Ready-to-Launch Health Care Access Grants
Final Report
Date submitted: July 8, 2020
Total amount of grant funds spent: $65,540
Performance period for the grant: September 2019 – May 2020
Name, organization, phone, title, and email of person submitting report:
Dave Somers
Outreach and Development Director
Envida719-425-2202
dsomers@envidacares.org_________________________________________

1. Description of Transportation Solution Implementeda) Please provide a brief (2-3 line) description of the solution you implemented.
Envida implemented a limited launch of a demand-responsive transportation solutionthat reduced barriers to care and rider anxiety, identified affordable and effective
transportation options, and lowered healthcare costs. Envida’s solution reduced
barriers to schedule and travel to appointments and reduced lost opportunity costs forproviders due to no shows and cancellations.
b) Please explain the components of the solution you implemented, including thefollowing:••••

Vehicles, operators, software, type of service (on-demand, advanced noticedemand-response, fixed route), hours, service area, etc.
The avenues through which you connected with customers (e.g., open
marketing, through organizations)
Fare structure
Any other operational details about the solution

Envida created a limited launch of a planned service and geographic expansion to
include Mobility on Demand (MOD) access in Park County and Teller County,
Colorado. The limited launch used our Demand Response (DR) service in El Paso
County to provide transportation services for Behavioral Health patients to and frommental health and substance use disorder appointments. In the grant period, one
vehicle and driver were added though a grant from the Colorado Community HealthAlliance (CCHA). By establishing partnerships with service providers AspenPointe and
BethHaven, Envida provided facility portal training to case managers and carecoordinators to allow them to schedule transportation services at the time a behavioral
health appointment was scheduled. This closed the gap between the provider
scheduling an appointment and the client separately seeking transit options.
Because these are NEMT rides for Medicaid participants, no fares were charged directly
to the clients. By integrating behavioral health clients directly into our existing demand
response scheduling software, the limited launch could be based on the expansion ofcurrent ride-scheduling and customer management software and operations. Allowing
direct online access for partner providers to request services limited the internal
workload of the expanded service offering.

2. Customer Desirabilitya) Who were the intended key customer groups that you had focused on as you
implemented your solution (please include end users, organizational partners, shortterm and projected long-term funders)? Who were the actual key customer groups
who took advantage of your solution? Did this represent a change from what you
expected?
The key customers for the limited launch were behavioral health providers located in El
Paso County, and their patients on Medicaid with limited transportation options. Prior
to the grant award, four providers were contacted and expressed interest:•

AspenPointe•

BethHaven•

Cedar Springs Hospital•

Peak View Behavioral HealthOf these, only AspenPointe and BethHaven engaged during the limited launch. The
experience with both AspenPointe and BethHaven indicated that utilization was low
until an internal advocate was identified who understood the opportunity to easily
access reliable transportation services and until Envida leveraged their feedback insupport at training sessions and through internal communications channels.
While the lack of participation in the limited launch from potential partners wasdisappointing, the number of new clients and rides requested prior to the limitations
imposed by the COVID-19 pandemic exceeded expectations.

b) Please summarize how customers (individual, organizational, etc.) view the benefitsof the program and services? Please provide any quotes from individuals ororganizations related to the solution that was implemented.
First quarter client surveys completed in March show 77% report keeping all follow-up
appointments and 15% kept all but one or two appointments. Similarly, 54% of clientssurveyed reported they felt a great deal better because they could access care, and
15% reported feeling a lot better. Clients feel safe and respected when riding with
Envida, as 85% reported always feeling safe and respected and 15% of riders usually
felt safe and respected when riding with Envida.
Similarly, in the second quarter survey, 50% of clients reported improved behavioral
health outcomes since Envida transportation services became available.
Providers were enthusiastic about being able to offer Envida services at the time abehavioral health appointment was made. All providers trained in using the facility
portal continued to use it throughout the limited launch. Due to appointment andfacility restrictions after March 16, no additional providers were added or surveyed forthe second quarter (April-June) period.
A client, Elizabeth Asher, stated, “Before I rode the city bus and I had too muchanxiety. Envida is smaller, friendlier, and very helpful. I no longer have anxiety attacks
getting to my appointments.”
Elizabeth Holden, Director of Clinical Quality Management at Colorado Community
Health Alliance, shared that in the CCHA organization that Envida has a reputation forbeing consistent and provides a great service.
Katie Blickenderfer, Director of Case Management at AspenPointe responded that
Envida has a reputation within their organization for having great services and is
known for excellent COVID transport.
c) What type of feedback did you receive from these customers? How was that feedback
received? (If you have it, please include the number of customers from whom you
have received feedback and the percentage of your total customers those giving
feedback represented plus survey or other data.)
Separate quarterly surveys for clients and providers were developed and completed.
Thirteen riders were surveyed in the first quarter and thirteen new riders have beensurveyed so far in the second quarter.
d) Please add further explanatory comments here.
The limited launch of survey collection also allowed Envida to revise questions andbetter align answer scales between the first and second quarter surveys. Based on
initial research, Envida had also planned to access behavioral health appointment andoutcome data from the Colorado All Payor Claims Database (CO APCD), but access tothis data was not possible due to HIPPA compliance concerns. Nevertheless, analysis
of internal data on rides requested and provided allowed Envida to demonstrate apositive impact on behavioral health.

3. Operational feasibilitya) Please indicate how many individual customers enrolled to use the solution. Was
there a different between the number enrolled and those who actually used thesolution? Please provide any reasons you have for this difference.
113 clients were enrolled for behavioral health rides in the limited launch. All enrolledclients completed at least one ride. 80 clients completed more than one ride in that
timeframe.
b) Please indicate how many organizational customers agreed to engage in
implementation of the solution (e.g, by enrolling customers, funding rides). Was therea different between the number who expressed interest and those who actuallyengaged with the solution? Please provide any reasons you have for this difference.
Prior to the limited launch, Envida contacted four organizations representing
behavioral health and residential service providers. Due to internal personnel changes
and related reorganization, Peak View was unable to participate as expected. Twotraining sessions were provided to Cedar Springs personnel, but no rides werescheduled despite repeated invitations to access the facility portal.
c) Please provide these data (by month if you have it or at least for the first and lastmonths) between the beginning of the implementation phase through the end of
February 2020 (before the COVID-19 pandemic):
•
•
•
•
•
•

# riders# rides scheduled# rides completed# rides completed that were shared rides (>1:1 ratio of driver:rider)—This is not
something Envida was measuring, and everything changed under COVID.
# no-shows and as percentage of total rides scheduled# Miles traveled (or average miles per ride)

Nonemergency medicaltransport- behavioral health
Total number of rides scheduled
Total number of completed rides
Percentage of completed rides

No Show
Percentage No Show
Cancellations
Percentage Cancellations
Number of riders

Nov. 19
87
51
63%
14
16%
22
25%
18

Dec. 19
73
55
75%
3
4%
15
21%
14

Jan. 20
140
111
79%
10
7%
19
14%
31

Feb. 20
402
290
72%
38
9%
74
18%
52

Mar. 20
330
231
70%
35
11%
64 (149)
19%
64

Apr. 20
116
74
64%
17
15%
25 (142)
22%
33

Table 1: Behavioral Health Rides November 2019 - June 2020

In order to show the COVID impact on Envida NEMT transportation services two setsof cancelation data are included. The first number for March (64), April (25) and May(28) indicates rides canceled within a twenty-four-hour period of the scheduled ride.

May-20
152
108
71%
16
11%
28 (186)
18%
27

The second number, in red, March (149), April (142) and May (186) reflect canceled
appointments due to COVID-19.
The average distance traveled per ride for behavioral health clients in the limited
launch period was 4.95 miles.
d) Please provide the following data with regard to interactions with organizational
partners:• # of partner staff engaged. Please indicate how there were engaged (e.g., trained,
helped to assess potential customers, help to enroll customers)
System access and facility portal training was provided to 79 individuals. After
training, 14 staff members from provider partners assessed clients’ needs and scheduled
rides. We attribute this disparity to internal procedure alignment within the partner
agencies to focus scheduling within an existing call center function.
e) Please describe any other operational activities not described above and provide any
metrics you have for those.
N/Af) Please describe any changes you made during the months the solution was
implemented in any areas related to operational feasibility.
Three staff members attended a certified Mental Health First Aid (MHFA) training inorder to address possible concerns with supporting clients being transported for
behavioral health appointments. The training was reviewed with the drivers, but ingeneral was seen as overly comprehensive for our needs. We have developed amodule for our in-house driver training to cover needs of and responses to thispopulation.
g) Please add additional relevant outcomes related to your project assumptions being
tested (e.g., patient/user access; healthcare provider buy-in and adoption; patients’adherence to health plans, etc.).
Converting rides from the local ambulance service to more cost-effective specialized
transit was in the original scope of the grant proposal. Of the five clients who reported
having used ambulance services, 80% reported they no longer use emergency services
and 20% reported rarely using it.
h) Please add further explanatory comments here.
Envida is pursuing an MOU with a health services district (former ambulance district)in Teller County to handle less urgent return trips following rides given for criticalneeds to hospitals and other care facilities.

4. Financial feasibilitya) Please provide the total amount of the grant spent on providing service (including
direct and indirect costs)
Of the total grant amount ($65,540), $51,113 or 78%, was spent on providing service.
b) What data were you able to gather in-house or from organizational partners that
helped you identify the cost-effectiveness of your solution. Below are some potential
formulas that could apply:
We spent X on rides, this led to a % decrease in missed appointments, which
saved the organization $X in nonbillable hours
We spent X on rides, this led to a % decrease in late arrivals to appointments,
which saved the organization valuable staff time trying to juggle appointment
schedules
We spent X on rides, this led to a X% increase in customers reporting that they
are now following through on recommended treatments (e.g., getting topharmacies, therapy)
We spent $33,004 on rides; this led to 77% of customers reporting attending all followup appointments, and 15% attending at least 70% of follow-up appointments
Our initial plan was to access pre- and post-implementation data on client adherence
to treatment plans from the Colorado authorized database or the Regional Accountable
Entity database. This data is not available due to HIPPA restrictions from either theauthorized agencies or the provider partners.
Based on the cost of a behavioral health appointment, we have calculated the potential
savings to the provider for use in future negotiations. With AspenPointe’s cost perappointment of $156, we have calculated based on the first quarter of data a potential
monthly saving to them of $4,316.
c) Please describe any changes you made in implementation processes to improvefinancial feasibility.
We know that Envida’s services act as a connector between individuals, residential
programs and behavioral health providers. As we work to extend services to the fulloperational launch serving behavioral health clients and providers in Teller and Park
counties, we are contacting entities such as the Fourth Judicial District and local school
systems to identify concentrations of needs to make overall services more efficient.
In addition, we can now provide a mobile application for clients to schedule rides tobehavioral health appointments using their smart phone or a web browser. Providers
see this as an important step for clients’ ability to manage and take responsibility for
their own care.
d) Please describe your plans to pursue long-term sustainable funding. Which of thefollowing types of funding sources will you pursue (check all that apply)?

o Received funding from our implementation partner organizations/agencies tocontinue services (please include the amount of funding)þ Received funding from other community organizations/agencies to continue
services (please include the amount of funding)
Envida has been awarded a grant from the Colorado Community HealthAlliance (CCHA) of $150,000 for operations, training, staff and equipment tosupport expanded services to behavioral health clients in two largely
underserved counties adjacent to our current service area.
Envida has been awarded a grant from the Colorado Springs HealthFoundation (CSHF) of $309,800, a portion of which will support the softwareand technology requirements of the expanded service area.
þ Received local, state, or federal funding to continue the program (please
include the amount of funding)
Envida has been awarded an Innovative Coordinated Access and Mobility(ICAM) grant from the FTA of $249,526 to expand services to behavioral
health clients in two largely underserved counties adjacent to our current
service area.
Envida has been awarded a MultiModal Options Fund (MMOF) grant from theColorado Department of Transportation and administered through the Pikes
Peak Area Council of Governments of $150,000 to purchase an additional
vehicle and other services in support of the expanded operational area.
Envida has applied for an Accelerating Innovative Mobility (AIM) grant fromthe FTA for $791,250 for operating funds, staffing and additional software
costs associated with the service expansion.
Envida is applying for a CTAA Transit Planning for All grant to specificallyaddress regulation to overcome access barriers. We need new legislation toensure inclusive transportation.
o Partnered with a university or research organization to continue services, aspart of a larger initiative (please include the amount of funding)o Have submitted proposals for funding to any of the above
o Have received no external funding, but will become self-sustainingo Have no plans to sustain the projecte) Please indicate how you will use longer-term funding. Will this be to maintain thecurrent level of service or expand services? What partners will you target? What data
will you share with them?
Funding above and from additional sources will be used to expand behavioral health toTeller and Park counties, two underserved counties immediately west of our current
service area in El Paso County and Colorado Springs.

Working withtraditional service
providers, local healthand emergency
response agencies aswell as judicial districts
and school systems,
Envida will offer
Mobility on Demandand demand response
services in areas withlimited public andprivate transportation
options.
Teller and Park counties, immediately west of Colorado Springs, have been identifiedin statewide demographics as including above average rates of undiagnosed or
untreated mental health and substance use disorders. In addition, they are somewhat
geographically remote from services available in Colorado Springs as access requires atrip over Ute Pass on US Highway 24.
By addressing barriers to transportation in underserved and hard-to-reach communities,
Envida has demonstrated an ability to increase access to treatment and improve
behavioral health outcomes. Data on transportation, including completed rides,
cancellations and no-shows, will be shared with providers in order to demonstrateadherence to treatment plans and identify additional barriers to treatment. If available,
long-term data on completion rates, access of emergency services, and healthoutcomes will be used to further evaluate effectiveness of services.

5. Partnershipsa) Please list your major individual and organizational partners in this project and, if it is
not clear by their title, what their role they have with your end users.
AspenPointe
Katie Blickenderfer, Director of Case Management
Charlton Clarke, Director of Healthcare Services
Ryan Smith, Director of Business Operations
BethHaven
Lisa Simmons, Residential Care Coordinator
Colorado Community Health Alliance
Megan Billesbach, Community Liaison
Amy Yutsy, Director, Medicaid Programs

Peak View Behavioral Health
Taline Meredith, CEO
Eric Giggs, Director of Business Developmentb) If your partners changed as the project progressed, please indicate why and how.
Although additional partners were listed in the initial grant proposal, Cedar Springs has
dropped away due to internal leadership changes and reorganizations. Peak View
Behavioral Health will join once COVID-19 restrictions allow for on-site training.
Once engaged, no partner left as the limited launch progressed.
c) Please describe any lessons learned about how to keep partners engaged.
Envida maintained regular contact with partner providers, including monthly service
reports and information on specific clients with unusual incidents of cancellation or
no-shows.
d) Please describe any long-term partnerships that you anticipate will grow out of thisproject.
Both Aspen Pointe and BethHaven have multiple service locations in Colorado Springs,
and we anticipate growing demand for services as COVID-19 restrictions are reduced.
AspenPointe, Ute Pass Regional Health Service District, Peak Vista Community HealthCenters and private providers serve Teller County and could be key partners in the
expansion there.
e) Please describe any strategies you have regarding most effective management of amulti-sector partnership.
NCMM’s design thinking approach has been a successful strategy to engage
community partners and other sectors for solutions to community issues.

6. Replicability
a. Please explain the generic steps/strategies/approaches you took in this project that
could help other communities replicate components of your project (e.g., building
community partnerships, collecting performance measures, successfully connectingwith a new group of riders, piloting innovative software/transportation strategies).
Establishing effective partnerships with behavioral health providers is the primary
indicator for successful implementation. For Envida, our Behavioral Health Mobility
Manager played a critical role in meeting with agency leadership and treatment staff
prior to the introduction of services. As we seek to expand our geographic service
area, participation in regional alliances or similar bodies has allowed us to establish
expertise as well as provided opportunities to identify potential partners.
Identifying the most effective access point for scheduling rides varies by agency but isalso critical to a successful implementation. This might be the treatment provider, acare coordinator, call center or other centralized appointment staff, or directly by theclient. Finding one internal peer advocate to demonstrate the efficiency of schedulingtransportation in conjunction with each client appointment also improved utilization of
the service.
Implementation of an effective Memorandum of Understanding (MOU) with partner
providers should include agreement to share data from both before and after service
implementation, service levels, training, expected usage, cost savings, supplemental
funding and access to survey agency personnel and clients.
b. Please explain the missteps/invalid assumptions/strategic mistakes you made thatwould help others learn from your experience.
Without the restrictions imposed due to the COVID-19 pandemic, Envida might havereached a point where the demand for services was growing faster than the agency
could manage to add capacity. Agencies seeking to offer services to behavioral healthproviders should manage the addition of new partners or locations for existing partners
carefully. This could include estimating unmet demand for services prior to launch, or
negotiating a limit to the number of rides available.

7. COVID-19 impactsa) Please summarize changes to your project environment that occurred as a result of
the COVID-19 pandemic (e.g., changes in state/local restrictions, lower enrollment ofparticipants, changes in partner engagement, change in customer interactions withyour solution)
The first case of COVID-19 in El Paso County was reported on March 5, 2020.
Additional cases were reported on March 13 and 14. On Monday, March 16, ourprimary provider partner, AspenPointe, shut down all in-person behavioral healthappointments and began closing most their facilities. Existing appointments wereconverted to a telehealth model. The Lighthouse Acute Treatment Center providing
crisis intervention services was the only clinic open for in-person care.
The Governor of Colorado implemented a stay-at-home order on March 26, reducing
the demand for non-emergency medical transportation to a minimal amount. The stayat-home order was replaced on April 27 with a program titled Safer at Home, which
implemented a phased reduction of business closures and operating restrictions, whilestill encouraging all residents to stay at home as much as possible.
Overall demand for Envida services fell 70% beginning the week of March 16 as local
stay-at-home orders were developed and implemented.
b) Please document any actions you have taken or changes in services you have
implemented to mediate the effects of the COVID-19 environment.
On March 23, Envida notified providers in Teller and Park counties with which wewere developing the full implementation scenario, originally scheduled for May 13, to
let them know that we would provide rides or transportation services such as grocery
delivery as needed in advance of the full launch of services. Though only a few such
requests were made, they typically were high-impact requests for transportation toappointments like dialysis services where access for the client was critical.

The City of Colorado Springs opened an isolation shelter for homeless individuals who
were exhibiting symptoms of COVID-19 on April 5. In the initial stages of planning,access to the shelter was identified as a critical component to successful
implementation. Envida signed on to provide transportation from area hospitals andestablished shelters to the isolation center so that infected individuals who do not needmore intensive care had a safe place with trained supervision to rest and recover whilethe virus runs its course. To accommodate this need in the community, Envida
expanded hours of operation and designated a vehicle and driver to support thisservice. Effective decontamination procedures were developed and implemented toensure the vehicle was disinfected after each trip.
In addition, Envida ran a program in April and May to call clients and check on theiroverall well-being. Drivers and the mobility manager contacted all transit clients toensure they were safe, and their physical and transportation needs were being met.
Most clients who received a call were pleased for the contact, and occasionally theconversation extended well beyond the intended purpose. Protocols were developed toensure appropriate follow-up with clients who expressed concerns or fears about theirsituation or emotional state.

8. Additional comments
We welcome all additional comments about your experiences, outcomes, or future plans.
Also, please attach any documents, photos, or other materials that you think would help
us in capturing your progress in this project. Please indicate if we have permission to use
any photos for educational purposes by including a signed statement to that effect.
NCMM funding for the limited launch was critical for Envida to test assumptions and learn
how to effectively serve a new population of clients. Specifically, we learned how toapproach and partner with behavioral health providers, the importance of an internal
champion when seeking to partner with a large organization, and the pent-up demand fortransportation services for this sector. We have been able to demonstrate that our services
are easy to access for both providers and clients, and that we are a dependable partner for
those agencies which are seeking to improve behavioral health outcomes.
Most importantly, Envida and its drivers recognize that our service isn’t just abouttransportation. It’s about giving people the tools to connect to the services they need, tocommunity, and to a more fulfilling life.