Individual/ Consumer-Based
_________________________________________________________________________________________________________


   Able-bodied seniors
   Frail elderly, chronically ill, severely ill persons
   Persons with disabilities with stable health
   Veterans
   Individuals without insurance/ low income
    persons
   Families with young children
   Non-English speaking individuals

                                                                                                      15
    Key Findings: Categorizing NEMT Needs
                  Institutional
_________________________________________________________________________________________________________



   Public transit - availability, service levels, reliability
   Public transit and NEMT- information needs
   Pedestrian access
   Vehicles - replacement, expansion, coordination (brokerage)
   Out-of-county transportation NEMT
   Coordination opportunities - emergency personnel; no
    single information #; funding changes




                                                                                                      16
                                Key Findings:
 Positive Impact on Health Care Indicators
_________________________________________________________________________________________________________




   “.... A strong case is made that improved access to
   NEMT for transportation-disadvantaged persons is
   cost effective in terms of better health care. In some
   cases…”
         - decreases health care costs
         - longer life expectancy or improved quality of life

                                           Transit Cooperative Research Program
   Cost Benefit Analysis of Providing Non-Emergency Medical Transportation, 2005




                                                                                                     17
                                Key Findings:
         NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________




1.    Alternatives to traveling – NOT make the trip
2.    Addressing missed medical appointments due
      to lack of transportation
3.    Continued improvements to:
          Lake Transit
          County streets and roads/ pedestrian path of access issues




                                                                                                      18
                                Key Findings:
         NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________




1.    Alternatives to traveling – NOT make the trip
2.    Addressing missed medical appointments due
      to lack of transportation
3.    Continued improvements to:
          Lake Transit
          County streets and roads/ pedestrian path of access issues




                                                                                                      19
                                Key Findings:
        NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________




4.    Expanded public transit info & travel training
5.    Transit fare subsidies for lowest income
      individuals
6.    Accessible vehicles - capital replacement
7.    Emergency Vehicles/ Personnel Use for Inter-
      facility Transfers and “5150” Transport



                                                                                                      20
                                Key Findings:
        NEMT-Related Gaps in Lake County
_________________________________________________________________________________________________________




4.    Expanded public transit info & travel training
5.    Transit fare subsidies for lowest income
      individuals
6.    Accessible vehicles - capital replacement
7.    Emergency Vehicles/ Personnel Use for Inter-
      facility Transfers and “5150” Transport



                                                                                                      21
   Key Findings: Positive Impact on
        Health Care Indicators
_________________________________________________________________________________________________________




   “.... A strong case is made that improved access to
   NEMT for transportation-disadvantaged persons is
   cost effective in terms of better health care. In some
   cases…”
         - decreases health care costs
         - longer life expectancy or improved quality of life

                                           Transit Cooperative Research Program
   Cost Benefit Analysis of Providing Non-Emergency Medical Transportation, 2005




                                                                                                     22
          Recommendations:
     Lake County NEMT Plan Goals
________________________________________________________________________________________________________________________




 Existing Goals
  Improve mobility
  Improve medical care access with improved
   NEMT services
  Promote public safety
  Sustainable – pursue near and long-
           term funding
                                                                                                                           23
          Recommendations:
     Lake County NEMT Plan Goals
________________________________________________________________________________________________________________________



 Existing Goals
          Improve mobility
          Improve medical care access with improved NEMT services
          Promote public safety
  Sustainable – pursue near and long-term funding
 Added Goal
  Coordination commitment – before agencies
           consider other transportation options that they are
           committed to working together on Lake County NEMT
           program
                                                                                                                           24
                      Recommendations:
                      Likely Service Pilots
_________________________________________________________________________________________________________




Potential Projects --
1.   TRIP-Type Mileage Reimbursement
2.   Taxi User-Side Subsidy/ Trips of Last Resort
3.   Purchase-of-Service on Existing Human Service
     Agency Transportation
4.   Travel Training Workshops
5.   Lake Transit Authority Service Enhancements
6.   Mobility Management/ Brokerage Capabilities
7.   One Number/ One Call Information Service


                                                                                                     25
                      Recommendations:
                      Likely Service Pilots
_________________________________________________________________________________________________________




Potential Projects --
1.   TRIP-Type Mileage Reimbursement
2.   Taxi User-Side Subsidy/ Trips of Last Resort
3.   Purchase-of-Service on Existing Human Service
     Agency Transportation
4.   Travel Training Workshops
5.   Lake Transit Authority Service Enhancements
6.   Mobility Management/ Brokerage Capabilities
7.   One Number/ One Call Information Service


                                                                                                     26
           Recommendations:
       Funding Challenges for NEMT
_________________________________________________________________________________________________________




   Twelve NEMT-related funding sources
   None have any “extra” for expansion
   Using funds in a consolidated manner,
    could “buy” more NEMT trips
   Small NEMT contributions could
    leverage additional/ new funds

                                                                                                     27
           Recommendations:
       Funding Challenges for NEMT
_________________________________________________________________________________________________________




   Twelve NEMT-related funding sources
   None have any “extra” for expansion
   Using funds in a consolidated manner,
    could “buy” more NEMT trips
   Small NEMT contributions could
    leverage additional/ new funds

                                                                                                     28
            Recommendations -
       NEMT Program Design Rationale

 Program      of Projects Approach
     Address breadth of needs
     Test individual pilot initiatives
 Brokerage-type         Infrastructure
     Leverage multiple resources
     Weave into a countywide program
     Increase capacity to seek continuing funding

                                                     29
                 Recommendations -
                   NEMT Program Design

   Program of Projects
       NEMT project cost range
         •   $ 9,000 – travel training – 4 annual workshops + passes
         •   $48,600 – human service trip purchase – 8,575 trips
         •   $52,000 – taxi trips of last resort – 6,557 trips
         •   $98,880 – mileage reimbursement – 23,760 trips
         •   Lake Transit enhancements – range of projects


 Brokerage-type               Infrastructure
         • $122,900 – 1.5 FTEs first year

                                                                       30
       Developing NEMT Program
             Action Steps -
To begin….
1.   Determine interest, willingness, ability
2.   Identify, develop “suite of projects”
3.   Develop grant applications – near-term and longer-term
4.   Determine optimal organizational structure and agreements –
     for Lake County NEMT Pilot Brokerage

With start-up funding secured…..
5.   Undertake hiring of Mobility Manager/ Broker
6.   Determine cost-reimbursement/ pricing for human service trips
7.   Undertake local research re Medi-Cal reimbursement
8.   Implement pilot projects; formal evaluations 1st and 2nd yrs.

                                                              31
    Developing NEMT Program
          Next Steps -
White Paper on Brokerage Opportunity

CTSA 5310 Application on Behalf of
  Seniors Centers




                                     32
Growing NEMT options for
  Lake County residents…

Final NEMT report available at: www.lakeapc.org
Documents tab


Lake County/City Area Planning Council
Terri Persons and Lisa Davey Bates (707) 263-7799
persont@dow-associates.com


A-M-M-A Transit Planning
Heather Menninger (951) 784-1333
heather@ammatransitplanning.com
www.ammatransitplanning.com

                                                    33
                  Recommendations:
               Lake NEMT $ Possibilities
 _________________________________________________________________________________________________________


1.    Transportation Development Act, LTF – up to 5%,
2.    Existing Lake County Human Service Agency funding – County Public
      Health; County Mental Health
3.    Mental Health Services Act funding
4.    First Five Lake grants
5.    Veteran’s Administration national transportation pilots
6.    Tribal Transit grant opportunities
7.    Redwood Coast Regional Center, transportation authorizations
8.    Caltrans Mobility Action Plan Pilot NEMT funding opportunity
9.    Caltrans Statewide Competitive Rural grants, 5316, 5317
10.   Caltrans Statewide Competitive 5310
11.   Health Care initiatives sponsored by Sutter and St. Helena Hospitals
12.   Medi-Cal fee-for-service resources; potential managed-care structure




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