October 2016

Rail News: Passenger Rail

Photo – Metro Transit, St. Louis

By Julie Sneider, senior associate editor



Transit riders in the north St. Louis area will have access to health care screenings at local rail stations starting in early 2017.



Bi-State Development Research Institute, an affiliate of Metro Transit's parent company, last month received a $940,251 "Ride to Wellness'' grant from the Federal Transit Administration (FTA) that will allow the agency to work with the St. Louis County Department of Public Health to offer basic health care services at select MetroLink rail stations.



The research institute was awarded the grant for an 18-month pilot project to use the county's mobile health van to provide health checkups at a yet-to-be-determined number of MetroLink stations in north St. Louis.



The grant was included in the $7.3 million the FTA awarded this year as part of the Ride to Wellness Initiative, which the federal agency created to increase partnerships between health and public transportation providers. The initiative's goals are to increase access to health care, improve health outcomes and reduce health care costs.



Lack of access to transportation can keep people from receiving health screenings and primary care. About 3.6 million people miss or delay non-emergency medical care each year because of transportation issues, according to the FTA. And those missed appointments can lead to greater health problems down the road for people with chronic conditions such as hypertension and diabetes.



"We know that public transportation can be a literal lifeline to patients to help them maintain good health," FTA Acting Administrator Carolyn Flowers wrote in a recent blog post. "Rides to Wellness focuses on improving the health of those with chronic conditions and ensuring that at-risk populations can more easily get to wellness appointments, healthy food and community services."



The grants awarded last month were the first awarded under the initiative, which was created under the federal FAST Act passed by Congress in late 2015.



The St. Louis project may be the only one among the 19 grants that involves a health care provider delivering medical care to patients at a rail station, according to an FTA list of the grant awardees.



St. Louis County public health and Bi-State Research Institute officials will soon determine which stations north of St. Louis will be on the mobile health clinic route. They expect to begin providing service in January 2017, said Spring Schmidt, the St. Louis County health department's director of health promotion and public health research.



"We haven't planned out the routes yet, but the van will be out for full-day periods, three days a week," Schmidt said.



The station stops will depend on where the need for basic health services is greatest, she said. In 2011, an assessment of the county's health needs determined north St. Louis County residents had less access to medical care and faced higher barriers associated with health care costs than residents in other parts of the county. Also, when in need of health care, a majority of north St. Louis-area residents are more likely to use an emergency room for primary care.



At transit stops, the van will offer basic care such as vaccinations, flu clinics and screenings for diabetes and hypertension, Schmidt said. Patients who don't have a primary care physician will get a referral, and they’ll be coached on how to use the public transit system to get from their home to the doctor's office. Patients also will be given a transit voucher if they need one.



"We will be funding several vouchers over the course of the pilot to see if that improves the patients' follow-up care if a health screening determines something of concern," said Schmidt. "We'll always document where we collect the basic information that will help us reach back out to someone with a health condition. We want this service to have a personal touch."



Clinic staff also will help uninsured patients determine if they qualify for benefits under the federal Affordable Care Act or Medicaid programs, Schmidt said.



The Ride to Wellness grant is an opportunity for Metro Transit to help address the region's "growing problem of access to health care," said Ray Friem, Metro Transit’s executive director.



"Every day, thousands of people rely on the Metro transit system to reach important destinations throughout the region, and we are very excited that they will be able to visit our MetroLink stations and conveniently and easily connect with important health resources and care at these mobile clinics," Friem said in an email.



The FTA grant is the second time that the St. Louis transit agency received funds to explore ways to help residents access basic health care services. Last year, the research institute received a $41,900 grant from the Missouri Health Foundation to study the feasibility of offering health services at some MetroLink train stations. The study evaluated issues to consider as part of a business plan for establishing basic medical care at a rail station or a Metro bus site.



A report on the study's findings was to be issued this past spring, but was postponed while the institute completed the application for the FTA funding. Now that it’s known the Bi-State institute received the FTA funds, the institute is back to writing the report.

During the Ride to Wellness pilot, county health and institute officials will assess how the project affects the population’s health, said John Wagner, the institute's project manager for economic development. Transit agency officials also will continue to work with health department officials to seek additional funding to continue the service beyond the 18-month period, he added.



"We hope the service will be well-received and the health benefits will be apparent to people," said Wagner.



