Alternative Modes of Care Delivery

By shifting where services are delivered, alternative modes of delivery can play a role in more effectively meeting patients’ health needs and reducing health inequities. This might occur through leveraging technology, specifically telehealth, as well as using mobile health units, pop-up clinics, direct mail, and non-emergency medical transportation.

Telehealth

Examples of Interventions

• NFPRHA Telehealth Resources
• NFPRHA also has sample telehealth workflows that provide detailed steps for providing common components of family planning and sexual health care via telehealth
• A key component of providing all people with access to high-quality, culturally responsive, and equitable family planning and sexual health services is ensuring an excellent patient experience. These NFPRHA telehealth videos explore how to leverage telehealth for providing access to patient-centered care in the family planning context.
• Visit the Reproductive Health Access Project for Telehealth for Reproductive Health Care Resources.
• • Telehealth Services: Taking an Inclusive, Equity-Driven, and Trauma-Informed Approach Job Aid, compiled by the Reproductive Health National Training Center, outlines six strategies to effectively communicate about telehealth services with patients. Each strategy includes action steps that incorporate the principles of inclusion and equity, while also taking a trauma-informed approach into account.
  • Equipment issues and poor audio quality can negatively impact patient experience of care, with lower levels of patient and provider comfort with technology and technology issues correlating with lower satisfaction scores. There are many resources available help minimize technical difficulties that may arise during telehealth visits. The Reproductive Health National Training Center’s Telehealth Etiquette for Family Planning job aid assists providers to ensure a positive patient experience when conducting telehealth visits..
  • Health care providers must make reasonable language accommodations for patients with Limited English Proficiency (LEP), a requirement that also applies to telehealth services. Unfortunately, LEP individuals do not always receive necessary accommodations. HITEQ Resources for Patients with Limited English Proficiency in Health Centers provides health centers with strategies to increase their telehealth capacity for LEP patients.
  • Mail delivery of prescription and over-the-counter (e.g., emergency contraception) medications is a strategy to increase access for telehealth patients with limited geographic access to a pharmacy, or who cannot afford out-of-pocket medication costs at a pharmacy. Mailing Prescription Medications to Patients is a NFPRHA resource that outlines considerations for health centers that are exploring the feasibility and permissibility of mailing medications to patients.Essential Access Health created a resource hub, called Telehealth Essentials, that includes clinical guidelines, clinic operations, and various toolkits to support telehealth efforts.

Mobile Health Units & Pop-Up Clinics

Examples of Interventions

• Pop It Up! A Guide to Pop-Up Clinics for Family Planning and Sexual Health Services is a NFPRHA resource guide that introduces different models for implementing pop-up clinics for family planning and sexual health services.
• Mobile Health Map, a program of Harvard Medical School, is the only comprehensive database of mobile health clinics in the country. Members of this collaborative research network and learning community share information that health care organizations can reference when planning or implementing mobile health programs, including information about locations, services, priority populations, and costs. 
•  The Case for Mobile, published by Mobile Health Map explores how health centers can leverage mobile health unit programs to sustain or expand their efforts to deliver health care in under-resourced communities. For this report, the developers of Mobile Health Map interviewed 25 health care leaders to explore their views and experiences related to mobile health care; they then used thematic analysis to identify patterns and create a conceptual framework.
• Mobile Health Units: A Strategy to Increase Access to Family Planning and Sexual Health Services[i] is a NFPRHA resource that provides an overview of mobile health units for family planning and sexual health services. To compile the guide, which includes examples and lessons learned from the field, NFPRHA conducted a literature review and interviews with several family planning and sexual health services providers that were operating or in the process of launching mobile health programs.
• For mobile health units, accurate prediction of demand is key to daily operations and staff and resource allocation. In this article, Using Public Data to Predict Demand for Mobile Health Clinics, Chen et al. explore how to predict demand for mobile health clinics, and propose a methodology that uses public data sources to account for factors that may affect the demand, including weather and foot traffic.

Non-Emergency Medical Transportation

Examples of Interventions

• The Rural Health Information Hub’s Rural Transportation Toolkit contains modules with resources and information focused on developing, implementing, evaluating, and sustaining rural transportation programs. 
• Promising Practices for Increasing Access to Transportation in Rural Communities, compiled by the Walsh Center for Rural Health Analysis and the University of Chicago, highlights key findings from the project, which identified 15 promising rural transportation program models.
• In Getting from Here to There: Improving Non-Emergency Medical Transportation for the Underserved, the Health Equity Project, in conjunction with Third Horizon Strategies, focuses on transportation as an important social determinant of health and suggests strategies that states and key stakeholders can undertake to improve access to Non-Emergency Medical Transportation among Medicaid beneficiaries and Medicaid-eligible populations.
• Ridesharing services are developing partnerships with health systems to provide non-emergency medical transportation that has been shown to improve access to primary and preventive care. Lyft has partnered with Allscripts and Epic, two large EHR vendors, to enable health care organizations to use their EHR platforms to schedule rides for patients with transportation barriers; and Uber has partnered with Cerner Corporation, another large EHR vendor, to integrate the Uber Health app with Cerner’s EHR
  platforms. Health care organizations seeking to support patients with accessing transportation may wish to explore their EHR’s current capabilities, if applicable. They also can explore how to work directly with ridesharing services to provide transportation to patients.