VA's SDOH pilot targets transportation barriers to healthcare

A recent pilot initiative from the Department of Veterans Affairs (VA) proved effective at improving medical transportation and patient access to care.

The pilot, which leveraged Lyft rideshare services to provide veterans with transportation to medical appointments, resulted in participating veterans having more needed medical appointments than those who did not participate in the program.

Medical transportation is a key social determinant of health (SDOH) that has a trickle-down impact on other SDOH. When people do not have access to reliable transportation, they might not access care, miss important follow-up appointments or decline to fill or pick up prescriptions from the pharmacy.

All of that has downstream impacts on healthcare organizations. In addition to the poor clinical quality outcomes experienced when patients can't access care, limited medical transportation access has been linked to higher no-show rates, which can hurt organizations' bottom lines.

A rideshare pilot program run out of the VA between 2020 and 2023 helped chip away at transportation issues, researchers documented in a new Health Affairs report. The VA Rideshare program, first implemented in 2019 and then expanded in 2020 in response to COVID-19, offers homeless veterans rides to medical appointments and other social services, such as food pantries or jobs.

The researchers linked 2022 VA Rideshare program data from Lyft with VA administrative data to assess characteristics and changes in healthcare utilization among housing-insecure veterans. Overall, folks enrolled in the rideshare intervention were more likely to have psychiatric diagnoses and higher urgent care utilization than their counterparts, but the rideshare pilot did prove to better support participants' care access.

Among the nearly 10,000 homeless veterans opting into the rideshare program, most used the program repeatedly for an average of over eight rides. The researchers said the folks using the rideshare program were representative of the overall VA homeless population, with most being older, non-Hispanic white and with high healthcare utilization patterns already in place before enrolling in the rideshare program.

Ultimately, the rideshare program made it easier for users to further access care. People who used the rideshare program had more VA outpatient, inpatient, ED or urgent care and homeless services visits than those not using the rideshare. Rideshare users also had fewer no-shows during the study period.

"These findings suggest that the VA Rideshare program facilitated greater access to care, and they contribute to the growing literature finding that transportation interventions can improve access to health care," the researchers explained.

These findings could be applicable to other programs focusing on SDOH, especially as the population ages, the researchers added.

"As the US population ages, including veterans, more older adults are expected to reduce or cease driving because of age-related changes in vision, cognition, and physical function," they said. "Rideshare programs may be important for older adults to stay active, keep socially engaged with others, and have access to community resources."

Rideshare agreements with healthcare organizations have become more commonplace as value-based care contracts have pushed providers to focus on patient outcomes and the SDOH that impact them. By funding rideshares to and from appointments, organizations have said they can connect patients to the care necessary for better outcomes and disease management.

In recent years, rideshare companies have expanded their scope, focusing not just on rides to and from medical appointments, but also on other SDOH. Some rideshare companies have worked to connect patients to other social services that can mitigate the effect of SDOH, while others have turned to prescription and medically tailored meal delivery.

Sara Heath has covered news related to patient engagement and health equity since 2015.