When you’re sick, you go to the doctor.

If you can.

Transportation challenges prevent many Michigan residents from accessing critical healthcare treatments, from routine checkups to specialized treatments like dialysis. At the Health Fund, we know that providers and communities are constantly working to improve healthcare and treat the whole patient—but patients must be able to get to appointments for those changes to happen.

On the face of it, the problem is simple: we need to get people from home to the doctor, Point A to Point B. But the closer you look, the more complex it becomes. There’s a whole web of public and private transportation options available to Michigan residents, with the best option changing from person to person. Then ask the next question—“Who’s paying for it?”—and that web can quickly start to look like a knotted, unintelligible mess.

We had two primary goals for From Here to There, our new transportation report:

1. Untangle the knot.
Not finding any cohesive, plain-language explanation of all the elements of health transportation in Michigan, we decided to make one ourselves. It doesn’t cover every bit of the fine print, but we hope it will help you grasp what’s out there and how it’s funded.

2. Evaluate ourselves.
This one’s for us. We took a look at our grantmaking in transportation over the last five years, assessing what we did well and what we could do more of, and using those takeaways to outline a path forward for our funding. In the interest of transparency and collaborative learning, we’re sharing those conclusions with you.

We highly recommend you read the full report, which provides context and examples to help clarify a complex issue—and still comes in at under 25 pages. Here are the quick hits:

How Michiganders get to the doctor

Michigan is home to 82 different public transit agencies, including 21 in urbanized areas. This includes fixed-route (buses and trains) and flex-route, or demand-response, services. Indispensable but far from perfect, transit is typically Medicaid’s first choice option when available.

Non-emergency medical transportation (NEMT) is not a mode of transportation, but rather a benefit for the state’s most vulnerable residents—those using Medicaid. Michigan’s NEMT model is a hybrid of a brokerage system and a fee-for-service system. Which system a resident should use depends on which county they are in, but both suffer from having too many cooks in the kitchen and, consequently, diffused responsibility. Still, NEMT is a crucial gateway to a ride for those with Medicaid.

Area Agencies on Aging, the Veterans Transportation Service, the MI Choice Waiver program, the Program of All-Inclusive Care for the Elderly (PACE) program, and others provide transportation for their specific populations of focus. Local nonprofits fill the gaps, often through volunteer drivers. One major barrier for these services is whether their potential riders are even aware of their services.

Transportation Network Companies (TNCs) like Lyft and Uber are reshaping health-related transportation, putting pressure on competition to match their low wait times and reasonable prices. Some responses have emerged, including Veyo, a technology-focused transportation service that now has an NEMT contract in Michigan. However, the tradeoff for convenience for many of these services is a lack of safety and accessibility measures—there is still much room for growth.

What we’ve funded

In the last five years, we’ve awarded 21 health-related transportation grants, supporting projects in every part of the state, connecting systems, educating residents on available options, and providing rides for those in need. Our internal evaluation team found four clear categories of funding:

Our largest category of grants aimed to streamline the process of getting a ride for patients. Bus.me, for example, developed a phone app that helps health providers schedule appointments with public transportation schedules, decreasing patient no-shows. In another project, Driven to Good Health provided a ride scheduling software to connect volunteer drivers with riders in Macomb, Oakland, and St. Clair counties. These grants have been especially effective for vulnerable population in Michigan.

Our report covers some of the complications of funding health-related transportation. Several of our grant awards have gone towards policy issues related to payment and reimbursement. For example, the Midland Area Community Foundation partnered with the Michigan Transportation Connection to smooth the flow of funds for NEMT clients in three counties, establishing a single fixed rate structure. The project exceeded its goals and received extended funding, including a $1 million grant from the Federal Transit Administration.

As we’ve already mentioned, there’s a dizzying number of health-related transportation options in Michigan, and for that reason we have put some of our funding behind simply educating people about what’s out there. One study showed that only about half of Medicaid enrollees know about NEMT. Initiatives like the Grand Traverse Regional Community Foundation’s 2019 Improving NEMT Ridership project aim to build NEMT awareness and ridership, helping to make sure existing structures are reaching their full potential.

Lastly, of course, we have funded what you probably think of when you hear “transportation funding”: providing rides. Eight projects directly provided over 28,000 rides to Michiganders in need. Grantees in this category are doing the important work of making sure people get to and from medical appointments, helping reduce readmission rates, manage chronic illness, fill prescriptions, and save lives.

Take a look at the full report for in-depth examples of some of the projects we’ve funded, including some of their most significant successes and challenges. We also describe three new models that we are watching—models we think may provide insight on the future of health transportation in Michigan.

In Conclusion

Health-related transportation isn’t going to improve overnight. There are a lot of moving parts, and lasting change will require lasting investment from policymakers, health entities, and communities alike. Too often, transportation work is siloed, simultaneous but disconnected. That’s where we see our role: not only supporting big projects, but also bringing people together. With that in mind, we came up with three guideposts to help us direct future investments:

We want to use what’s already in place in new, impactful ways. That could be bringing together organizations that are doing similar work to create one comprehensive program or implementing scheduling software that multiple providers can use. This guidepost doesn’t exclude innovative solutions, but it doesn’t rely on them, either.

We have a unique ability to connect organizations whose work can benefit or inform one another, and we can help bring together the people who influence policy, funding, and state-level decisions. We can’t fund every local collaborative looking to strengthen transportation systems, but we can use our resources and expertise to build the connective tissue between transportation and health entities at the state and regional levels.

Lastly, we want to be sure that projects we fund are patient-centered. And to do that, we have to get feedback from those that are actually getting rides to appointments. If it’s not working for them, it’s not working. Expanding user testing plans and evaluation tools will help ensure that the projects are accomplishing what they intend.

Health-related transportation is about more than getting from Point A to Point B. It’s the way people access the care they need to live healthy lives, which is, in our opinion, a fundamental right. The world of health-related transportation can be messy and confusing, but many of the pieces are already there. Through both streamlining existing tools and creating new ones, bridging together key systems and key voices, we can overcome these challenges and fill the potholes on the road to better transportation—together.

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