Bridging gaps in access to care can improve patient outcomes

Access to healthcare is as important as the quality of the care itself. Obstacles such as language barriers and lack of transportation options can have a significant impact on patients—potentially leading to missed appointments, longer hospital stays, increased readmission rates and a higher likelihood of adverse medical outcomes.

Contracts for nonclinical services in the HealthTrust portfolio aim to bridge these gaps and bring patients closer to the care they need.

Open to interpretation

Yolanda Robles
Yolanda Robles

One in 12 Americans does not speak English very well, according to the U.S. Census. This isn’t surprising, as more than 350 languages are spoken in this country, says Yolanda Robles, CEO of CulturaLink, a medical interpretation supplier (HealthTrust contract #6225). This number is continually growing, she explains, with more people whose primary language is not English coming into the country each day—in particular from Africa and rural areas in Mexico and Guatemala.

“The face of America is changing, and it’s changing the face of healthcare,” Robles says. Because of this ongoing transformation, remote interpretation via phone and video has become an integral part of most healthcare systems’ services.

Robyn Suminski
Robyn Suminski

Non-English-proficient patients who don’t have access to interpretation services could face a variety of medical risks, explains Robyn Suminski, Vice President of Account Operations at CyraCom (HealthTrust contract #2905). They could remain at the hospital longer than needed, be misdiagnosed, be subject to medical errors, struggle to understand their condition or be readmitted to the hospital. “Everyone has a right to receive the best medical care and outcomes, regardless of their background or the language they speak. The use of medical interpreters reduces these disparities and improves clinical outcomes,” says Suminski.

Angie Mitchell
Angie Mitchell, RN

Angie Mitchell, RN, former AVP, Clinical Services at HealthTrust, says the practice in years past was to allow family members and friends to translate or interpret for patients, but it fell short. “Their ability to effectively and accurately translate or interpret medical information was not there,” Mitchell adds. For two decades or more, The Joint Commission has had standards in place requiring the provision for interpretation and translation services. As a result, many healthcare systems engage professional interpreters to fill this role. Medical interpreters undergo extensive training (often upward of 100 hours) in medical terminology, making them uniquely qualified to interpret complicated clinical information. “This is critical in order to ensure there is an effective care plan that the patient understands and can be an active participant in,” explains Mitchell.

While most healthcare institutions offer robust interpretation services, there are still gaps. One 2016 study found that nearly one-third of U.S. hospitals fail to offer interpreters to patients who speak limited English—despite federal mandates, per the Civil Rights Act of 1964.

Scott F. Cooper
Scott F. Cooper

Although this statistic is worrisome, the medical interpretation industry is making strides in the right direction. Scott F. Cooper, Esquire, Managing Director at Language Services Associates (HealthTrust contract #2926), explains that the industry as a whole has grown in recent years. And access to interpretation services in rural areas has improved drastically due to technological advances. “If you live in a rural area, your access to an interpreter might have been significantly more limited a few years ago, before it became easier to patch somebody in through a cellphone or video conference call,” he says. “This is one of the more encouraging things happening—that in the future, there will be greater access to more languages irrespective of where you live.”

The road to better care

Limited access to nonemergency medical transportation (NEMT) can affect a patient’s entire continuum of care, leading to missed appointments and, ultimately, worse outcomes. The American Hospital Association (AHA) found that 3.6 million Americans miss medical appointments each year due to a lack of transportation services.

Sven Johnson
Sven Johnson

While this barrier exists throughout the country, it’s especially persistent in rural areas, low-income neighborhoods and communities with high elderly, disabled and chronically ill populations, says Sven Johnson, Senior Vice President of Innovative Operations at Global Medical Response (GMR) (HealthTrust contract #7340). A study published in 2013 found that 1 in 4 low-income patients missed or rescheduled a medical appointment due to lack of NEMT services, Johnson says. And in rural communities, where as many as 25% of hospitals risk closure, the outlook is bleak. “Not only is there a challenge today, but that challenge is becoming more pronounced over time as medical resources in those communities become more and more limited,” Johnson adds.

The transportation gap has a deleterious ripple effect. Research from McKinsey & Company conducted in 2019 found that people with unmet transportation needs were 2.6 times more likely to report multiple emergency room visits and 2.2 times more likely to be admitted as an inpatient within a year. “That’s a significant increase in health system costs,” Johnson notes. “It impacts readmission rates and other key measures for facilities. Plus, on an individual level, it results in more adverse healthcare outcomes.”

Matthew McCormick
Matthew McCormick

Companies like GMR work to bridge this gap. Access to Care, the transportation division of GMR, primarily works with Medicaid, Medicare, health insurance plans and governmental institutions to provide NEMT services to underserved populations, says Matthew McCormick, GMR’s Vice President of Commercial Managed Transportation.

Fortunately, this sector has seen growth in recent years. McCormick notes some pilot programs have popped up in some areas of the country where, for instance, an employed but low-income pregnant woman can get free transportation to prenatal visits.

Kim Allen
Kim Allen

However, if not designed and operated properly, patient transportation services might be considered an improper inducement to gain patients or enticement to provide care. According to Kim Allen, Senior Director of Contracts on HealthTrust’s Commercial Services team, laws and regulations, including the federal Anti-Kickback Statute, as well as varying state and local requirements, mean that every healthcare organization needs its own policies regarding patient transportation. “Any facility wanting to put a patient rideshare program in place should have the following stakeholders involved early on in the discussion process: Care Management, Procurement, Legal and Compliance. Personnel from these teams can develop your best use cases and map out the pros and cons of each solution, while ensuring compliance with the law,” says Allen.

In 2017, the Department of Health and Human Services Office of Inspector General (HHS OIG) implemented a Patient Transportation Safe Harbor to the federal Anti-Kickback Statute establishing requirements that, if followed, affords protection to healthcare providers who wish to offer free or discounted local transportation to federal health program beneficiaries.

The safe harbor paved the way for healthcare providers to evaluate opportunities with rideshare companies to schedule rides for their established patients who needed help getting to and from medical appointments. HealthTrust has a contract with Lyft (#27671) to offer its members patient (and staff) rideshare programs. On behalf of the membership, HealthTrust has also executed a Business Associate Agreement (BAA) with Lyft to ensure Health Insurance Portability and Accountability Act (HIPAA)-compliant handling of any protected health information (PHI), as well as additional security measures.

Accelerating change

Despite the immense challenges our country has faced during the COVID-19 pandemic, the crisis has forced healthcare institutions across the country to implement innovative solutions for both clinical and nonclinical barriers to care. Telemedicine, for example, will likely be a fundamental part of our healthcare system following the pandemic, Robles says. (Read more about telemedicine in the time of COVID-19.)

“Overall, COVID-19 has helped us think outside of the box,” Mitchell notes. “Some of the efficiencies and ideas that have come about because of the pandemic might have some longevity in healthcare.”

Cooper agrees. “COVID-19 seems to be changing things much faster than years of lobbying to change some of these rules could,” he adds.

View details of HealthTrust’s agreement with Lyft in the contract package. For additional information on creating a rideshare program, contact Kim Allen. For more details on GMR or language service suppliers, contact Eric Clapp, Contract Manager, Strategic Sourcing.

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