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CalACT Spring Conference Presentation – April 2011

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CalACT Spring Conference Presentation – April 2011

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  1. _______________________________________________________________________________________________________________________Developing aNON-EMERGENCYMEDICAL TRANSPORTATION PLANFOR LAKE COUNTY_______________________________________________________________________________________________________________________ CalACT Spring Conference Presentation – April 2011 Terri Persons, Lake County/City Area Planning Council Heather Menninger, A-M-M-A Transit Planning

  2. Lake County NEMT PlanNon-Emergency Medical Transportation_______________________________________________________________________________________________________________________ • What we did and why • Defining the case for coordinated NEMT program • Recommended program elements • Current initiatives

  3. Lake County/City APCNEMT 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 • Health care conditions: primary care development, service gaps, care coordination • Public transportation: services and funding • Published studies on NEMT cost/benefit • Document NEMT need • Countywide household survey- 33,000 residences • Agency survey-200 organizations • 3 Public workshops, intercept surveys • Key stakeholder interviews • Analysis and Plan Development

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

  6. Key Findings:Countywide Household Survey • 3% well-distributed response – 1,052 households; 1,890 persons 48% of respondents age 65 and older

  7. Key Findings: Household SurveyAccessing Health Care_________________________________________________________________________________________________________ How do people report getting to health care?

  8. Key Findings:Accessing Health Care Missing medical appointments…

  9. Key Findings:Accessing Health Care Missing medical appointments… - More likely originating on North Shore - Trips intermittent and one-time for some - Trips continuing for others

  10. Key Findings:Accessing Health Care Missing medical appointments… - More likely originating on North Shore - Trips intermittent and one-time for some - Trips continuing for others Scale of need modest – 12% of responding individuals, among representative respondents.

  11. Key Findings: Household SurveyAccessing Health Care_________________________________________________________________________________________________________ Who is missing appointments due to lack of transportation? • Youth most likely to miss medical appointments due to transport. • Seniors least likely to miss appointments due to transport. • Responding non-senior adults and those with no insurance more likely to miss.

  12. Key Findings: Household SurveyAccessing Health Care_________________________________________________________________________________________________________ Appointments scheduled by age group and those without insurance – past six months • Youth - fewer appointments, smaller range. • Seniors younger and oldest - greatest range of # of appointments, • No insurance adults - fewer appointments, smaller range.

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

  18. Key Findings:NEMT-Related Gaps in Lake County_________________________________________________________________________________________________________ • Alternatives to traveling – NOT make the trip • Addressing missed medical appointments due to lack of transportation • Continued improvements to: • Lake Transit • County streets and roads/ pedestrian path of access issues

  19. Key Findings:NEMT-Related Gaps in Lake County_________________________________________________________________________________________________________ • Expanded public transit info & travel training • Transit fare subsidies for lowest income individuals • Accessible vehicles - capital replacement • Emergency Vehicles/ Personnel Use for Inter-facility Transfers and “5150” Transport

  20. Key Findings:NEMT-Related Gaps in Lake County_________________________________________________________________________________________________________ • Expanded public transit info & travel training • Transit fare subsidies for lowest income individuals • Accessible vehicles - capital replacement • 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 -- • TRIP-Type Mileage Reimbursement • Taxi User-Side Subsidy/ Trips of Last Resort • Purchase-of-Service on Existing Human Service Agency Transportation • Travel Training Workshops • Lake Transit Authority Service Enhancements • Mobility Management/ Brokerage Capabilities • One Number/ One Call Information Service

  25. Recommendations: Likely Service Pilots _________________________________________________________________________________________________________ Potential Projects -- • TRIP-Type Mileage Reimbursement • Taxi User-Side Subsidy/ Trips of Last Resort • Purchase-of-Service on Existing Human Service Agency Transportation • Travel Training Workshops • Lake Transit Authority Service Enhancements • Mobility Management/ Brokerage Capabilities • 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…. • Determine interest, willingness, ability • Identify, develop “suite of projects” • Develop grant applications – near-term and longer-term • Determine optimal organizational structure and agreements – for Lake County NEMT Pilot Brokerage With start-up funding secured….. • Undertake hiring of Mobility Manager/ Broker • Determine cost-reimbursement/ pricing for human service trips • Undertake local research re Medi-Cal reimbursement • 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_________________________________________________________________________________________________________ • Transportation Development Act, LTF – up to 5%, • Existing Lake County Human Service Agency funding – County Public Health; County Mental Health • Mental Health Services Act funding • First Five Lake grants • Veteran’s Administration national transportation pilots • Tribal Transit grant opportunities • Redwood Coast Regional Center, transportation authorizations • Caltrans Mobility Action Plan Pilot NEMT funding opportunity • Caltrans Statewide Competitive Rural grants, 5316, 5317 • Caltrans Statewide Competitive 5310 • Health Care initiatives sponsored by Sutter and St. Helena Hospitals • Medi-Cal fee-for-service resources; potential managed-care structure

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