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Introduction¹

Two divisions of the National Academies of Sciences, Engineering, and Medicine, the Health and Medicine Division (HMD) and the Transportation Research Board (TRB), held a joint workshop on June 6–7, 2016, to explore partnerships, data, and measurement at the intersection of the health care and transportation sectors.

The workshop took place against the background of a promising policy context. The cost reimbursement structure for health care delivery has been shifting over time, in part due to the Patient Protection and Affordable Care Act (ACA), from a fee-for-service model to a value-based payments model. In the new context, providers have to work differently to achieve good outcomes and therefore assume a risk for readmission and other avoidable suboptimal outcomes. The ACA has also led to changes in tax-exempt hospital reporting, as it requires changes in the way hospitals deliver a benefit to the community commensurate to their tax exemption. In early 2016 the Centers for Medicaid & Medicare Services (CMS) issued a funding opportunity announcement for testing the “accountable health communities” model for linking clinical and community services. This model centers on testing three interventions that promote collaboration between clinical care and community services providers: (1) screening

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¹ The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop has been prepared by the rapporteurs with the assistance of staff as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.

community-dwelling Medicaid and Medicare beneficiaries for unmet health-related social needs (e.g., transportation); (2) linking beneficiaries to needed community services; and (3) encouraging alignment between clinical and community services to ensure that needed services are available to beneficiaries. The CMS announcement also refers to the agency’s “better care, smarter spending, and healthier people” approach, which echoes the Triple Aim concept of better care and better population health at a lower cost, which has also played an important role in encouraging health care delivery systems to pay greater attention to population health and to tradeoffs in how the nation spends its health dollar. Finally, evidence from the public health sector demonstrates that health care is only one of the determinants of health, which also include genes, behavior, social factors, and the built environment (from sidewalks to transit). These contextual elements are key to understanding why health care organizations are motivated to focus beyond their walls and to consider and respond in unprecedented ways to the social needs of patients, including transportation needs.

The workshop began with a welcome from the executive directors of the two divisions, Clyde Behney (HMD) and Neil Pederson (TRB), who remarked on the importance of interdisciplinary collaboration, as exemplified by the workshop. In explaining the relationship between transportation and health care, Pederson said,

Pederson situated the workshop in the context of a range of interactions that transportation has with health: safety, the spread of disease, environmental adverse health effects, healthy and safe transportation, access to health care services, and mobility for older adults and individuals with disabilities. Behney expressed an appreciation of the joint project’s focus on data and measurement issues to help inform opportunities for the two fields to work together. He added that such a health sector concept as the learning health system and also lessons learned about trauma care in military situations could help improve transportation outcomes, too.

In her introductory comments, planning committee chair Ysela Llort said that the workshop was “taking place against a promising backdrop of policies, initiatives, and partnerships that are supporting greater atten-

tion to the social determinants of health at the population level and to the social needs of patients. Factors such as how individuals get to their doctor’s appointment and to other essential destinations are increasingly part of decision maker considerations.” She explained that workshop speakers and discussants would explore data, measurement, and value related to the issues of governance, industry, and research at the intersection of transportation and health care (see Box 1-1). Llort also emphasized that the workshop would not yield recommendations, although participants could make observations.

This intersectoral workshop was planned by a committee of 10 individuals, five with transportation sector expertise and five with health care delivery system knowledge. Chaired by Ysela Llort, the committee also included Rich Garrity, Paul Hughes-Cromwick, Judith Kell, Catherine Lawson, Perry Meadows, Michelle Proser, Marsha Regenstein, Elaine Wells, and Nigel Wilson. These 10 members outlined three objectives for the workshop and used them to guide the selection of speakers and the design of the sessions. The workshop was intended to (1) showcase models of transportation services that facilitate individuals’ access to health care providers; (2) discuss data sources and information technology obstacles and solutions from and across the health care and transportation perspectives; and (3) explore opportunities to ascertain the value realized by transportation providers, health systems, and funders/payers—if providing transportation services results in improved health outcome.

ORGANIZATION OF THE WORKSHOP AND PROCEEDINGS

The first day of the workshop, which was titled Exploring Data and Metrics of Value at the Intersection of Health Care and Transportation, consisted of four context-setting presentations and a discussion (Chapter 2), followed by two panels on cross-sector collaboration to provide transportation services in urban (Chapter 3) and rural (Chapter 4) areas, and a breakout session with two concurrent sets of presentation and discussion to explore some issues in greater depth (Chapter 5). On the second day, the workshop continued with a panel that explored data and barriers (Chapter 6) and another panel that built on the data discussion by exploring the return on investment of and incentives to creating better cross-sector linkages to support patients (Chapter 7). The workshop concluded with a conversation in which individual speakers and participants discussed some of the ideas and themes they found meaningful, important, or actionable (Chapter 8). Workshop appendixes include Appendix D, an environmental scan prepared by Heidi Guenin to inform the workshop, and a structured annotated bibliography (Appendix E) intended to provide an overview of relevant peer-review and gray literature (reports, briefs, etc.).

In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, instead focusing solely on issues identified by the speakers, discussants, and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. This Proceedings of a Workshop has been prepared by the workshop rapporteurs Theresa Wizemann and Alina Baciu as a factual synopsis of what occurred at the workshop.