WCHC teamed up with Hitch Health to provide transportation for patients through a ride sharing service, but had to halt the pilot program in at least one location due to significant barriers resulting from the rural geography of WCHC's service area.
California, United States
Case Study: A Transportation Solution for Rural Communities
Summary Information
West Counties Health Clinic (WCHC) is located in western Sonoma County, a rural area of far flung and isolated communities. Over 80 percent of WCHC patients live at or below the federal poverty line and many are homeless. WCHC also serves a number of people displaced by the 2017 Tubbs Fire, one of the most destructive fire in California history. Many WCHC patients must travel long distances for medical care. Some patients don’t have access to a vehicle or a friend or family member who can reliably drive them. At the same time, bus service can be spotty and often involves long waits and travel times, which can be grueling for fragile patients. For very poor patients, gasoline and bus fare costs may also be prohibitive. Transportation is one of the top three social determinants of health (SDOH) affecting the WCHC patient population.
WCHC partnered with Hitch Health to provide a transportation option to their most vulnerable patients. When a patient makes an appointment through the Hitch Health system, they receive an SMS text message offering a ride to the clinic on the date of their appointment. (Patients do not need to have a smartphone to receive the messages, nor do the they need access to the Lyft app.) If the patient accepts the ride, they receive reminders, and are picked up and taken to their appointment at the scheduled time. The system also provides clinic staff with updates on when the patient will arrive. When the appointment is over, the patient texts again, and a driver comes to take them home. This process is automated and does not involve active management by frontline health center staff.
In July 2018, WCHC launched a one-week test pilot at the Gravenstein Community Health Center near Sebastopol. The initial pilot included only patients from certain zip codes who were scheduled for primary care visits. That trial led to further refinements and more testing that varied from the text message content, to changing the how many patients were sent messages at time, to working with health center front office scripts for questions or requests about the program.
Patient response at the Gravenstein clinic was good, and the system seemed to be working well, so the project team decided to try implementing Hitch Health at the Russian River Health Center in Guerneville as well. This clinic is located in the most rural part of WCHC’s service area, where transportation insecurity is greatest and where there is very little Lyft coverage, since most Lyft drivers are concentrated in Santa Rosa, 40 minutes from Guerneville. When the clinic tried implementing the ride system, Lyft drivers repeatedly cancelled scheduled pick-ups. “We learned quickly that the rural geography created significant barriers to Lyft access both in pickup and drop-off,” according to Kathleen Figoni, WCHC’s innovation project manager. After a month of operations, WCHC had to halt the pilot at the Russian River location.
