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Improving transportation options to reduce infant mortality

Sidewalk and the city of Columbus are exploring ways to connect new and expecting mothers with the care they need.

By Willa Ng, Corinna Li, and Richard Sun

A registered nurse examines an infant

A registered nurse examines an infant during a home visit to the Linden neighborhood of Columbus, Ohio, in 2014.
(AP / Courtney Hergesheimer)

Columbus, Ohio, has one of the highest infant mortality rates among U.S. cities, a public health problem that hits underprivileged parts of the city disproportionately hard. A recent analysis found that eight lower-income Columbus neighborhoods accounted for 44 percent of all infant deaths before age one, despite making up just 30 percent of new births. No family should have to suffer this tragedy, and Columbus has set ambitious goals to address the problem by 2020.

One of the clearest contributing factors to this health disparity is transportation. Getting around Columbus without a car is tough, but owning one can be prohibitively expensive, especially for lower-income households. Public transportation is often inconvenient. Many neighborhoods lack safe sidewalks, making it tough to walk to or from a bus stop, and some clinics are in locations with little-to-no pedestrian facilities. What would be a short drive to a major hospital from North Linden, for instance, can take an hour on the bus.

To expand these options, Sidewalk Labs has been working with the city and local organizations on improving access to health providers through non-emergency medical transport (NEMT) services, such as taxis or ride providers. The collaboration emerged from our participation in the U.S. Department of Transportation’s Smart City Challenge, which Columbus won. Drawing on the insights from our teams working on mobility and community healthcare, Sidewalk is exploring ways that data and digital tools can connect new and expecting mothers with the care they need.

Columbus hopes to improve bus service with a new bus-rapid transit system called CMAX, but navigating transit can be difficult for pregnant women even in the best service conditions. Patients who miss an appointment can end up waiting hours to see a provider, creating additional complications around time off or child care. Worse still, a bad transportation experience can lead a patient to skip future visits to doctors, clinics, or pharmacies.

NEMT services can complement the city’s transportation system and improve healthcare access, but coordinating among patients, healthcare providers, and transportation providers creates challenges of its own. The status quo has many failure points: patients must call their health plan and doctor’s office about a ride, health plans must call NEMT services, services must find an available transport vehicle and connect with a patient. Any problems that arise are felt most acutely by patients, but the current system is sub-optimal for everyone involved.

Our initial explorations into existing NEMT options in Columbus showed a number of limitations. From the patient’s perspective, many services require advanced booking, lack critical features such as wheelchair lifts or car seats for small children, and can be unreliable or expensive. Often patients aren’t even aware their insurance covers NEMT services. From a care provider’s view, many offices are too short-staffed to arrange a ride on a patient’s behalf.

Based on our work with the city and local stakeholders, we see three aspects of NEMT service that carry the greatest opportunity for innovation:

  • One is around intuitive, user-friendly tools that make it easy for a patient or a healthcare provider to book a ride without making multiple phone calls—and that still work well for patients who don’t have smartphones.
  • Another is around automated support and real-time monitoring features that help NEMT services do things like verify insurance eligibility, track driver locations, and alert a doctor’s office if a patient doesn’t show. The system should capture this type of usage and outcome data and provide tools for healthcare institutions, health plans, and policy makers to evaluate—and improve—service.
  • The third area involves expanding vehicle supply. Partnerships with ride-hail companies like Lyft or Uber could help NEMT providers augment their fleet, improving reliability and reducing wait times.

These are the opportunities we’ll be exploring, working closely with the city and local community groups like Celebrate One, a city-driven initiative working to reduce infant mortality. At the end of the process, we’ll recommend strategies for the city to pursue if it so chooses, as well as major metrics to track, such as service quality. The key to this collaboration—as it was throughout the Smart City Challenge—will be listening to the local community and empowering the city to work with innovative service providers to help residents lead healthier lives.