Case Study: CalvertHealth Medical Center's Efforts to Address Transportation Barriers and Improve Access
CalvertHealth Medical Center
This case study is from “Transportation and the Role of Hospitals,” which offers strategies and case examples to help hospitals and health systems address transportation issues in their communities. For more information and to access the full guide, click here.
Introduction
Located in southern Maryland, CalvertHealth Medical Center is the only hospital in Calvert County. More than 77 percent of Calvert County’s 90,000 residents visit the hospital for health care services. In addition to the main campus in Prince Frederick, the health system has four satellite medical centers, located in Dunkirk, Lusby, Solomons and Twin Beaches.
Calvert County is a rural county with only one highway, so people who live away from the highways or town centers have difficulty accessing essential services. CalvertHealth’s 2014 community health needs assessment (CHNA), developed in partnership with Conduent Healthy Communities Institute (HCI) Corporation, identified access to health care services as one of the community’s top three priority health needs. Lack of transportation was identified as one of the most significant socio-economic barriers to health in the county. About 4 percent of households in Calvert County do not own a car, making it difficult, particularly for low-income households, to travel to hospitals, doctor’s offices and grocery stores.
Interventions
To address transportation barriers and improve health care access and delivery in Calvert County, CalvertHealth Medical Center has introduced several initiatives.
Mobile Health Center. CalvertHealth’s CHNA and Conduent HCI’s integrated data platform, with real-time community health data, facilitated the development of many programs that address barriers to health care. Using HCI’ SocioNeeds Index and access to care maps, CalvertHealth identified regions and populations in Calvert County experiencing difficulty accessing care. Since 2016, the Mobile Health Center, managed by the hospital’s community wellness department, delivers care to residents who cannot visit hospitals or doctor offices regularly for primary and preventive care services. With support from the CalvertHealth Foundation, donations from local businesses and organizations, and proceeds from two fundraising events, more than $300,000 was raised to buy the Mobile Health Center. Essentially a 40 foot “state-of-the-art” truck, the Mobile Health Center has two fully equipped exam rooms—one for medical/dental services and one transitional room—a waiting area, classroom space and a wheelchair lift. The hospital has created a video tour of the Mobile Health Center.
Limited access to health care services due to transportation barriers and lack of health insurance is overwhelming in North Beach/ Chesapeake Beach, Prince Frederick and Lusby. The Mobile Health Center schedules regular visits to community centers and local churches in these three areas. In addition to providing primary care services and dental care, the Mobile Health Center offers screening for diabetes, cholesterol and high blood pressure. On selected dates and locations, the mobile unit also screens for lung cancer, skin cancer, breast health, bone density and hearing and vision.
The Mobile Health Center serves as an engagement and care center where a certified registered nurse practitioner is there to discuss medical concerns, identify health risks and help patients navigate to the appropriate level of care within the health system and find local health resources within their geographic area. With this initiative, CalvertHealth is working to provide education, support and outreach to community members and promote wellness.
CalvertHealth CARES. Since 2013, CalvertHealth has been a member of Partners in Accountable Care Collaboration and Transitions (PACCT), a community coalition of health care providers and about 30 local agencies. The coalition is committed to sharing and developing best practices and solutions to improve patient outcomes and experience. CalvertHealth CARES (Collaborative Activation of Resources and Empowerment Services), an initiative of PACCT launched in 2015, is a free, comprehensive community benefit program to meet the needs of patients after discharge and reduce readmission rates and emergency department usage. Patients are offered health services based on medical need. CalvertHealth CARES includes several initiatives, including the Medication and Transportation Assistance Program (MAP/ TAP) and the CalvertHealth CARES Clinic.
The Transportation Assistance Program (TAP) was developed after PACCT and other community organizations reported the transportation challenges of community members. Hospital patients and employees verbally reported significant transportation barriers in the community, such as inaccessible locations of bus stops, limited taxi services, and lack of sidewalks and walk bridges. In addition, the number of no-shows to physician appointments was an issue. To address the transportation challenges encountered by patients and employees, TAP was integrated into the CalvertHealth CARES program. The hospital budgets $2,000 annually for this program.
CalvertHealth CARES has conducted patient interviews to determine the underlying reasons for missed appointments and then identify the services needed the most. If patients specifically report they miss their medical appointment due to inaccessible transportation, they are referred to TAP. TAP uses a quantitative screening tool to assess the needs of patients with transportation barriers. A social worker conducts the screening and scores the assessment to identify patients who are greatly affected by transportation due to poor health, lack of finances, unemployment, homelessness or other reasons. TAP partners with a local taxi service to provide patients with a taxi voucher. The taxi service transports patients from Calvert County and some patients outside the county to and from their medical appointments. Patients are required to make their own cab arrangements and asked to tip their driver. The taxi company sends an invoice to the hospital for payment. 16 Transportation and the Role of Hospitals Additionally, as part of the CalvertHealth CARES Clinic, a pharmacist visits patients who are experiencing difficulties picking up prescriptions, attending doctor’s appointments or understanding their medication and care plan. The pharmacist delivers medications to patients and educates them about their medication to build health literacy.
Collaboration with STAAR Alert. As part of a grant funded by the Health Services Cost Review Commission, Totally Linking Care— a coalition that includes CalvertHealth, seven other hospitals and several community organizations—is partnering with STAAR Alert, a medical alert system that offers personalized in-home care services to patients. This partnership is a new approach to delivering health care to patients with limited access due to poor medical conditions, aging or lack of transportation. This service provides medical management devices, electronic pill boxes, electronic scale, blood pressure cuffs and glucometers in patient’s homes. Patient reports can be downloaded by the hospital and transmitted to the patient’s primary care doctor or to the collaborative.
Impact
In the first six weeks of its launch, the Mobile Health Center provided services to 330 residents at local schools, health fairs, churches and community events. The mobile unit also provides dental screening at a community center that serves local elementary schools, and individuals who need additional treatment are connected to CalvertHealth’s dental clinic. The CalvertHealth CARES’s TAP program covered taxi transportation for 16 patients between January and June 2015, with an average expenditure of $62. Between March 2015 and January 2017, CalvertHealth CARES received 1,721 referrals for its CalvertHealth CARES clinic and MAP/TAP program. Overall, the hospital has seen a nearly 9 percent reduction in readmission rates since the start of CalvertHealth CARES. With the launch of the CalvertHealth partnership with STAAR Alert in November 2017, the hospital hopes to decrease the number of patients who cannot visit physician offices because of transportation issues.
Lessons Learned
Bridging gaps in health care is a need. » Investing in patients is the key to understanding how to care for them.
Next Steps
The Mobile Health Center is organizing visits to the local Head Start and Judy Center programs as well as expanding services to senior centers and partnering with faith-based organizations to address identified health disparities. The center is also exploring partnering with schools and local youth organizations to offer health assessments and physicals for sports participation. The CalvertHealth community wellness department is developing a program to address the health needs of the Spanish-speaking population in the county. The CalvertHealth CARES program will continue to focus on enhancing current services, including seamless implementation of the STARR Alert system.
Contact
Karen L. Twigg Director, Care Coordination and Integration CalvertHealth Medical Center (410) 535-8217 karen.twigg@calverthealthmed.org
Margaret Fowler Director of Community Wellness CalvertHealth Medical Center (410) 414-4573 margaret.fowler@calverthealthmed.org