1 ____ ___________________________________________________________________________________________________________________ Developing a N ON- E MERGENCY M EDICAL T RANSPORTATION P LAN FOR L AKE C OUNTY _______________________________________________________________________________________________________________________ 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 Plan Non-Emergency Medical Transportation _______________________________________________________________________________________________________________________  What we did and why  Defining the case for coordinated NEMT program  Recommended program elements  Current initiatives

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4 Lake County/City APC NEMT Plan G oals ________________________________________________________________________________________________________________________ For Lake County residents –  Improve mobility  Improve access to medical care by improved NEMT services  Promote public safety  Be sustainable

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 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

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

8 Key Findings: Household Survey Accessing Health Care _________________________________________________________________________________________________________ How do people report getting to health care?

9 Key Findings: Accessing Health Care Missing medical appointments…

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

11 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.

12 Key Findings: Household Survey Accessing 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.

13 Key Findings: Household Survey Accessing 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.

14 Key Findings: Household Survey Accessing Health Care _________________________________________________________________________________________________________ Within Lake County – Countywide majority of trips to Doctors’ offices – 63% Countywide majority of trips to Doctors’ offices – 63% Out-of-Lake County - 25% of households report out-of-county destinations 25% of households report out-of-county destinations

15 Key Findings: Categorizing NEMT Needs Individual/ Consumer-Based _________________________________________________________________________________________________________ Able-bodied seniors Able-bodied seniors Frail elderly, chronically ill, severely ill persons Frail elderly, chronically ill, severely ill persons Persons with disabilities with stable health Persons with disabilities with stable health Veterans Veterans Individuals without insurance/ low income persons Individuals without insurance/ low income persons Families with young children Families with young children Non-English speaking individuals Non-English speaking individuals

16 Key Findings: Categorizing NEMT Needs Institutional _________________________________________________________________________________________________________ Public transit - availability, service levels, reliability Public transit - availability, service levels, reliability Public transit and NEMT - information needs Public transit and NEMT - information needs Pedestrian access Pedestrian access Vehicles - replacement, expansion, coordination (brokerage) Vehicles - replacement, expansion, coordination (brokerage) Out-of-county transportation NEMT Out-of-county transportation NEMT Coordination opportunities - emergency personnel; no single information #; funding changes Coordination opportunities - emergency personnel; no single information #; funding changes

17 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

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 _________________________________________________________________________________________________________ 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

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: 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

22 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

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

24 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

25 Recommendations: Likely Service Pilots _________________________________________________________________________________________________________ Potential Projects 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: Likely Service Pilots _________________________________________________________________________________________________________ Potential Projects 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

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

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

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

30 Recommendations - NEMT Program Design  Program of Projects NEMT project cost range NEMT project cost range $ 9,000 – travel training – 4 annual workshops + passes$ 9,000 – travel training – 4 annual workshops + passes $48,600 – human service trip purchase – 8,575 trips$48,600 – human service trip purchase – 8,575 trips $52,000 – taxi trips of last resort – 6,557 trips$52,000 – taxi trips of last resort – 6,557 trips $98,880 – mileage reimbursement – 23,760 trips$98,880 – mileage reimbursement – 23,760 trips Lake Transit enhancements – range of projectsLake Transit enhancements – range of projects  Brokerage-type Infrastructure $122,900 – 1.5 FTEs first year$122,900 – 1.5 FTEs first year

31 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 1 st and 2 nd yrs.

32 Developing NEMT Program Next Steps - White Paper on Brokerage Opportunity CTSA 5310 Application on Behalf of Seniors Centers

33 Final NEMT report available at: Documents tab Lake County/City Area Planning Council Terri Persons and Lisa Davey Bates (707) A-M-M-A Transit Planning Heather Menninger (951) \ Growing NEMT options for Lake County residents…

34 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, Caltrans Statewide Competitive Health Care initiatives sponsored by Sutter and St. Helena Hospitals 12. Medi-Cal fee-for-service resources; potential managed-care structure