Magic Wand – No,
Ideas and Other Technical Assistance – Yes
Honestly, although I study NEMT examples across the country, I feel frustrated that all I can offer are strategies and case studies and that I am unable to come in with a magic, comprehensive solution that will work everywhere. This is the dark side of a federal system that funds and regulates healthcare and transportation in 50 different ways, more if we count the District of Columbia and US territories. The bright side, however, is that solutions borne of creativity, commitment, and common sense can sprout anywhere and can be adapted and adopted almost everywhere.
I spoke this month at the CTAV conference to mobility management professionals and others about non-emergency medical transportation ideas and about OIG regulation and advisory interpretations of relevant rules, which generally allow for – but do not require – healthcare contributions to transportation services.
Virginia has witnessed a lot of changes in the last 40 years. The Northern part of the state, near Washington, D.C., has become densely populated with car-free and car-lite residents who heavily rely on transit, microtransit, ridehailing (Uber and Lyft) services, biking and walking. But most of the state has either become suburban or has remained rural in character. For car-dependent areas, there are substantial difficulties for those who are unable to drive or whose driving is limited, particularly in reaching medical care and treatment.
From suburbs to rural areas, Virginia transit, community transportation providers, and volunteer programs confront similar challenges of demand outstripping supply, of long distances, and of people who need to travel a few times a week or even everyday to life-sustaining dialysis and chemotherapy. There is a strong commitment across the Commonwealth to serve those in need, but because many transportation services are county-based, the relative fiscal well being of each county has much to do with the availability of service.
The Commonwealth of Virginia has a robust association of mobility managers (VAMM) that operates as a part of the Community Transportation Association of Virginia (CTAV). My talk to the Virginia mobility management attendees at the CTAV conference focused on old-fashioned coordination and solutions, such as group rides on particular days of the week; emerging strategies, such as use of ride hailing technology and creative outreach; and healthcare practices around comprehensive care that count transportation access as essential to treatment and recovery. I also spoke about the possibilities allowed under the OIG rule and advisory opinions, which, when taken together, make for a sunny picture IF – and it’s a big “if” – hospitals, healthcare clinics, and other medical and treatment facilities choose to contribute dollars to transportation services.
The common threads are perseverance and commitment. Partners from different fields can be difficult to find and might not instantly grasp the benefits of transportation that make common sense to anyone in mobility management. Do not stop trying just because the first contact does not pan out or because that person hesitates to instantly move forward with transportation. Exercise patience and a paintball approach. You never know who will be the “in.” Gain knowledge about your potential partner’s concerns and constraints. Being a trusted community partner with a good reputation goes a long way as well. That good reputation is the foundational building block of partnership.
While we at NCMM do not have that one magic solution, or a magic wand to go with it, we help with expertise, knowledge, lots of peer contacts, resources, and thoughtful assistance. There are good examples, there is stuff to read, and there are professionals in similar organizations. All of these can assist with moving forward, even if they don’t involve wands or instant results.