Module #3: Top 3 Social Determinants of Health (SDoH) Access to Care/Transportation For more information on TCPI SANs please use this link: http://www.tcpisan.org/

HCDI Overview HCDI-SAN Learning Library: Top 5 (SDoH) Overview HealthCare Dynamics, International – founded and led by clinicians 25+ years supporting CMS quality and population health programs NICHE: Policy to Practice Strategy focused on health care delivery systems and the quality/cost for vulnerable populations Customized learning and action platforms focused on clinicians, patients and health care systems HCDI-SAN Learning Library: Top 5 (SDoH) Overview Access To Care/ Transportation The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities These social factors may also affect the patient’s ability to self-manage and adhere to their shared decisions. Looking at SDoH data can help practitioners better recognize the root causes that affect population health.

Learning Objectives: Social Determinants of Health- Transportation/ Access to Care Upon completing review of this slide-deck presentation, the participant will able to understand the: Relationship between ‘transportation/access and health’ Significance and impact of the lack of transportation and access to care Prevalence of inadequate transportation/access to care nationally

Overview: Social Determinants of Health SDoH also refers to the bigger set of forces that shape the conditions of daily life of an individual. These forces can be social norms, culture, social practices, economic policies, developmental agendas along with political systems of any state/nation SDoH are considered as the root cause of our health and disease. Often times it is also known as the ‘cause of the cause’.

How is Transportation Related to Health? Because transportation touches many aspects of a person’s life, adequate and reliable transportation services are fundamental to healthy communities. Transportation issues can affect a person’s access to health care services. These issues may result in missed or delayed health care appointments, increased health expenditures and overall poorer health outcomes.

Social Determinants Of Health: Access to Care/Transportation Each year, 3.6 million people in the United States are unable to receive medical care due to transportation issues including: lack of vehicle access, inadequate infrastructure, long distances and lengthy times to reach needed services, transportation costs and adverse policies that affect travel.

Access To Care: Transportation Access to care often means providing patients with affordable care. However, for many, ‘access’ also literally means transportation to their providers' facilities. For those with chronic conditions who make frequent visits to their providers, unreliable transportation often results in lack of care. Hospitals and community-based organizations work within their communities to ensure transportation is available to all in need in order to facilitate regular visits with their primary care providers.

Access To Care: Transportation Many Medicaid beneficiaries cite transport as a major barrier to accessing care due to cost, lack of transport options, and/or geographic isolation.  Non-Emergency Medical Transportation, broadly defined by CMS as patient transportation to Medicaid-eligible medical services, has long been a required benefit of the Medicaid program. Nationally, Medicaid-subsidized patient transportation has grown into a $3 billion+ industry, connecting patients to more than 100 million visits per year. 

What is the role of hospitals in addressing transportation issues? A multi-faceted approach to reducing transportation gaps is needed. Hospitals and health systems play a vital role in developing strategies geared toward addressing these issues, including screening and evaluating patients’ transportation needs and providing transportation services through community partnerships or programs.

Community Resources: Social Determinants of Health Whether it’s access to food, transportation, financial services or education, addressing social determinants is a critical component of both quality of care and quality of life. Aunt Bertha is deploying this comprehensive approach, powered by technology, to help lead the way for patients in need and the people who serve them. https://www.auntbertha.com/

Community Resources: Access to Care/ Transportation to Care The Lyft deal with Allscripts permits 180,000 doctors to call rides for their patients.

Learning In Action: “Food For Thought” How might having data on patient access to care/transportation affect how your office provides care? Do you think that patient access to care/transportation issues are common among your patients? What resources might be available in your community to help address patient access to care/transportation disparities? How might your practice be more efficient and effective in connecting patients with patient access to care/transportation related issues to community resources?

Questions? Uchenna Okoli SDoH@hcdi.com 301-552-8803 www.hcdi.com For more information on TCPI SANs please use this link: http://www.tcpisan.org/ 15

Learning & Action Network Acronym Guide: AAPM: Advanced Alternative Payment Models APM: Alternative Payment Models CEHRT: Certified Electronic Health Record Technology CFYH Tool: ‘Caring for Your Health’ Social Determinants Indicator Tool CMS: Centers for Medicare & Medicaid Services HCDI: HealthCare Dynamics International LAN: Learning and Action Network MACRA: Medicare Access and CHIP Reauthorization Act MIPS: Merit Based Incentive Payment System PTN: Practice Transformation Network QPP: Quality Payment Program REaL Data: Race Ethnicity and Language Data SAN: Support and Alignment Network SDoH: Social Determinants of Health TCPI: Transforming Clinical Practices Initiative