According to the Centers for Medicare & Medicaid Services (CMS), research shows that 5.8 million people in the US do not receive medical care each year due to transportation issues. More recent research from 2022 found that 21% of adults without a vehicle or public transportation went without needed medical care.
Related to social determinants of health, these statistics highlight how essential reliable transportation is to accessing healthcare. Limited, unreliable, or unaffordable transportation creates barriers to health by making it harder for patients to attend health appointments, receive medical treatments, or carry out health-related tasks, such as picking up medications or healthy foods.
Through various avenues—including care management programs, value-based care models, and collaborative provider-insurance designs—healthcare organizations can:
- Improve patient care outcomes
- Enhance chronic condition management
- Lessen reliance on emergency and acute medical services
When care teams are compensated and equipped to identify transportation barriers and have resources and connections to support addressing them, they will find that patients attend more appointments, are on time, and can commit to their care plans.
Understanding the transportation barrier
Several factors make transportation more challenging for some patients.
For those who own a private vehicle or have family or friends who provide transportation, the increasing cost of fuel, insurance, and maintenance can be prohibitive.
Many patients who don’t have access to a private vehicle and rely on public transportation find issues with access, reliability, timeliness, and cost.
These issues are compounded by the time of day and geography. For example, mid-day and more rural locations have less service, if any.
Research quantifies the transportation challenges
An April 2023 report funded by the Robert Wood Johnson Foundation (RWJF) and written by the Urban Institute provides context to which patients are more at risk for transportation insecurity.
Who is skipping needed healthcare due to transportation issues?
- 21% of adults without access to a vehicle or public transit
- 17% of adults with a disability
- 14% of adults from low-income households
- 12% of adults with public health insurance
- 9% of patients with neighborhood access to public transportation services but without a vehicle
- 5% of all US adults reported forgoing healthcare due to transportation barriers
- 8% of Black adults
Distance compounds transportation issues
People living in more rural areas experience increased transportation barriers. There are fewer healthcare providers, so they must travel further to access care, and fewer transportation options are available.
Research published in 2023 discovered that rural residents, who comprise 20% of Americans, now travel farther for medical and dental care due to shortages and care deserts.
Based on data from the 2001, 2009, and 2017 National Household Travel Surveys, the study found that 33% more rural residents traveled 30 minutes or more for medical or dental care in 2017 than in 2001, which was also true for 20% more urban residents. The issue of distance, then, is affecting more than rural patients.
Disparities in travel time to medical and dental care were more significant for specific groups. For example, Hispanic patients traveled an additional 17 minutes and, on average, three times the distance for care than those in urban areas.
Research examples highlight specific challenges. In Doña Ana County, New Mexico, researchers found that accessing healthcare was a key reason to use public transportation. Rural patients in Minnesota travel three to four times farther than urban patients to receive care, particularly for neurology and cardiology.
Factors that make patients more at risk for transportation issues
According to RWJF’s 2023 research, several risk factors make transportation barriers more likely and are the strongest predictors of unmet medical needs, including:
- A low family income — below 138% of the federal poverty level
- Having a disability
- Lacking household access to a vehicle
Adults without a vehicle and fair or poor public transportation are strongly associated with forgoing needed medical care. This is true even after adjusting for other demographic, socioeconomic, and geographic characteristics.
How to identify transportation barriers
In 2024, Medicare introduced coverage for an optional social determinants of health (SDOH) assessment. Using CPT code G0136, qualified providers can conduct the evaluation during the Annual Wellness Visit without any beneficiary cost-sharing. Reimbursement rules allow an SDOH assessment every six months; however, patients would bear some cost-sharing.
Transportation barriers are one of four areas emphasized by the Centers for Medicare & Medicaid Services (CMS) as part of the assessment, looking for insecurities around:
- Food
- Housing
- Utilities
- Transportation
Conduct a health risk or social needs assessment
Provider organizations may choose to conduct an SDOH risk assessment, a health risk assessment, or health-related social needs assessment. Another way to identify which patients may be more at risk for SDOH challenges, specifically transportation issues, is to use population data analysis, such as that included in the ThoroughCare platform.
Analytics reports can find those patients who meet the preconditions for, or have, reported transportation issues. ThoroughCare provides patient demographics reports that can be filtered by race, zip code, and income or poverty level. Additionally, ThoroughCare offers an embedded SDOH assessment as part of an Annual Wellness Visit.
ThoroughCare also features a health-related social needs report that provides insights into all of the SDOH areas that CMS requests. It highlights personal safety, mental health, and other vulnerabilities. Regarding transportation and how it affects healthcare access, the assessment asks patients:
“In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?”
Lastly, ThoroughCare’s population health dashboard offers a data visualization called 'resource difficulties.'
This bar graph shows the number of patients who struggle with barriers in each SDOH category. Care team members can click on a barrier area to see a detailed list of patients who struggle to access needed medical care.
Identify patient populations via publicly available data
Providers can use free, publicly available databases and analytics tools to gain a more expansive view of which patient populations struggle with transportation issues.
The Department of Transportation provides a transportation-focused tool through its US DOT Equitable Transportation Community (ETC) Explorer. It’s an interactive web application that uses 2020 census tracts and data to explore the cumulative burden communities experience, including transportation insecurity, health vulnerability, and social vulnerability.
Using the DOT’s tool, care teams can identify zip codes, neighborhoods, and communities that are facing transportation insecurity and access various data about that area.
The value of investigating health-related transportation barriers
The Saban Community Clinic (SCC) is a Federally Qualified Health Center in Southern California.
Their assessment of patients’ transportation challenges revealed opportunities to enhance access to care, reduce appointment lateness or no-shows, and increase patient satisfaction and engagement.
- 31% of participants with transportation issues utilized public transportation to get to their most recent medical appointment
- 50% reported missing an appointment in the past twelve months due to transportation issues
- 80% of patients who used public transportation reported being late by more than 20 minutes
Through SCC’s research, clinicians uncovered patients' suggestions on how the provider organization could improve health access through direct or indirect support or advocacy. A sampling of responses confirmed their research and gave them strategic direction for future planning, including:
- Provide a way for patients, particularly those utilizing public transportation or ride-hail, to inform the clinic when they are running late for their appointments
- Create transparent and flexible policies around lateness
- Consolidate appointments for healthcare services
- Train staff on how to connect patients to insurer-provided travel assistance and other alternative travel services
- Increase mobile health access for patients who are 5 to 10 miles away
Ways to address transportation insecurity
Healthcare organizations that participate in care management programs, value-based care, and innovative insurance design models tend to have more flexibility to offer coordination, financial, or direct transportation resources.
These organizations also have the opportunity to share in cost savings or performance rewards that benefit from improving patient transportation access.
According to CMS, transportation barriers account for 25% or more of missed clinic appointments. Also, patients offered free transportation to healthcare services are more likely to attend the recommended number of appointments to manage their chronic health conditions.
Based on data gathered from earlier patient or population analysis, healthcare leaders can brainstorm ways their organization may be able to reduce transportation barriers, including:
- Are there any simple ways to make accessing care more manageable for our patients with transportation barriers?
- Are there ways that we can advocate for patients or connect them with community resources to ease their transportation burden?
- How can we use technology like telemedicine or telephonic care and care management services to deliver care while lessening the need for transportation?
Ride-sharing apps offer benefits
Services such as Uber and Lyft can support patients with accessing healthcare. Both platforms offer third-party solutions for non-emergency medical transportation, as well as prescription and grocery delivery.
ThoroughCare supports SDOH screening
Providers can use ThoroughCare’s standardized health risk assessment to fulfill Annual Wellness Visit service requirements while screening for SDOH. ThoroughCare enables digital care coordination, so providers can proactively engage patients and address barriers to healthcare access. Our solution can:
- Streamline the creation of patient care plans
- Support staff workflows with guided, validated assessments
- Help motivate patients through clinical recommendations and SMART goals
- Analyze patient risk factors and generate clinical recommendations
- Identify behavioral health conditions
- Monitor key performance metrics to spot gaps in care
- Track and log services for an audit-proof record of care
ThoroughCare supports comprehensive integration with leading EHRs, health information exchanges, remote devices, and advance care plans while helping providers visualize and interpret operational data through analytics.
