Connecting Health and Transportation to Improve Access to Care

March 29, 2024 | Shelby Rowell, Anna Bartels

Three-quarter front view of a red city bus with another bus visible in the background.

Access to reliable, affordable transportation shapes our ability to reach healthcare, social services, employment, and other resources. Recognizing the critical link between health and transportation, many states are encouraging agencies to strategically align resources. Such partnerships can lead to in-kind, staff-time support to jointly plan policies and programs, share data, or serve on cross-agency advisory boards. These partnerships can also lay the groundwork for braiding and layering investments. ASTHO and the University of Washington explored state public health agencies’ cross-sector collaborations related to access to care and highlighted several promising examples from across the nation.

Arizona Successfully Braids Funding Streams

The Arizona Department of Health Services (ADHS) has braided funding between state and federal programs—and closely partnered with healthcare leaders—to develop a 24/7 service that coordinates medical transfers between hospitals. This program helps the state maintain constant visibility on hospital bed availability and improve patient access to care, especially during surges in volume, such as during RSV season.

In 2020, ADHS launched the Arizona Surge Line to load-level hospitals, so that no facility would become overwhelmed during the pandemic. The governor issued an executive order requiring all 130 public and private hospitals in the state to participate in the Surge Line, which ultimately grew to include over 230 hospitals in seven states and transferred over 10,000 patients at a total cost of approximately $2 million annually. ADHS closely collaborated with a steering committee of hospital and medical leaders to set protocols, and the Surge Line platform worked with Health Current—the state health information exchange—to show hospital bed availability and coordinate patient transfers.

In Dec. 2022, ADHS transitioned the Surge Line into the Arizona Resource, Equity, and Access Coordination Hub (AZ REACH), a permanent program coordinating medical transfers between Indian Health Services and critical access hospitals. By Sept. 2023—less than a year from its creation—AZ REACH assisted in approximately 4,000 patient transfers and provided the public health system of Arizona with real-time surveillance of the health and healthcare system. AZ REACH is funded through the HHS Hospital Preparedness Program, CDC COVID-19 Health Disparities Grant, CDC Public Health Crisis Response funding, and American Rescue Plan Act funding.

Vermont Invests in Equitable Access to Transportation for Healthcare

A Health in All Policies (HiAP) approach often comes as an executive-level directive to integrate health considerations into policy-making across all state agencies and at all levels of government. In 2015, Vermont’s governor issued an executive order to create a HiAP Taskforce, and the state has since maintained a strong culture of health and collaboration across all governmental agencies. For example, the Vermont Agency of Transportation (VTrans) documents how its budget, policies, and programs influence physical activity, air quality, safety, and equitable access to services. VTrans has also subsequently launched two programs to improve access to health and health-related services for populations who are medically underserved:

  • The Rides to Wellness project operates in several pilot regions and provides transportation to individuals who rely on community health centers for preventive and routine healthcare. This program aims to improve patients’ health outcomes, reduce missed health center appointments, and reduce preventable emergency service utilization. Although VTRans is currently the sole funder of the pilot, the project hopes to attract more funders by demonstrating improved financial performance of health centers, hospitals, and payers.
  • The Recovery and Job Access Rides program provides individuals experiencing substance use disorder with rides to treatment appointments, as well as job interviews and up to 30 days of commutes. The Vermont Department of Health’s Alcohol and Drug Abuse program provides in-kind, staff-time support. The program budget is split across Section 5311 funding, VTrans funding, and Agency of Human Services funding in a braided service model.

Oregon Transportation and Health Agencies Form Long Term Partnership

Oregon state leadership has long recognized that—in order to achieve the Triple Aim of better health, better care, and lower costs of care—the state must ensure cross-agency alignment around the social determinants of health. Memorandums of understanding (MOUs) can serve as such a tool to maintaining relationships and business processes between agencies, even spanning across shifts in leadership or administration. MOUs, for example, may delineate clear roles between participating parties and set expectations for accountability and communication.

The Oregon Health Authority’s Public Health Division and Oregon Department of Transportation (ODOT) formalized their commitment to joint strategic planning through an MOU, initially signed in 2013 and reconfirmed in 2018. The MOU outlines shared priorities between both sectors, including improving equitable access to healthcare services. Although there is no dedicated funding to support the partnership activities, both agencies contribute significant in-kind support, such as staff time to develop a workgroup on health, housing, and transportation that represents six different state departments and meets to align various state plans. For example, ODOT contributes to the state health improvement plan, and both agencies share information on their respective active transportation projects.

Find Out More

Cross-sector collaboration is necessary to make effective use of resources, avoid duplication, and meet both the health and social needs of populations historically underserved. State health agencies are at different stages of partnership development, and the process of braiding funding and aligning programming between sectors can be challenging operationally; however, there are many current success stories that can be modeled and replicated. Learn more in the report, Cross Sector Collaborations: Addressing Health Inequities in Access to Care Through Public Health and Transportation Partnerships.

The development of this product is supported by the National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce (Public Health Infrastructure Center) at the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) through the cooperative agreement CDC-RFA-OT18-1802. The information, content, or conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by, CDC or the U.S. Government.