Primary Care Plan: Shuttle Out, Uber In

Thomas Breen photoYale-New Haven Hospital has decided that Uber rides will help car-less New Haveners make it to a planned new Long Wharf primary care center more reliably than shuttles or (obviously) local buses.

So, as part of the process of obtaining state approval to open the new center, the hospital Wednesday afternoon promised to provide those rides for free.

That Uber update is one of the key proposals included in a five-point transportation plan that Yale-New Haven Hospital (YNHH) submitted to the state Office of Health Strategy (OHS).

YNHH Director of Strategy & Regulatory Planning Jeryl Topalian sent the 60-page document to OHS Hearing Officer Micheala Mitchell as the last submission in the hospital’s application to close down its primary care facilities on York Street, Chapel Street, and Whitney Avenue and move them to a single location at 150 Sargent Dr. on Long Wharf. The new primary care center, to be run in collaboration with Fair Haven Community Health Care and the Cornell Scott Hill Health Center, is called the New Haven Primary Care Consortium (NHPCC).

“YNHH has spent considerable time over the past two weeks exploring the potential for providing dedicated shuttle services,” Topalian wrote in response to the state’s request for more details on how the thousands of car-less patients who use YNHH primary care services every year will be able to get to a facility relatively removed from public transportation.

“After thoughtful evaluation,” Topalian continued, “we do not believe that implementation of a shuttle service will materially improve access.”

Instead, the hospital proposes to expand an existing contract with the ride share service Uber to provide free on-demand car rides for car-less patients who live within 10 miles of 150 Sargent Dr. and who would otherwise have to spend 40 minutes or more on the bus to get to their relocated primary care providers.

Click here to download the hospital’s full transportation plan.

The state also ordered the hospital and its two partners in the new proposed primary care center, Fair Haven Community Health Care and the Cornell Scott Hill Health Center, to detail their hardship waiver policies to mitigate out-of-pocket costs for the city’s poorest patients. (More on that below.)

One local critic of the proposed primary care center move, New Haven Urban Design League President Anstress Farwell, remained unimpressed Wednesday with the hospital’s transportation plan.

“They’re showing that it’s not impossible” to get to the Long Wharf facility without a car, she said. “They’re not showing that it’s less difficult” than getting to the current Downtown and Whitney Avenue locations. She urged the state to reject the hospital’s application for a Certificate of Need (CON) to move its primary care services to Long Wharf, and called on the hospital to scout out a new, more alternative transportation-friendly location.

Uber, Veyo, and Free Parking

 

In an opening “Background” section of the hospital’s submission, Topalian wrote that YNHH surveyed over 2,500 of its 25,000 annual primary care patients this summer to better understand how they get to and from the existing primary care center locations.

“The results of the survey showed that 66% of respondents utilize a car to get to their appointments,” Topalian wrote, “while 15% use public transportation, and 10% walk. Other transportation modes include medical taxi (5%), taxi/Uber/Lyft (3%), and other (1%).”

The hospital decided not to pursue new dedicated shuttle services to the proposed 150 Sargent Dr. location, Topalian wrote, because the 33 percent of patients who do not currently use a car are distributed over 23 New Haven neighborhoods, with the most coming from the Hill, Fair Haven, and Dixwell. That’s because car-less patients would still need to walk or take public transportation to get to a shuttle pick-up spot, wait for the shuttle to arrive, and then do the same commute on their way home.

“A bus or a ride-sharing service will provide more direct access and reduce waiting time,” Topalian wrote.

Instead of a dedicated shuttle service, Topalian outlined five alternative transportation strategies for car-less patients to make it out to Long Wharf.

• The first is ... more, free parking. The new site will provide 250 dedicated patient parking spaces, 38 of which will be handicapped spots. All of the surface parking spots at 150 Sargent Dr. will be free of charge for patients. “The percentage of patients who will benefit from this change today is estimated at 66%,” Topalian wrote, “however, it is possible that a greater number of patients will decide to drive with the barrier of expensive and/or difficult to find parking removed.”

• The second is an expanded contract between YNHH and the ride share service Uber. The hospital currently works with Uber to provide on-demand rides for certain patients at Bridgeport Hospital, Topalian wrote. “This strategy will be an integral element of our transportation plan to enhance patient access at 150 Sargent Drive.”

The hospital will offer a ride-sharing service for free to all current primary care patients who transition to 150 Sargent “regardless of financial or insurance status, provided they cannot get to 150 Sargent Drive by car, do not require special transportation assistance, and meet the following criteria for eligibility for the service: patients must live within 10 miles of 150 Sargent Drive, and where currently available public transportation requires one or more transfers or a trip of 40 minutes or longer.”

Topalian wrote that YNHH leadership has already met with Uber to discuss the program, and that the ride share service is on board. The new service, she said, will only be available to “established patients, which include those who have already scheduled an appointment or have previously attended an appointment.”

• The hospital will help Medicaid beneficiaries with HUSKY A, C, and D enroll in the Veyo non-emergency medical transportation (NEMT) program. That program includes “a combination of public transportation assistance, ride-share vehicle, wheel-chair accessible vans, and mileage reimbursement”. She said the hospital will work with eligible car-less patients get access to wheel-chair accessible vans through the Veyo program.

• YNHH reiterated its commitment to advocate for a more frequent, reliable, and direct public buses to 150 Sargent Dr. She noted that the Long Wharf location is currently served directly by CT Transit bus routes 274 and 274C, which originate Downtown.

“In addition to increasing the number of direct bus routes,” Topalian wrote, “NHPCC will advocate for increased frequency of stops during ‘off peak times,’ so that buses run every 15 minutes during the day, rather than on the half hour.”

• Finally, the hospital committed to evaluating its transportation plan for the new primary care center on an ongoing basis after the proposed move and opening of the new facility in September 2019.  Topalian wrote that Fair Haven Community Health Care and Cornell Scott Hill Health Center staff will monitor “no show” and late appointments to see if transportation was a factor. She said the women’s primary care and pediatric patients will be survey during the six to 12-month period following the Fall 2019 opening to assess their satisfaction with 150 Sargent’s accessibility.

“In summary,” Topalian wrote, “YNHH’s patient transportation plan will include a combination of multiple solutions including ample free on-site patient parking at 150 Sargent Drive, with improved access for medical vans and increased handicapped spaces, YNHH- funded ride sharing through Uber, Veyo assistance for eligible CT Husky beneficiaries, and advocacy for more convenient public bus service to/from 150 Sargent Drive. The NHPCC will evaluate the transportation plan once the transition to the 150 Sargent Drive occurs, and will make adjustments based on patient and provider feedback as needed.”

“Totally Inadequate”

Two local public critics of the proposed primary care center move, Farwell and New Haven Legal Assistance Association Attorney Sheldon Toubman, said that the hospital’s transportation plan does little to address the transportation burdens that car-less patients will face at the Long Wharf facility.

“This plan for transportation from YNHH is totally inadequate,” Toubman stated by email.

He noted that committing to “advocating” for improved bus service is not the same as actual improved bus service. “It could be many years before any benefit at all would come from such advocacy,” he wrote. “[I]n the meantime, patients will go untreated because, as the hospital recognizes, bus service today to the proposed location is inadequate.”

He also dismissed the Uber plan as inadequate for people with disabilities and for patients without smart phones.

Farwell agreed, noting that the length and detail of YNHH’s transportation plan is testament in and of itself of the longer travel times, required transfers, and other barriers to access presented by the proposed Long Wharf location.

“You can’t claim that this idea of moving to Long Wharf actually means that [access to health care] is improved for most of the patients,” she said. “Most of the patients will have to struggle more to get down there.”

She called on the hospital to reveal which other potential locations it has looked at to host a new, centralized primary care center.

In addition to its relative inaccessibility, she said, Long Wharf is in a flood plain. “Facilities serving poor people tend to end up in the flood plain,” she said, referencing the severe damage sustained by the Charity Hospital in New Orleans after Hurricane Katrina.

She said that, if the hospital is serious about improving public bus service in New Haven, it should provide its employees with something analogous to a U-Pass, which would cover their bus fare on the current public transit system.

“Advocating doesn’t do a whole lot,” she said. “They cant just advocate. They have to do.”

Click here to download critical testimony submitted to the state by Toubman, Farwell, and others.

Hardship Waivers

The hospital’s submission also provides details on how Fair Haven Community Health Care, Cornell Scott Hill Health Center, and YNHH will provide hardship waivers to reduce costs for the center’s poorest patients.

Fair Haven Health will waive any access fees for patients who have no income, according to the submission. A vice-president of clinical affairs will decide on whether or not to waive visit fees for patients facing significant social or economic changes, such as homelessness or shut-off utilities.

Cornell Scott Hill Health Center will consider waiving visit fees for patients who fall into one of nine listed hardship categories, including homelessness, eviction, or domestic violence.

And YNHH committed to establishing a patient assistance fund for patients who would have been eligible for financial assistance at the current primary care centers.

Below are links to previous articles about the proposed New Haven Primary Care Consortium.

Farwell Questions Primary Care Move’s Impact On Poor
Primary Plan’s Obstacle: Broken Bus System
Plan Reimagines Primary Care For Poor
West River Questions Primary Care Move
Harp Backs Primary Care Move

Also below are Facebook Live videos of portions of Wednesday’s night’s public hearing, and of an interview earlier this year with Lagarde and Taylor on WNHH’s “Dateline New Haven.”

 

 

 

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posted by: 1644 on December 13, 2018  9:04am

You can’t claim that this idea of moving to Long Wharf actually means that [access to health care] is improved for most of the patients,” she said. “Most of the patients will have to struggle more to get down there.”
Huh?  Given that the vast majority of patients already drive,  free and abundant parking, as well as easy highway access, will make access much, much easier for those patients.  Those who are now walking (10%) will have a much more difficult trip due to waiting for a ride or taking bus, and many using public transportation will have a longer trip.  On the plus side, the concentration of services in one place may eliminate the need for all to make multiple trips to multiple locations.  Overall, those driving or being driven (most of the patients) will find the roomier location much more convenient.

posted by: 1644 on December 13, 2018  9:08am

BTW, regarding the Uber black car image, Y-NHH’s plan states, “It will not include air, luxury (excludes Select, Black, and SUV), or ambulance-level transportation.”

posted by: Brian McGrath on December 13, 2018  9:51am

This is a good plan and use of the building. Long Wharf is not far away and is effectively next door to any patient anywhere with a free uber ride. Complaints on that basis are illogical. One day, all of Long Wharf will be a booming part of an expanded New Haven downtown. This would be a good time to build a pedestrian tunnel from the railroad station. Once all the land around the station is used up, services to the station can also locate at Long Wharf.

posted by: TheMadcap on December 13, 2018  12:04pm

I’m just going to throw out there that the several medical professionals I know who work for Yale all think this is stupid, both the planned move and the now convoluted ways they’re coming up with to try to show access to the proposed facility isn’t an issue

posted by: yim-a on December 13, 2018  7:18pm

Wait, Cornell Scott, Fair Haven and Yale will all have separate free care policies?  Under one roof?

Oh boy,  sounds like a recipe for a dysfunctional healthcare purgatory.  Good luck with that.

posted by: 1644 on December 13, 2018  8:39pm

Yim-a: Good catch.  What is the chain of command here? 

BTW, another great quote from advocate Farwell: “Advocating doesn’t do a whole lot..”  :)

posted by: LivingInNewHaven on December 13, 2018  11:42pm

This looks great on paper. Maybe I missed it, but if the most needy of patients will use this Yale/Uber arrangement, doesn’t this increase direct patient costs? How does this additional cost affect the bottom line?  I’m not a financial person but it seems desperate and too expensive to be offering free transportation by Uber.  All the patients that normally get rides from friends and family, within the 66%, will now drop down to the Uber’d patients. I’m just a little confused.

posted by: Esbey on December 14, 2018  2:35pm

One advantage of this plan, to the health-care partners, is that unlike a shuttle van it will be very easy to subtly restrict and limit over time. One can put the Uber program in fine print, put potential users on hold, make the paperwork a bit burdensome, etc, redefine “established patient,” etc.  Pretty soon that 66% of car drivers becomes 90% (with the carless just getting less health care) and at that point, maybe the program quietly goes away.  Even better, the car drivers are much less like to be on low-paying medicaid plans, but rather have juicy private insurance.

Given the current plan, at some point some do-gooders (I genuinely mean that as a compliment) are going to try to fund actually accessible health care centers, and then the state will be asked to chip in for that, etc.  One might call the new center, for example, “Fair Haven Community Health Care,” or maybe “Hill Health Center,” which could also be named after its founder. 

I think the consolidated program should be downtown, near the terminus of many public transport lines.  This would strengthen both healthcare and transit.