If you pay any attention to the news around health care, you have probably heard it said that your zip code matters more for your health than your genetic code. It's a platitude that has become the rallying cry for the conversation about social determinants of health; and when social and economic factors, health behaviors, and physical environment accounts for 80 percent of one's life expectancy, this is rightfully so.
The results of a recent survey from Kaiser Permanente examining social needs in America indicate that 1 in 3 Americans are frequently or occasionally stressed providing for their families' housing, food, transportation, or social support needs. Those experiencing unmet social needs were twice as likely to rate their health as fair or poor compared to those who did not, and 28 percent of respondents reported that a social need was a barrier to health care in the last year. Ideally, no one should be denied from fulfilling their full health potential, so when we speak of addressing social determinants of health, what we mean is taking steps toward health equity.
When you consider that 1 in 3 Americans means roughly 110 million people are running into hurdles meeting their everyday needs—barriers which vary from household to household—then achieving equity in health means our work is cut out for us. Ultimately, it will take a collaborative effort on behalf of many partners beyond the health care ecosystem to begin comprehensively solving for health disparities (i.e. government, private businesses, technology companies). But, if a zip code is a better barometer of someone's quality of health than their genetic code, then a first step in meeting this challenge is by creating a tangible solution that reaches across zip codes.
According to an issue brief released by Lung Cancer Alliance, and the Center for Health Law and Policy Innovation at Harvard Law School, approximately 3.6 million Americans, in urban and rural settings, miss or delay essential, non-emergency medical care due to transportation barriers every year. It is no surprise that the ability to access the doctor’s office plays a pivotal role in health outcomes, but missed appointments are also an expensive problem. With the rates for patient no-shows as high as 30 percent in some cases, missed appointments cost health care systems a prodigious $150 billion every year.
No matter how you look at it, missing medical appointments is something we can’t afford. Leveraging transportation, particularly through non-emergency medical transportation (NEMT), presents an opportunity to expand access to care for every patient, in a cost-effective way, that isn’t bound by zip code.
Facilities like MD Anderson Cooper Cancer Center in Camden, N.J.—where 37.4 percent of the city is living in poverty and nearly 14 percent of the population is living with a disability (according to U.S. Census reporting) – knows they are fighting a multi-faceted battle. Prior to launching with Roundtrip in 2017, patients at MD Anderson Cooper Cancer Center cited transportation to and from appointments as the third most common barrier to care. Since launching, patients that need a ride now have a no-show rate performing five times better than the national average—which hovers between 18-25 percent—to just 4 percent.
In Central Pennsylvania, Geisinger Health System offers many services that are not available anywhere else locally, including the region’s only Level I Trauma Center, Geisinger relies extensively on their local network of transportation companies to meet transportation needs. The systemwide burden of delayed transportation affects bed turnover and results in patients staying extra nights and the disruption of planned transfers to post-acute care facilities. We are able to provide Geisinger with detailed and dynamic data reporting, breaking down every ride with over 40 separate data points, including arrival time, proof of medical necessity, and cost.
Like Roundtrip, more companies are emerging in NEMT as dedicated facilitators between transportation entities, social workers, and patients. In the information age, the work these companies are doing is constantly contributing to a stockpile of data that we are only beginning to unravel. By collectively reducing the barriers to care, the industry has the potential to create a systematic ripple effect that impacts other social determinants of health, improving health outcomes for millions of people across the country.