Healthcare	  Access	  Mobility	  Design	  Challenge	  February	  26,	  2015	  OPPORTUNITY	  Develop a dynamic scheduling software structure that would facilitate theincorporation of patient’s transportation needs while scheduling their appointments	  The	  pa.ent	  deals	  with	  TWO	  WORLDS	  APART	  	  They	  need	  to	  schedule	  their	  appointment	  and	  decide	  /	  ﬁgure	  out	  which	  transporta.on	  op.on	  they	  will	  use.	  	  There	  is	  a	  lot	  of	  confusion	  from	  the	  pa.ent’s	  perspec.ve	  on	  which	  service	  to	  use	  and	  when	  it	  is	  appropriate	  to	  schedule	  their	  ride	  through	  various	  demand-­‐
response	  	  services	  and	  depending	  on	  their	  eligibility	  for	  transporta.on	  beneﬁts.	  FUNDING	  AND	  SUPPORT	  Collabora.on	  Funding	  	  Support	  Future	  Collabora.ons	  	  The	  pa.ent	  calls-­‐in	  to	  schedule	  their	  doctor’s	  appointment	  AND	  their	  ride	  if	  they	  men.on	  they	  need	  transporta.on	  irrespec.ve	  of	  their	  transporta.on	  beneﬁts	  or	  eligibility.	  	  	  The	  Ul.mate	  Goal	  is	  to	  allow	  pa.ents	  to	  use	  SMART	  TRANSIT	  to	  schedule	  their	  appointment	  and	  their	  transporta.on	  online.	  MARKET RESEARCH : CO-CREATION SESSIONS• WRTA	  Hub	  • Neighbor	  2	  Neighbor	  	  • Worcester	  Community	  Connec<ons	  Coali<on	  • Family	  Health	  Center	  IT	  Department	  • Family	  Health	  Center	  /	  	  Pa<ent’s	  at	  Wai<ng	  Room	  Area
• Centros	  Las	  Americas	  /	  La<no	  Elder	  Program• South	  East	  Asian	  Coali<on	  	  	  	  MARKET	  RESEARCH	  :	  HOW	  DO	  PATIENTS	  GET	  TO	  THE	  FHC	  ?	  HOW MUCH DOES IT COST A 3-MILE ONE-WAY TRIP TO THE FHC BY MODE?

People	  men.oned	  they	  are	  willing	  to	  pay	  between	  $1.50	  to	  $3.50	  per	  trip.	  	  23%	  men.oned	  they	  can’t	  aﬀord	  to	  pay	  the	  bus	  fare.	  

WRTA	  	   	  $1.50	  (Single	  Fare)	  Car	  	  	  $1.71	  (IRS	  Standard	  Mileage	  Rates)	  WRTA 	  $3.50	  (One	  Day	  Pass)	  Uber	  	   	  $8.07	  (Booking	  fee	  and	  <p	  included)	  Taxi	  	  	  $10.88	  (Taxi	  Fare	  Finder)	  PT-­‐1	  	  	  	  	  	   	  $19.39	  (HST	  Region	  5	  –	  Worcester)	  PBSTM	  	   	  $25.80	  (patrons	  pay	  only	  $2.25	  per	  trip)	  WRTA’s	  average	  trip	  length	  is	  3.3	  miles.	  

Based	  on	  the	  assump<ons	  related	  with	  pa<ents’	  frequency	  of	  visits	  and	  costs	  associated	  by	  mode,	  we	  can	  es<mate	  that	  the	  average	  out-­‐of-­‐pocket	  yearly	  expenses	  for	  those	  pa<ents	  that	  use	  transit	  for	  one-­‐way	  trip	  paying	  a	  single-­‐fare	  is	  $1.2M.	  A	  round	  trip	  will	  be	  double	  the	  amount,	  $2.4M.	  	  	  If	  the	  One-­‐Day	  Pass	  is	  used	  the	  average	  annual	  pa<ent’s	  out-­‐of-­‐pocket	  expense	  in	  transit	  is	  $2.8M,	  or	  $67.48	  per	  person.	  BUSINESS MODEL§ Develop	  as	  an	  Open-­‐Source	  so]ware	  in	  collabora<on	  with	  Cambridge	  Systema.cs	  (CamSys)	  § The	  1-­‐Click	  open	  source	  pla^orm	  developed	  by	  CamSys	  	  has	  a	  community	  of	  users	  in	  6	  states,	  a	  good	  star<ng	  point	  § CamSys	  can	  develop	  a	  “beta”	  deployment	  of	  	  Smart	  Transit	  System	  (unsupported	  not	  hosted	  by	  CamSys)	  for	  a	  minimum	  of	  about	  $150K-­‐$200K.	  Func<onali<es	  get	  beaer	  with	  cost.	  	  § Par<cipa<ng	  agencies	  (hospital)	  pay	  for	  annual	  suppor<ng	  and	  maintenance	  cost	  of	  the	  order	  $12,000-­‐$36,000	  § Background	  Research	  on	  transit	  partnership	  and	  survey	  cost	  for	  each	  hospital	  is	  of	  the	  order	  of	  $20,000	  	  § Approximate	  cost	  of	  pilo<ng	  the	  product	  for	  atleast	  3	  hospitals	  is	  about	  $	  72,000	  (hos<ng	  +suppor<ng	  +	  maintainance	  cost)	  § Total	  funding	  requested	  for	  :	  $(200,000	  +	  60,000	  +	  72,000	  +	  20,000)	  ≈	  $350,000-­‐$400,00	  HOW MUCH MONEY FHC IS LOSING DUE TO MISSED APPOINTMENTS?
The	  FHC	  cited	  to	  have	  an	  average	  of	  800	  missed	  encounters	  in	  a	  monthly	  basis.	  Currently,	  the	  standard	  rate	  per	  person/visit	  is	  $154.	  	  It	  is	  es<mated	  that	  the	  FHC	  losses	  $1,478,400.00	  	  	  million	  of	  dollars	  per	  year	  solely	  on	  missed	  appointments.	  
51%	  	  missed	  their	  appointments	  due	  to	  transporta<on,	  that	  translates	  to	  	  $739,200	  	  loss	  speciﬁcally	  related	  to	  transporta<on	  problems.	  

In	  average,	  180	  pa<ents	  use	  the	  WRTA	  ﬁxed-­‐route	  in	  a	  daily	  basis	  to	  go	  to	  FHC.	  	  If	  FHC	  pays	  $3.50	  for	  a	  One-­‐Day	  Pass	  for	  these	  pa<ents,	  the	  daily	  expense	  will	  be	  $630.	  In	  a	  year	  (251	  weekdays)	  the	  expense	  will	  reach	  $158,130.00.	  	  	  This	  amount	  is	  only	  10.7%	  of	  FHC	  loss	  due	  to	  missed	  appointments.	  	  	  NEW OPPORTUNITIES AND COLABORATIONSCollabora.on	  with	  MassDoT	  and	  Cambridge	  Systema.cs	  	  for	  next	  grant	  cycle	  Tap	  into	  exis.ng	  transit	  ini.a.ves	  in	  Massachuseis	  like	  use	  of	  transit	  database,	  Massrides	  ini.ated	  by	  GATRA	  region,	  MART’s	  general	  public	  shuile	  service	  	  	  Implement	  a	  MassHealth	  Smart	  Transit	  Card	  where	  the	  day	  of	  the	  appointment	  a	  One-­‐Day	  Pass	  is	  uploaded	  unto	  the	  beneﬁciaries	  card	  based	  on	  request	  for	  transporta.on	  using	  the	  Smart	  Transit	  app.	  

Par.cipate	  on	  UBER’s	  Aﬃliate	  Program.