HCC Rides, formerly a partner of Missouri Rural Health Association’s HealthTran, is an innovative transportation program bridging the gap in public health access. The program, put on by the Health Care Collaborative (HCC) of Rural Missouri, will begin serving patients in Lafayette County on July 1, 2021. Beginning as HealthTran in 2018, the program offered clients rides to and from their primary care, dental, and behavioral health appointments. The program served HCC patients in Lexington and members of HealthTran’s network partners.

According to Chief Network Development Officer Suzanne Smith, HCC decided the areas and patients they serve required more flexibility. The service is now transitioning to offer a more fluid approach to community transportation tailored to their community’s specific needs.

HCC Rides will focus on health care-related rides for now. In the future, HCC hopes to include trips to grocery stores alongside their promotion of healthy eating. The program will continue serving Lafayette County and will recruit drivers from Ray, Carroll, Saline, and Eastern Jackson Counties.

Focused on Flexibility

Unreliable or unaffordable access to transportation can lead to missed health appointments, delays in necessary care interventions, and missed or delayed use of medications. The resulting consequences of these negative impacts on rural residents’ health may influence their decisions regarding health care. Geographic challenges, such as large distances to care facilities, may also influence these decisions. Even if transportation is available, residents may find traveling to appointments inconvenient amid work, school, or childcare schedules. According to Transportation and Health in Rural Missouri, some residents may have to travel over 100 miles round trip for health care services.

One obstacle of existing public transportation services, including the services for Medicaid enrollees, is the lack of flexibility. While these programs are helpful for appointments scheduled in advance, they offer little wiggle room for changes or emergencies. The same is true for public buses; even if there is no cost, hours of operation and routes are limited.

Because of these challenges, HCC Rides focuses on flexibility. The program aims to promote independence, especially for those who feel like a burden relying on others or miss appointments due to inconvenience. “We’ve had people say, I would not have been able to get to and from my dialysis because my kids would have had to take off work,” said Smith. “We’re able to alleviate the burden some older patients may feel when relying on others.”

While the program primarily provides rides to and from health and wellness appointments, flexible access to care-adjacent errands prevent patients from missing or delaying necessary medication or tests. Riders can request stops to the pharmacy to drop off prescriptions or pick up medication. Patients undergoing dialysis, chemotherapy, and other treatments, or patients who feel too sick to drive, are also able to utilize HCC Rides. If a patient needs a test from an outside facility, drivers capable of and comfortable driving that distance will be available.

According to Smith, many HCC patients don’t have insurance, access to transportation, or both, and will utilize the emergency room (ER) for care. “A lot of the clients we see don’t have transportation or Medicaid and use the ER as primary care. We want to try and get as many people away from that as we can so that the ambulances and emergency rooms can be used for true emergencies.” Establishing a reliable service for uninsured residents helps bridge the access barrier gap both financially and geographically. This also allows emergency resources and services to be retained, a critical need as rural facilities often face resource shortages, especially in emergency departments.

Going the Extra Mile

The unexpected benefit to HCC Rides and similar programs is the impact of rider-driver friendships. “We didn’t anticipate it, but the drivers and patients became their own little family,” Smith said. Through HealthTran’s earlier years and now as the program transitions to HCC Rides, these relationships have motivated patients to consistently attend wellness appointments. “Drivers and riders would take each other gifts from their gardens and developed relationships that were super special to see. We plan to continue doing that.”

For rural residents, the barriers in health care can be daunting. Combined with the stigmas rural residents face around seeking care, especially regarding mental health, these barriers may weaken a person’s trust in providers or care facilities. However, establishing a friendship with a friendly face to rely on routinely for rides to appointments helps rebuild that trust and strengthen the bridge to continuing care. “Drivers will call patients to make sure that person is okay, like if they know that patient has had a procedure done and a family member was taking them,” Smith said. “I love relationship building. Being able to see those patients and drivers become so close makes my heart happy, and to know that those drivers are going the extra mile for their patients.”

This connection also builds program longevity; connecting patients to people within their area they can routinely schedule rides with creates a sustainable model to extend into the future. The emotional connection developed between riders and drivers establishes a long-term, reliable, trustworthy transportation option for that patient. According to Smith, this is unfortunately especially true when drivers build relationships with their patients who eventually pass away. “That’s a part I don’t think we thought about ahead of time, how close we get to our patients and then it feels like losing a family member.”

How It Works

HCC Rides will use an app called Assisted Rides to provide a rideshare-like service notifying drivers of nearby rides and connecting them to patients. If a ride is not immediately picked up by a driver, HCC Mobility Manager Chris Carney will personally alert available drivers.

Drivers must be 21 years or older and able to pass both a criminal background and drug screening. A vehicle inspection must be completed to ensure the vehicle is clean and in good working order. All drivers must complete proper training prior to providing rides. “We want to make sure that the folks driving our patients and clients are providing a safe ride,” Smith said. At this time, there are no guidelines regarding COVID-19.

Drivers are reimbursed $0.80 per mile there is a patient in the car and are paid every two weeks. When the program starts, there will be no costs for passengers. However, that may change down the road.

Volunteer drivers, in their own vehicles, will supplement HCC’s two new Ford Escapes which will be driven by employees. Each of HCC’s vehicles will transport two to three passengers in case multiple people travel together.

Throughout the years, the program’s primary form of recruitment for both drivers and riders has been word of mouth. “It has been amazing seeing the number of people served,” said Smith. “We’ve given over 3,000 rides since 2018, even with COVID-19 in the middle of that. It’s been amazing to see the growth and the other organizations out there knowing we have this service and referring people to us.”

Mobility Manager Chris Carney will help guide riders and volunteer drivers every step of the way as they navigate HCC Rides. For more information, including becoming a volunteer driver, contact Carney at 660.214.2851 or by e-mailing chris.carney@hccnetwork.org. Listen to Smith discuss HCC Rides in her HCC podcast interview here.

As for HealthTran, the rural transportation provider still remains active in Lafayette and surrounding counties.