Services – Small Health Care Provider Quality Improvement Program – Cascade Medical Center 

The Georgia Health Policy Center recently spoke to Tom Reinhardt, CEO of Cascade Medical Center — a Critical Access Hospital in Idaho, about how providing transportation for prevention and wellness is a key aspect of health care access and health care quality in rural areas. 

To date, what has been the biggest accomplishment in your quality improvement program?  

A few years ago, we started the Healthy Aging Planning Network — a coalition of organizations, agencies, and city government — to look at the needs of the aging in our community and to help people live as long as possible independently at home. One of the things identified in our community health needs assessment was the need for people to get to their medical appointments. Transportation is challenging for people who cannot drive or cannot afford reliable transportation. There just is not a lot of public transportation in rural areas and in the western-central mountains of Idaho, we have five months of winter, and some people really are reluctant to drive when conditions are like that. The Healthy Aging Planning Network thought it be great if we had a van that we could pick people up and bring them to their medical appointments. We felt like this was a great way that we could improve the quality of care. Through this HRSA Quality grant, we picked up our first patient six months ago and we have been able to transport hundreds of patients since then to primary care appointments, to physical therapy, and even to specialty appointments at other health care facilities. 

What is an early learning that you would share with others launching a similar program?  

This is expensive, so you need a pretty sizable grant to pull it off. In and of itself, providing transportation does not generate revenue, although if you get people to an appointment that they otherwise would not have been able to at your facility, then you do get reimbursed for it.  

We had a lot of learnings from the start in terms of the risk management of operating a transportation service. It was difficult finding an insurance company that will underwrite this. I would encourage others to reach out to other hospitals or community health operators that have a program like this and borrow from their policies. We certainly benefited from another organization’s leadership who were kind enough to give us their policies and then we tailored them to our needs.  

How do you see participation in FORHP’s Quality Program as impacting your broader health improvement efforts? 

This program is one arrow in our quiver of a dozen arrows that we need to fire off to improve community health. Certainly, this program in and of itself does good things. And if it was the only program that we had, it would still be doing good things. But it is exponentially more powerful when we link it to other things that we do.  

For example, in the past two years we started a community health worker program. They go to the food bank and health fairs, and they identify people who have limited resources who do not have transportation. We bring the van to these events so that people can see that it is there for them. We are working with other agencies in our community to improve pathways for safe recreation and exercise. All these things matter. Collectively, they make the community a more livable area and a healthier area for everyone, not just seniors. 

What’s next on the horizon for your grant-funded program? 

Over the next six months, we will continue to fine tune our program. We will get better in terms of scheduling. In rural areas, we have great distances to cover. If you are taking a patient to Boise, 80 miles away, you may only be able to make one patient transport in a day. We need to improve the efficiency of our program. I know that does not sound as sexy as adding a second van, but that is not the goal right now. If it gets to the point where we are overwhelmed with need and people and the one van cannot handle it anymore, then we will certainly sit down and look at that as an option that is not within the next six months, maybe within the next two years.

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