Primary Care Plan: Shuttle Out, Uber In

Yale-New Haven Hospital has decided that Uber rides will help car-less New Haveners make it to a planned new Long Wharf primary care center more reliably than shuttles or (obviously) local buses.

So, as part of the process of obtaining state approval to open the new center, the hospital Wednesday afternoon promised to provide those rides for free.

That Uber update is one of the key proposals included in a five-point transportation plan that Yale-New Haven Hospital (YNHH) submitted to the state Office of Health Strategy (OHS).

YNHH Director of Strategy & Regulatory Planning Jeryl Topalian sent the 60-page document to OHS Hearing Officer Micheala Mitchell as the last submission in the hospital’s application to close down its primary care facilities on York Street, Chapel Street, and Whitney Avenue and move them to a single location at 150 Sargent Dr. on Long Wharf. The new primary care center, to be run in collaboration with Fair Haven Community Health Care and the Cornell Scott Hill Health Center, is called the New Haven Primary Care Consortium (NHPCC).

“YNHH has spent considerable time over the past two weeks exploring the potential for providing dedicated shuttle services,” Topalian wrote in response to the state’s request for more details on how the thousands of car-less patients who use YNHH primary care services every year will be able to get to a facility relatively removed from public transportation.

“After thoughtful evaluation,” Topalian continued, ​“we do not believe that implementation of a shuttle service will materially improve access.”

Instead, the hospital proposes to expand an existing contract with the ride share service Uber to provide free on-demand car rides for car-less patients who live within 10 miles of 150 Sargent Dr. and who would otherwise have to spend 40 minutes or more on the bus to get to their relocated primary care providers.

Click here to download the hospital’s full transportation plan.

The state also ordered the hospital and its two partners in the new proposed primary care center, Fair Haven Community Health Care and the Cornell Scott Hill Health Center, to detail their hardship waiver policies to mitigate out-of-pocket costs for the city’s poorest patients. (More on that below.)

One local critic of the proposed primary care center move, New Haven Urban Design League President Anstress Farwell, remained unimpressed Wednesday with the hospital’s transportation plan.

“They’re showing that it’s not impossible” to get to the Long Wharf facility without a car, she said. ​“They’re not showing that it’s less difficult” than getting to the current Downtown and Whitney Avenue locations. She urged the state to reject the hospital’s application for a Certificate of Need (CON) to move its primary care services to Long Wharf, and called on the hospital to scout out a new, more alternative transportation-friendly location.

Uber, Veyo, and Free Parking

In an opening ​“Background” section of the hospital’s submission, Topalian wrote that YNHH surveyed over 2,500 of its 25,000 annual primary care patients this summer to better understand how they get to and from the existing primary care center locations.

“The results of the survey showed that 66% of respondents utilize a car to get to their appointments,” Topalian wrote, ​“while 15% use public transportation, and 10% walk. Other transportation modes include medical taxi (5%), taxi/Uber/Lyft (3%), and other (1%).”

The hospital decided not to pursue new dedicated shuttle services to the proposed 150 Sargent Dr. location, Topalian wrote, because the 33 percent of patients who do not currently use a car are distributed over 23 New Haven neighborhoods, with the most coming from the Hill, Fair Haven, and Dixwell. That’s because car-less patients would still need to walk or take public transportation to get to a shuttle pick-up spot, wait for the shuttle to arrive, and then do the same commute on their way home.

“A bus or a ride-sharing service will provide more direct access and reduce waiting time,” Topalian wrote.

Instead of a dedicated shuttle service, Topalian outlined five alternative transportation strategies for car-less patients to make it out to Long Wharf.

• The first is … more, free parking. The new site will provide 250 dedicated patient parking spaces, 38 of which will be handicapped spots. All of the surface parking spots at 150 Sargent Dr. will be free of charge for patients. ​“The percentage of patients who will benefit from this change today is estimated at 66%,” Topalian wrote, ​“however, it is possible that a greater number of patients will decide to drive with the barrier of expensive and/or difficult to find parking removed.”

• The second is an expanded contract between YNHH and the ride share service Uber. The hospital currently works with Uber to provide on-demand rides for certain patients at Bridgeport Hospital, Topalian wrote. ​“This strategy will be an integral element of our transportation plan to enhance patient access at 150 Sargent Drive.”

The hospital will offer a ride-sharing service for free to all current primary care patients who transition to 150 Sargent ​“regardless of financial or insurance status, provided they cannot get to 150 Sargent Drive by car, do not require special transportation assistance, and meet the following criteria for eligibility for the service: patients must live within 10 miles of 150 Sargent Drive, and where currently available public transportation requires one or more transfers or a trip of 40 minutes or longer.”

Topalian wrote that YNHH leadership has already met with Uber to discuss the program, and that the ride share service is on board. The new service, she said, will only be available to ​“established patients, which include those who have already scheduled an appointment or have previously attended an appointment.”

• The hospital will help Medicaid beneficiaries with HUSKY A, C, and D enroll in the Veyo non-emergency medical transportation (NEMT) program. That program includes ​“a combination of public transportation assistance, ride-share vehicle, wheel-chair accessible vans, and mileage reimbursement”. She said the hospital will work with eligible car-less patients get access to wheel-chair accessible vans through the Veyo program.

• YNHH reiterated its commitment to advocate for a more frequent, reliable, and direct public buses to 150 Sargent Dr. She noted that the Long Wharf location is currently served directly by CT Transit bus routes 274 and 274C, which originate Downtown.

“In addition to increasing the number of direct bus routes,” Topalian wrote, ​“NHPCC will advocate for increased frequency of stops during ​‘off peak times,’ so that buses run every 15 minutes during the day, rather than on the half hour.”

• Finally, the hospital committed to evaluating its transportation plan for the new primary care center on an ongoing basis after the proposed move and opening of the new facility in September 2019. Topalian wrote that Fair Haven Community Health Care and Cornell Scott Hill Health Center staff will monitor ​“no show” and late appointments to see if transportation was a factor. She said the women’s primary care and pediatric patients will be survey during the six to 12-month period following the Fall 2019 opening to assess their satisfaction with 150 Sargent’s accessibility.

“In summary,” Topalian wrote, ​“YNHH’s patient transportation plan will include a combination of multiple solutions including ample free on-site patient parking at 150 Sargent Drive, with improved access for medical vans and increased handicapped spaces, YNHH- funded ride sharing through Uber, Veyo assistance for eligible CT Husky beneficiaries, and advocacy for more convenient public bus service to/from 150 Sargent Drive. The NHPCC will evaluate the transportation plan once the transition to the 150 Sargent Drive occurs, and will make adjustments based on patient and provider feedback as needed.”

“Totally Inadequate”

Two local public critics of the proposed primary care center move, Farwell and New Haven Legal Assistance Association Attorney Sheldon Toubman, said that the hospital’s transportation plan does little to address the transportation burdens that car-less patients will face at the Long Wharf facility.

“This plan for transportation from YNHH is totally inadequate,” Toubman stated by email.

He noted that committing to ​“advocating” for improved bus service is not the same as actual improved bus service. ​“It could be many years before any benefit at all would come from such advocacy,” he wrote. “[I]n the meantime, patients will go untreated because, as the hospital recognizes, bus service today to the proposed location is inadequate.”

He also dismissed the Uber plan as inadequate for people with disabilities and for patients without smart phones.

Farwell agreed, noting that the length and detail of YNHH’s transportation plan is testament in and of itself of the longer travel times, required transfers, and other barriers to access presented by the proposed Long Wharf location.

“You can’t claim that this idea of moving to Long Wharf actually means that [access to health care] is improved for most of the patients,” she said. ​“Most of the patients will have to struggle more to get down there.”

She called on the hospital to reveal which other potential locations it has looked at to host a new, centralized primary care center.

In addition to its relative inaccessibility, she said, Long Wharf is in a flood plain. ​“Facilities serving poor people tend to end up in the flood plain,” she said, referencing the severe damage sustained by the Charity Hospital in New Orleans after Hurricane Katrina.

She said that, if the hospital is serious about improving public bus service in New Haven, it should provide its employees with something analogous to a U‑Pass, which would cover their bus fare on the current public transit system.

“Advocating doesn’t do a whole lot,” she said. ​“They cant just advocate. They have to do.”

Click here to download critical testimony submitted to the state by Toubman, Farwell, and others.

Hardship Waivers

The hospital’s submission also provides details on how Fair Haven Community Health Care, Cornell Scott Hill Health Center, and YNHH will provide hardship waivers to reduce costs for the center’s poorest patients.

Fair Haven Health will waive any access fees for patients who have no income, according to the submission. A vice-president of clinical affairs will decide on whether or not to waive visit fees for patients facing significant social or economic changes, such as homelessness or shut-off utilities.

Cornell Scott Hill Health Center will consider waiving visit fees for patients who fall into one of nine listed hardship categories, including homelessness, eviction, or domestic violence.

And YNHH committed to establishing a patient assistance fund for patients who would have been eligible for financial assistance at the current primary care centers.

Below are links to previous articles about the proposed New Haven Primary Care Consortium.

• Farwell Questions Primary Care Move’s Impact On Poor
• Primary Plan’s Obstacle: Broken Bus System
• Plan Reimagines Primary Care For Poor
• West River Questions Primary Care Move
• Harp Backs Primary Care Move

Also below are Facebook Live videos of portions of Wednesday’s night’s public hearing, and of an interview earlier this year with Lagarde and Taylor on WNHH’s ​“Dateline New Haven.”