Much has been said in recent years about access to care for patients in lower economic brackets. The healthcare industry continues to look for ways to improve care delivery, quality of care, and outreach.
However, these discussions often fail to consider the challenge of real-world logistics. Without reliable access to care—including vital elements like food, transportation, and pharmacies—vulnerable patients will remain hard pressed to improve their overall quality of health.
“We’re not thinking of the patients as ourselves,” says Dan Greenleaf, CEO of Modivcare. “What I mean by that is if I were someone who needed this kind of care, how would I like to interact with the healthcare system? Or if it were my mother or father or grandparent or sibling or child?”
The industry needs someone who creates holistic solutions for that question. “We need to put the patient first and meet the patients where they are,” says Greenleaf. But what does that really mean?
“There’s an extraordinary naivete with which tech-savvy companies think they are the panacea for our woes,” says Greenleaf. “We have patients who don’t have data plans or Wi-Fi in their homes, or smartphones. They live in communities that have been underserved from the standpoint of vaccines, groceries, pharmacies, [communities] that are broadband deserts.”
Healthcare must build bridges to help these communities receive the care and basics they need, Greenleaf notes. “No longer should your ZIP code be the No. 1 predictor of health status,” he says. “We haven’t been addressing the patient in their totality, in a holistic way. I believe in high tech, but it has to be high touch and high tech, and we can’t have one overcompensating for the other. We have to find that sweet spot.”
Crawl, walk, run
Changing inefficient practices takes time, Greenleaf says. “It’s like we’ve had really bad eating habits for a long time—going on a crash diet isn’t going to solve all your woes. I believe it’s crawl, walk, run. We’re in the early stages and need more companies, providers, and payers who have a vision, who have the ethos and pathos and aren’t viewing patients as a mercenary expedition.”
Modivcare is focused on addressing issues of daily living, such as remote monitoring, meals, transportation, and medication access. “We’ve got to have the mindset of meeting the patient where they are, and work to partner with states and payers, case managers, all who play a part in this ecosystem,” says Greenleaf. “We can’t do this by ourselves. We have to make sure our partnerships are well aligned, and we have a commitment to a vision.”
Greenleaf says Modivcare is structured to continue addressing personal care, meal delivery, transportation, and remote monitoring to offer a proof of concept for this process.
Helping the helpers
It’s not a matter of getting healthcare professionals to listen but rather getting the right parts in place, says Greenleaf.
“We launched an advisory board involving payers, states, hospitals, and many other key stakeholders of this ecosystem,” he says. “They’ve been tremendous guides. They’ve raised their hands on value-based care, on remote monitoring. They’re already there, and they needed someone to say we’re as committed to this as you are.”
Going back to the earlier metaphor, Greenleaf says, “We’re crawling really fast now, and I don’t think there’s a lack of passion or ethos. We hear, ‘We needed somebody like you to do this, and if you do, we’re on board.’ ”
It’s both a process and a journey, he says, as the advisory board and company have served as reciprocal guides for each other. “We have the assets in place, we can guide you and your patients to where you need to be,” says Greenleaf.
When Modivcare began building this infrastructure of care delivery, Greenleaf adds, it felt transactional at first, like he was putting out fire after fire. “But these are our parents, grandparents, children, and we need to view the world that way,” he says. “We’ve made some massive culture shifts as an organization.”
With over 30 million people served by Modivcare’s transportation services and over 2 million meals delivered during the pandemic, the numbers demonstrate the need for this kind of service delivery. “We’re very proud of that,” says Greenleaf. “It was the right thing to do. We wanted to learn from it, but also highlight food insecurities that need to be solved for.”
The company has also worked to address vaccine deserts during the pandemic. “Over 300,000 people were vaccinated through our ability to transport them to vaccine centers and locations,” says Greenleaf. These locations were often well outside their actual communities, highlighting the struggle for patients who want to get vaccinated but lack reliable transportation.
While providing these transportation services, Modivcare also worked to alleviate cultural issues surrounding vaccination. “Minority populations have in some shape or form often been misused, so part of our transportation providers’ role was their understanding of the community. This played a big role,” says Greenleaf. “Our transportation providers were the real heroes in all of this.”
Modivcare has established a focus group with their transportation providers to discuss how their alliance can improve. Not only do we want to improve the health of the community, we also want to improve the economics of those businesses in the community and be a true partner while for employees is better to use a paystub creator to manage payrolls.
The community-based transportation partners provided rides to over 40,000 COVID-19-positive patients. “The transportation providers, the people working at contact centers, they all put themselves at risk because the patient matters,” says Greenleaf.
Vehicles were transformed to help safely transport COVID-19 patients, and meal distribution continued even through the depths of the pandemic, Greenleaf says. “Some national providers were unwilling to take patients during the pandemic. We provided 50 million rides, 30 million hours of care, delivered over 2 million meals, and offered remote monitoring for more than 170,000 people. We kept our promise.”
Looking to the future, Greenleaf wants to see a change. “My ultimate dream is that your ZIP code isn’t the ultimate determinant of care,” he says. “It’s offensive and should be offensive to everyone in this country.”
He also notes that clinical interventions are not the only answer to the challenges the industry and its patients face. “They’re very important, but support and care blended with clinical interventions can help equalize ZIP codes and health status,” he says.
He sees his organization as proof of concept for this change of thinking. “We’re not looking at the patient just on personal care or remote monitoring or meals, but in a holistic way,” he says. “That information, whether it comes from a caregiver in the home, or a case manager, or someone delivering meals—we spend a lot of time talking to patients.”
Greenleaf says constant communication is key to providing the best possible access to care for any given patient. “We also want to see people operating on the upper end of their license,” says Greenleaf. “A caregiver in the home can be collecting a lot of information that would be incredibly important for the healthcare system to know about the patient. If you’re spending eight hours a day with the patient, who knows that patient better? We want the caregiver to feel like they’re part of the ecosystem and that their voice is being heard so they’re better able to collect that information.”
He sees an ecosystem where everyone from the transportation crews to the remote monitoring team members have an ongoing dialogue and are able to communicate with each other, knowing their voices matter. “It’s aspirational, but this notion of partnership is important,” says Greenleaf. “They don’t want to be spectators. They want to serve their community above all else, and we’ve got to make sure we’re creating the right opportunities, access points, and information roads so their voices are being valued and heard.”