final report -...

2018

Final Report

MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY

JUNE 2018

PREPARED BY:

Kimley-Horn

PREPARED FOR:

Potomac Health Foundation

Potomac And Rappahannock Transportation Commission (PRTC)

Final Report June 2018

MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page i

Contents

1. Introduction ........................................................................................................................ 1

1.1 Background and Overview ............................................................................................................ 1

1.2 Wheels to Wellness ........................................................................................................................... 2

2. Current State of Practice .................................................................................................... 4

2.1 Research ............................................................................................................................................ 4

2.1.1 Researched Programs and Contacts ...................................................................................... 4

2.2 Findings ............................................................................................................................................... 6

2.2.1 Service Model Bins ........................................................................................................................ 6

2.2.2 Program Evaluation Criteria ....................................................................................................... 6

2.2.3 Program Reviews .......................................................................................................................... 7

2.2.4 Funding Mechanisms ................................................................................................................. 13

2.2.5 Virginia TNC Regulations ........................................................................................................... 15

2.2.6 Research Conclusions ............................................................................................................... 16

2.3 Recommended Future Research/Outreach ............................................................................ 17

2.3.1 Data Availability and Contact with Major TNC Companies ............................................. 17

2.3.2 Non-paratransit Partnership Examples with TNCs ................................................................. 17

2.3.3 Documented Costs and Success of Pilot Programs ............................................................ 17

3. Alternatives Development ............................................................................................... 18

3.1 Evaluation Measures and Criteria Development ..................................................................... 18

3.1.1 Mobility ......................................................................................................................................... 18

3.1.2 Accessibility ................................................................................................................................. 18

3.1.3 Program Delivery ........................................................................................................................ 18

3.1.4 Funding ......................................................................................................................................... 18

3.2 Preliminary Alternative Program Development ........................................................................ 19

3.3 Scoring Process and Alternatives Analysis ................................................................................. 22

4. Recommendations ........................................................................................................... 24

4.1 Workshop .......................................................................................................................................... 24

4.2 Preferred Alternative ...................................................................................................................... 24

4.2.1 Description ................................................................................................................................... 25

4.2.2 Process Flow ................................................................................................................................ 27

4.2.3 Scoring of the Preferred Alternative ....................................................................................... 28

4.3 Discussion of Scoring and Benefits .............................................................................................. 29


MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page ii

4.4 Barriers and Risks ............................................................................................................................. 31

5. Next Steps ......................................................................................................................... 32

5.1 Implementation Steps .................................................................................................................... 32

5.2 Strategic Implications .................................................................... Error! Bookmark not defined.

6. References ........................................................................................................................ 36

Reference A: Inventory of Data Collection & Research (Research Task 1)

Reference B: Current State of Practice (Research Task 2)

Reference C: Alternatives Development Memo (Research Task 3)

Figures

Figure 1: Wheels to Wellness Timeline ............................................................................................................ 3

Figure 2: Key Funding Sources ...................................................................................................................... 14

Figure 3: Combined Alternative Scoring Results ....................................................................................... 22

Figure 4: Preferred Alternative Process Flow .............................................................................................. 28

Figure 5: Combined Alternative Scoring Results (with Preferred Alternative) ..................................... 29

Figure 6: Implementation Timeline ............................................................................................................... 34

Tables

Table 1: Research Summary ............................................................................................................................ 5

Table 2: Program Evaluation Criteria ............................................................................................................. 7

Table 3: Wheels to Wellness Summary ........................................................................................................... 8

Table 4: Brookdale Senior Living & Lyft .......................................................................................................... 8

Table 5: City of Gainesville, Florida “Freedom in Motion” Senior Transportation Pilot ......................... 9

Table 6: City of Laguna Beach Senior Mobility Pilot Program .................................................................. 9

Table 7: GRTC Transit System (Richmond) – UZURV/Roundtrip ............................................................... 10

Table 8: MBTA (Boston) – Uber and Lyft ...................................................................................................... 10

Table 9: Fairfax County Human Services .................................................................................................... 11

Table 10: MedTrans Network ......................................................................................................................... 11

Table 11: PSTA (Pinellas County) – Transportation Disadvantaged Program ...................................... 12

Table 12: MARTA Rides to Wellness .............................................................................................................. 12

Table 13: NV Rides ........................................................................................................................................... 13

Table 14: Evaluation Measures Summary ................................................................................................... 19

Table 15: Summary of Preliminary Alternatives .......................................................................................... 20

Table 16: Preferred Alternative Description................................................................................................ 27

Table 17: Preferred Alternative Risks and Mitigations ............................................................................... 31

Table 18: Implementation Action Steps ...................................................................................................... 33

MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 1

1. INTRODUCTION

GAs healthcare availability improves for underserved populations across the nation, barriers are

becoming more evident for the populations which need reliable and effective means of

transportation for non-emergency medical needs. The Potomac and Rappahannock

Transportation Commission (PRTC) received a grant from the Potomac Health Foundation (PHF)

in June 2017 to perform a Mobility on Demand Healthcare Access Feasibility Study (referred to in

this document as the ‘Study’) to determine the feasibility of leveraging new and emerging

transportation service models to enhance and/or improve access to healthcare, especially for

underserved populations in the Prince William area.

This report contains the research, results, and recommendations from the Study. It is broken into

the following sections and content:

1. Introduction (background and a review of Wheels to Wellness)

2. Current State of Practice (research, findings, and recommended future research)

3. Alternatives Development (evaluation measures, preliminary alternatives, and scoring)

4. Recommendations (workshop, preferred alternative, scoring, benefits, barriers and risks)

5. Next Steps (implementation steps and opportunities)

It describes the review of existing practices, legislation, documentation, and includes information

gathered from leading industry experts. This research is then analyzed and coalesced into a

current state of practice, describing the best practices and lessons learned from across the

nation. Lastly, this information was used to develop alternatives and evaluations, culminating in

a recommended, implementable transportation solution for PRTC to offer its customers.

1.1 Background and Overview

PRTC is a is a multimodal, multijurisdictional agency representing the greater Prince William

County area. Located in Virginia about 25 miles southwest of Washington, D.C., PRTC provides

transit services through the region. Service include commuter and local bus services in Prince

William County and the cities of Manassas and Manassas Park, a ride-matching service,

commuter benefits programs, and the Virginia Railway Express (VRE) in partnership with the

Northern Virginia Transportation Commission (NVTC). Most relevant to the purpose of the Study,

PRTC also provides a service called Wheels to Wellness, which is a taxi-voucher program for

seniors, persons with disabilities, and low-income households.

In mid-2017, PRTC solicited a proposal to aid in the Mobility on Demand Healthcare Access

Feasibility Study. This contract was developed in order to:

THE GOAL OF THE PROJECT IS TO DEVELOP A FEASIBLE SOLUTION

FOR FLEXIBLE TRANSPORTATION TO AND FROM NON-EMERGENCY

MEDICAL APPOINTMENTS FOR THE RESIDENTS OF THE PRINCE WILLIAM

AREA OF VIRGINIA. THE SOLUTION SHOULD BE RELIABLE, ACCESSIBLE,

EQUITABLE, AND SUSTAINABLE FOR PRTC AND ITS CUSTOMERS.



▪ Identify any similar existing or planned programs or partnerships

▪ Analyze and review the costs and benefits of these programs

▪ Research and identify any pertinent federal guidance and state or local regulations

▪ Identify any potential barriers to program participation and suggest program design

remedies

▪ Define any industry best practices and interest level of potential partners

▪ Make recommendations as to the feasibility of pursuing partnerships with Transportation

Network Companies (TNCs) or other service providers

▪ Estimate the potential impact of such a program in the Prince William County area

▪ Recommend performance measurements for any such program

From October 2017 through June 2018, the project team (PRTC and PRTC’s selected consultant,

Kimley-Horn) worked together to complete the Study. The project was broken into four distinct

tasks, reflective of typical research methodology:

▪ Data Collection/ Assembly and Study

▪ Current State of Practices and Like Services

▪ Preliminary Alternative Development and Evaluation

▪ Preferred alternative

1.2 Wheels to Wellness

Wheels to Wellness is the existing PRTC program designed to meet the transportation needs of

seniors, persons with disabilities, and low-income households. Needs vary from individual to

individual, but Wheels to Wellness was designed for residents who were unable to reach public

transportation, and those who’s transportation options were limited by cost. It was never

intended to supplement or replace paratransit service in the area.

Wheels to Wellness began as a result of the 2008 recession, when Prince William County was

forced to discontinue financial support for the Prince William County Area Agency on Aging’s

transportation program. The Area Agency on Aging applied for a federal New Freedom grant

through the Metropolitan Washington Council of Governments Transportation Planning Board

(MWCOG TPB) to fund the development of a county-wide mobility plan with PRTC taking on a

partner role, procuring consultants and managing plan development. At the request of

MWCOG TPB low-income households were added to the population to be served by the plan.

Eligibility in PRTC’s Wheels to Wellness program is described by the required criteria

(as of Fall 2016):

1. Must reside in the PHF specified zip codes within Prince William County, VA and

2. Must not qualify for Medicaid

3. Must be 80 years of age or older and

4. Must have a disability as defined by the ADA

5. Must have a household income less than 1.9 times the federally-defined poverty level

Note that for the period of time from inception (February 2013) to Fall of 2016, only the first and

second criteria above and one of the criteria three through five were required for eligibility.



Wheels to Wellness began operations in 2012, with grant support from the Potomac Health

Foundation. Over several years, the program experienced a decline in funding and support,

with increases in eligibility restrictions in order to maintain program fiscal viability. Currently, the

program is set to continue operation with support from the Potomac Health Foundation and the

MWCOG through summer of 2019. Thus, PRTC’s goal through this study is to identify

augmentations or to propose a replacement of the existing program for the continued service

of the populations in need.

A summary of the Wheels to Wellness service is described in Table 3 as part of the research

summaries in the Current State of Practice section of this report. A timeline of Wheels to Wellness

operations is shown in Figure 1.

Figure 1: Wheels to Wellness Timeline

Source: PRTC



2. CURRENT STATE OF PRACTICE

As part of the study methodology outlined in the introduction, the project team performed a

substantial review of existing programs and strategies currently in use. This section outlines the

organizations and individuals contacted and summarizes the information collected from the

interviews and research. Note that this information may also be found in Reference B.

2.1 Research

The purpose of the research portion of this

study was to collect existing data and

information that is relevant and available

for use during the study development

process. In an effort to gain insight to the

existing state-of-the-art mobility, the project

team:

▪ Investigated peer transit agencies

▪ Interviewed subject matter experts

▪ Connected transportation network

companies (TNC)s

▪ Researched existing Mobility as a

Service (MaaS) programs

▪ Contacted health provider networks

▪ Reviewed industry publications

2.1.1 Researched Programs and Contacts

The following table( Table 2) summarizes the research performed as part of this study including

the points of contact and/or the publishing agency. Contacts and research were found though

industry partners and contacts, as well as by referencing the Shared Use Mobility Center

Clearinghouse database. The ‘Type of Research’ column describes if it was a conversation,

document review, or other source. The ‘Organization/Title’ column states the document title (if

any) and agency, company, or who the publishing organization is. The ‘Contact‘ column states

the individual (or individuals, if any) who were interviewed.



Table 1: Research Summary

Type of Research Organization/Title Contact

Topic Matter Expert

Commute Seattle Jonathan Hopkins

Transportation Research Board Katherine Kortum

Spare Labs Kristoffer Vik Hansen

Via Louis Papas

Atlanta Regional Commission (past) Renee Autumn Ray

Program Review

NVRides Jennifer Kanarek

Brookdale Senior Living/Lyft Not Applicable

City of Gainsville, Florida Not Applicable

City of Laguna beach Senior Mobility

Pilot Program

Not Applicable

Program Review

Greater Richmond Transit Company

(GRTC) & UZURV Partnership

Tim Barham

Carrie Rose Pace

Massachusetts Bay Transportation

Authority (MBTA) Pilot Program

Not Applicable

MedTrans Network and Uber Not Applicable

Atlanta Regional Commission Rides to

Wellness

Amanda Tyler

Pinellas Suncoast Transit Authority (PSTA)

Transportation Disadvantaged Program

Not Applicable

Healthcare Provider

Healthcare Provider

Novant Health Not Applicable

Virginia Commonwealth University Ryan Raising

Service Provider Uber Nick Zabriskie

Local Government Fairfax County Human Services

Transportation

Susan Shaw

Cynthia Alarico

Document

Feasibility of Using Private Operators and

Independent Contractors for ADA

Paratransit Services (DRPT, 2015)

Not Applicable

Shared Mobility and the Transformation

of Public Transit (TRB, 2016)

Not Applicable

Policy Implications of Transportation

Network Companies (Texas A&M

Transportation Institute, 2017)

Not Applicable

State Guidance

Document

Virginia TNC Regulations (Misc.

Documents)

Not Applicable

Federal Guidance

Document

Federal Transit Administration Grant

Programs

Not Applicable

Federal Guidance

Letter to TNCs

Anthony R. Foxx, former U.S. DOT

Secretary on TNCs (December 5, 2016)

Not Applicable



2.2 Findings

This section describes and summarizes the findings from the research portion of this study.

Included are the descriptions of the service models (groupings for reviewing the programs), the

evaluation criteria used to analyze the programs, reviews of each of the programs, the funding

mechanisms as determined in each of the reviews, a description of TNC regulations in the state

of Virginia, and conclusions regarding the cumulative research.

2.2.1 Service Model Bins

To categorize and compare the researched programs, a set of three distinct service model bins

were created. The three bins and brief descriptions of each are described below.

Taxi/TNC/Transit Subsidy Program

The first and most common and congruent program to the existing Wheel to Wellness service is a

subsidy program. Through various methods such as paper voucher or transit pass, a transit

provider subsidizes rides for the end user on services other than the transit company vehicles. The

transit provider may support an alternative booking method such as a third-party reservation

company or independent service provider application.

On-Demand Flexible Transit

The second program style, On-Demand Flexible Transit, operates generally as a paratransit-style

or micro-transit style service. The end users request transit rides which may or may not have co-

pay/fee, depending on the program structure. This includes first-mile, last-mile to transit

connections to augment the breadth and efficiency of the system.

Aggregate Provider

The third program style operates as a collaboration with loosely organized affiliates; as such,

aggregate providers act as a clearinghouse for trips. These services primarily act as a resource

to users, connecting the trip purpose and need with the service provider. Most often this style of

service is offered by non-profit or benevolent organizations.

2.2.2 Program Evaluation Criteria

A set of key evaluation criteria was used to extract relevant topics and information during the

research and review process. These are shown in Table 2.



Table 2: Program Evaluation Criteria

Program Delivery &

Operations

Funding & Payment

Process

Challenges & Barriers Lessons Learned

▪ Structure

▪ Key Personnel

▪ Daily functioning of

the service

▪ Status of the

program

▪ Funding

mechanisms

▪ User payment

process

▪ Applicable subsidies

▪ Specific insights

gleaned from

conversation

▪ Limits on success or

expansion

▪ Program highlights

▪ Valuable

information in

relation to PRTC

Other Considerations - Other information regarding the program which is not included in the

above categories

Helpful Links Web links to the program website or other supporting documentation for further

reading

2.2.3 Program Reviews

This section is organized into the three service model bins (Taxi/TNC Subsidy Programs, On-

Demand Flexible Transit, and Aggregate Providers) and includes a review of the existing Wheels

to Wellness program as an example. Lastly, a list of considered programs which were only

partially reviewed. Within each section, the programs are summarized in brief following the

evaluation criteria described in the previous section. Full program reviews and evaluations are

provided in Reference A.

The following programs are reviewed in this section:

▪ Wheels to Wellness

▪ Taxi/TNC Subsidy Programs

Brookdale Senior Living & Lyft

City of Gainesville, Florida “Freedom in Motion” Senior Transportation Pilot

City of Laguna Beach Senior Mobility Pilot Program

GRTC Transit System (Richmond) – UZURV/Roundtrip

MBTA (Boston) – Uber and Lyft

▪ On-Demand Flexible Transit

Fairfax County Human Services

MedTrans Network

PSTA (Pinellas County) – Transportation Disadvantaged Program

Metropolitan Atlanta Rapid Transit Authority (MARTA) Rides to Wellness

▪ Aggregate providers

NV Rides

▪ Other Programs Considered

Arlington Rideshare

A Mississippi City

Veyo



Wheels to Wellness

Table 3: Wheels to Wellness Summary

Program Delivery &

Operations

Funding & Payment

Process


▪ Taxi voucher program

funded through PHF

Grant

▪ Began as a senior (80+)

needs program

▪ Expanded to include

low-income residents

and disabled persons

▪ Currently provides 1,424

trips per year (peak

participation was 20,183

trips)

▪ Restricted to medical-

related appointments

▪ Users must not be

Medicaid-eligible

▪ Currently funded through

combination of grants by

MWCOG and PHF

▪ Subject to variable

funding due to unstable

grant history

▪ User pays $3.00 with card

for medically-related

trips, then subsidized up

to $15.00 from PRTC

▪ Maximum monthly

subsidy is $180.00

▪ Reliance on grant funds

did not provide enough

stable funding

▪ Restriction of funds

modified eligibility

requirements, limiting

participation to low

income AND either senior

(80+) or disabled

▪ Debit card/

reimbursement scheme

▪ Expanded geographic

coverage is desirable to

reach the maximum

number of participants

▪ Uncertainty in funding

led to difficulties in

spreading awareness of

the program

Other Considerations - Wheels to Wellness is housed under PRTC (transit agency), where many comparable programs

full under human services departments of the local government

Helpful Links http://www.prtctransit.org/special-programs/wheels-to-wellness.html

Taxi/TNC Subsidy Programs

Table 4: Brookdale Senior Living & Lyft

Program Delivery &

Operations

Funding & Payment

Process


▪ Residential ride-

scheduling service for

the senior residential

community

▪ Service provided by Lyft,

with Brookdale staff using

the Lyft concierge

service

▪ Currently active for

residents

▪ Brookdale residents’ rides

are billed directly to their

room account

▪ No external funding since

rides are paid in full by

user

▪ Service is limited to a

very select number of

people, specifically

Brookdale residents

▪ Lyft provides a platform

that may be easily used

by any user, and the end

user may not need to be

the scheduler of the ride

▪ This style of service may

support a banking-

detached user to

schedule a ride

Other Considerations - Since the program is for Brookdale seniors only, no public agency is involved with the

operations

Helpful Links https://www.brookdale.com/en/brookdale-life/blogs/2017/04/transportation-for-seniors-brookdale-and-lyft-partner-up-to-give-

residents-a-ride.html

http://www.prtctransit.org/special-programs/wheels-to-wellness.html

https://www.brookdale.com/en/brookdale-life/blogs/2017/04/transportation-for-seniors-brookdale-and-lyft-partner-up-to-give-residents-a-ride.html

https://www.brookdale.com/en/brookdale-life/blogs/2017/04/transportation-for-seniors-brookdale-and-lyft-partner-up-to-give-residents-a-ride.html



Table 5: City of Gainesville, Florida “Freedom in Motion” Senior Transportation Pilot

Program Delivery &

Operations

Funding & Payment

Process


▪ Currently a pilot program

with Uber

▪ Started as a program for

two neighborhoods

which expanded under

the ElderCare program

of Alachua County

▪ Senior ride program (60+)

for any trip purpose

▪ When a trip is booked

(using the Uber app), the

cost is charged at the

copay amount to the

ElderCare account

▪ Currently active through

a pilot program structure

▪ Funding source is

currently unconfirmed

but assumed to be

locally funded

▪ End user income

determines the required

copay amount

(between $1 and $5)

▪ Booking must be

performed through the

Uber application, which

may be difficult for some

populations

▪ Variable copay

requirement helps to

meet the specific

financial needs of each

individual user

Other Considerations - Uber provided limited-capacity smartphone to a number of individuals to be able to use the

Uber app

Helpful Links http://policies.sharedusemobilitycenter.org/policy/643/files

Table 6: City of Laguna Beach Senior Mobility Pilot Program

Program Delivery &

Operations

Funding & Payment

Process


▪ Pilot program with Uber

▪ Senior ride program (55+

if unable to drive, 75+

otherwise), and disabled

persons (18+)

▪ Eligibility is determined

through application

process

▪ Currently provides

daytime service only

▪ City provides a call-

number for seniors not

wishing to use a smart

phone

▪ Currently active through

a pilot program structure

▪ Expanded for six months

in 2016, but no updates

following that period

▪ End user income pays

50% of ride up to $5

▪ Out-of-city medical trips

have $8 maximum

▪ Compliments a

donation/ volunteer

program “Sally’s Fund”

▪ Booking is performed

through the Uber

application, which may

be difficult for some

populations

▪ Must use a credit card to

set up fare payments

▪ Public services may be

partnered with existing

volunteer programs to

supplement and expand

Other Considerations - As a promotion, the first two months of using the service are free for the user, up to 40 rides per

month

Helpful Links http://www.lagunabeachcity.net/civicax/filebank/blobdload.aspx?BlobID=18564

http://policies.sharedusemobilitycenter.org/policy/643/files

http://www.lagunabeachcity.net/civicax/filebank/blobdload.aspx?BlobID=18564



Table 7: GRTC Transit System (Richmond) – UZURV/Roundtrip

Program Delivery &

Operations

Funding & Payment

Process


▪ UZURV and Roundtrip are

on-demand/ reservation

companies which

coordinate with private

vehicle operators

▪ Program operates

separately from the

transit service (no

connection to bus

required)


through application and

user is provided an

identification card

▪ The user may currently

call or go online to

schedule a ride

▪ Credit card is required

▪ Payment is subsidized as

a reduced rate at the

time of booking

▪ User provides $6 co-pay

and GRTC subsidizes up

to $15

▪ Funding is provided

through GRTC operations

budget (local, state, and

federal funds)



▪ Allows GRTC to access a

number of potential

vehicle operators

through single contract

▪ Existing market in

transportation for on-

demand and short-

notice trips

▪ Started at a small scale,

by design

Other Considerations - UZURV and Roundtrip are two options for GRTC’s CARE program (paratransit) that provide an

alternative that can be used same-day, on demand for those able to use the service

Helpful Links http://ridegrtc.com/services/specialized-transportation/care-on-demand/

Table 8: MBTA (Boston) – Uber and Lyft

Program Delivery &

Operations

Funding & Payment

Process


▪ On-demand ride-

scheduling service in

combination with private

operator

▪ Separate from transit

service


through application and

interview

▪ Lyft provides call center

support

▪ Uber provided limited

smartphones for some

users

▪ Set to expire in August of

2018

▪ Agency reimburses Uber

or Lyft:

▪ UberPool - first $1 and

anything over $41

▪ Uber and Lyft – first $2

and anything over

$42

▪ Credit card required

▪ Payment is subsidized

when booking is

performed, in the vehicle

operator application



▪ Each user required to

choose to use either

Uber or Lyft as a service

▪ Drivers may not be

trained to serve

individuals with special

needs

▪ As a pilot program, MBTA

has the ability to cancel

or modify the program at

any time (how it was

expanded in March

2017) after more than

10,000 rides were taken

Other Considerations - One in five participants of the pilot no longer use the agency paratransit service

Helpful Links https://www.mbta.com/accessibility/the-ride/on-demand-pilot; http://www.mass.gov/governor/press-office/press-

releases/fy2017/the-rides-on-demand-paratransit-service-expanded.html;

http://ridegrtc.com/services/specialized-transportation/care-on-demand/

https://www.mbta.com/accessibility/the-ride/on-demand-pilot

http://www.mass.gov/governor/press-office/press-releases/fy2017/the-rides-on-demand-paratransit-service-expanded.html

http://www.mass.gov/governor/press-office/press-releases/fy2017/the-rides-on-demand-paratransit-service-expanded.html



On-Demand Flexible Transit

Table 9: Fairfax County Human Services

Program Delivery &

Operations

Funding & Payment

Process


▪ The department of

Human Services provides

both a taxi voucher

program and a flexible

transit program

▪ Applications are required

for each of the program

services: low-income

seniors, disabled persons,

and low-income

households

▪ Requires the use of one

of four taxicab vendors

(no TNC participants)

▪ Paper vouchers are

purchased at a reduced

rate of $20 for $33 of

coupons for low income

seniors, or $10 for $33 of

coupons for other eligible

users

▪ Some program funding is

provided through section

5310

▪ Other program funding

provided through Fairfax

County general funding

▪ The program is sustained

through a combination

of county funding and

grants

▪ Paper vouchers require

users to purchase in-

person or through the

mail

▪ Housing in Human

Services department (as

opposed to DOT)

allowed staff to focus on

specialized needs

▪ Fairfax County Human

Services was interested in

partnership with PRTC

and continue

conversations about

regional connections

Other Considerations - The program is currently pursuing a county-issued debit card for users as opposed to paper

vouchers as well as a common intake for the differing eligibility requirements; the county also provides a flexible transit

system called Fasttran

Helpful Links https://www.fairfaxcounty.gov/neighborhood-community-services/transportation;

https://www.fairfaxcounty.gov/neighborhood-community-services/transportation/fastran

Table 10: MedTrans Network

Program Delivery &

Operations

Funding & Payment

Process


▪ Coordinator of

transportation medical

benefits

▪ Often hires ambulatory

livery companies,

sometimes Uber

▪ End user calls MedTrans

to schedule a trip

through a variety of

providers

▪ Funded through

healthcare plans

▪ End user has variable

costs, depending on their

healthcare plan, but the

fee to MedTrans is

negotiated

▪ No specific Challengers

or barriers noted

▪ No specific lessons

learned through service

operations

Other Considerations - None

Helpful Links https://www.natmedtrans.com/; https://blog.lyft.com/posts/nationalmedtrans-concierge

https://www.fairfaxcounty.gov/neighborhood-community-services/transportation

https://www.fairfaxcounty.gov/neighborhood-community-services/transportation/fastran

https://www.natmedtrans.com/

https://blog.lyft.com/posts/nationalmedtrans-concierge



Table 11: PSTA (Pinellas County) – Transportation Disadvantaged Program

Program Delivery &

Operations

Funding & Payment

Process


▪ Service currently consists

of several components

based on user

requirements

▪ Eligibility is based on

application and income

▪ Program uses a

dispatcher to assign the

appropriate service to

user

▪ On-demand service

began as first-mile, last-

mile with Uber

▪ Received $300,000 from

Florida Commission for

Disadvantaged

▪ Received funding from

FTA Mobility on Demand

Sandbox grant

▪ User pays reduced rates

if eligible

▪ No specific Challengers or

barriers noted

▪ Breaking a program into

different user segments

may lead to operational

efficiencies

Other Considerations - None

Helpful Links https://www.psta.net/programs/td-transportation-disadvantaged/; http://www.fdot.gov/ctd/index.htm

Table 12: MARTA Rides to Wellness

Program Delivery &

Operations

Funding & Payment

Process


▪ 18-month pilot program

▪ Program is managed by

the Atlanta Regional

Commission (ARC) in

partnership with four

clinics and MARTA

▪ Provides MARTA system

farecards for the clinic

patients

▪ ARC also will provide

travel trainings for

unfamiliar system users

▪ Eligible users are

provided fare cards

which are reloaded by

MARTA

▪ $337,628 start-up funding

provided by FTA Rides to

Wellness Program

▪ Partnership agreements

are complicated,

leading to difficulties

▪ Geographic area are

limited to those served

by MARTA bus, rail, or

demand responsive

system

▪ Individual feedback from

patients who use the

service allow for

improvements and

ensure continued use

▪ Important to identify non-

profits and grassroots

leaders in the community

to help connect with

individuals

▪ Partnering directly with

healthcare clinics proved

effective

Other Considerations - FTA funding cited that 200 individuals were intended to receive selection for this program and

a summit would be created for future opportunities and collaboration

Helpful Links https://www.transit.dot.gov/funding/grants/fy-2016-rides-wellness-demonstration-and-innovative-coordinated-access-and-

mobility; https://www.smartcitiesdive.com/news/atlanta-pilots-rides-to-wellness-program-to-increase-healthcare-access/510138/

https://www.psta.net/programs/td-transportation-disadvantaged/

http://www.fdot.gov/ctd/index.htm

https://www.transit.dot.gov/funding/grants/fy-2016-rides-wellness-demonstration-and-innovative-coordinated-access-and-mobility

https://www.transit.dot.gov/funding/grants/fy-2016-rides-wellness-demonstration-and-innovative-coordinated-access-and-mobility

https://www.smartcitiesdive.com/news/atlanta-pilots-rides-to-wellness-program-to-increase-healthcare-access/510138/



Aggregate Providers

Table 13: NV Rides

Program Delivery &

Operations

Funding & Payment

Process


▪ Volunteer network,

operated through

partnership of Fairfax

County and Jewish

Council for the Aging

▪ Staff operates as a ride

clearinghouse,

connecting users to

appropriate services

(approximately 12

programs)

▪ Provides scheduling

software and background

checks for membership

service providers

▪ Specifically for seniors

▪ Funding for NV Rides

operation is provided

through Fairfax County

▪ Funding for the member

programs comes from

various sources

▪ Users do not directly

pay for rides, unless it is

a membership-style

program (such as

‘villages’ – a Fairfax

County Aging in Place

Program)

▪ Many providers are

community-based (such

as faith) and hesitant to

join a network

▪ The only requirements for

providers are the driver

background check and

proof of insurance

▪ Looking to expand, but

limited to service area

due to funding sources

▪ Marketing to seniors can

be difficult; in-person,

grassroots efforts are the

most effective

▪ Many independent

volunteer programs do

not have requirements

for vehicle conditions or

driver training (NV rides

does)

Other Considerations - In order to expand the service area, NV Rides is looking at other grant sources outside of

Fairfax County

Helpful Links http://www.nvrides.org/

Other Programs Considered

Programs listed below were encountered during research, but we not included as a full review

as a result of irrelevance or minimal information availability.

▪ Arlington Rideshare is a partnership between Arlington County and Via. The service fee is $3

flat, paid using a credit or prepaid card. An application is used for the booking interface.

▪ A Mississippi City is pursuing a ‘ground-up’ transit system approach, starting with a smaller

on-demand service modeled to grow into a transit system. Full details had not been publicly

released during the research stage of this study.

▪ Veyo is a service which provides medical transportation for healthcare benefits. Veyo

contracts with multiple service providers to supply a ‘virtual fleet’ of vehicles, paid for by user

insurance.

2.2.4 Funding Mechanisms

A core component of the programs reviewed for this study was the funding source for the

inception of the service and continued operations. The team found that funding has the

potential to stand as both an opportunity and a barrier to the development of a service model.

Opportunities included those which support innovation, technology, and forward thinking.

Barriers included the required establishment of sustained dedicated funding and operations

which rely on grants.

http://www.nvrides.org/



Figure 2 describes the four primary funding sources the reviewed programs used to maintain

operations.

Figure 2: Key Funding Sources

The following sections list potential funding sources as identified during research. Note that

depending on the program structure selected, some of the funding sources may not be

applicable.

Federal Transit Administration

▪ Enhanced Mobility of Seniors & Individuals with Disabilities - Section 5310; both Traditional and

Nontraditional projects; may be applied to operating assistance or capital projects

▪ Mobility on Demand (MOD) Sandbox Program; may or may not be renewed in an upcoming

term (to which PRTC previously applied)

▪ Public Transportation Innovation - Section 5312; issues grants as funding becomes available

▪ Transportation Investment Generating Economic Recovery (TIGER) Program (BUILD?)

Virginia

▪ Enhanced Mobility of Seniors & Individuals with Disabilities - Section 5310; disbursement

through Virginia Department of Rail and Public Transportation (DRPT)

▪ DRPT Demonstration Project Assistance

Key

Funding

Sources

Federal Transit Administration

Virginia

Local & Regional

Community

Local government or

regional funding

opportunities through grants

or partner organizations

Grassroots opportunities

which allow operations to

exist independently without

strong centralization

Disbursement of allocated

federal funding or other

programs which exist at the

state level

Federal programs which may

be restricted to capital

investments as opposed to

an operational budget



▪ DRPT Senior Transportation Program

▪ Virginia Health Care Foundation Health Safety Net grant

Local and Regional

▪ Continued support from Potomac Health Foundation

▪ Local jurisdictional general funds

▪ Coordinated Human Service Transportation Plan for the National Capital Region – Section

5310 funding through MWCOG Grant and Transportation Planning Board

Community

▪ Benevolent contributions from community members and organizations

▪ Non-monetary contributions from towns and villages

2.2.5 Virginia TNC Regulations

As part of the research task of this study, a review of Virginia regulations was performed with

respect to TNC operations in the Commonwealth. A TNC (or a TNC partner) is defined as a

person who provides prearranged rides using a digital platform that connects passengers with

TNC partners. It is important to note that a TNC, by definition, must use a digital platform to

arrange rides, and the rides themselves must be prearranged (no street-hailing). As such, TNC’s

stand distinct from ridesharing (which is a not-for-profit activity between non-contractual parties)

and motor carriers (which are subject to separate regulations). Cash payments must not be

accepted for TNC trips.

Similar to other vehicle-based professions, a TNC contractor (driver) may not operate a motor

vehicle for more than 13 hours during a 24-hour period. A TNC must also provide an option for

customers who require a wheelchair accessible vehicle, but may not apply any additional

charge for the service. Service animals must be permitted in the vehicle as well.

According to state law, TNC’s must disclose the following to the public:

▪ According to state l Fare calculations and rates (including fare estimates)

▪ Driver screening information

▪ A reporting process for drivers under the influence

▪ Vehicle Standards

▪ Training and testing policies for new drivers

▪ Phone number for customer support

According to state law, TNC’s must disclose the following to their passengers:

“A transportation network company is a for-hire motor carrier that provides

prearranged rides for compensation using a digital platform that connects

passengers with drivers using personal vehicles”.

-Virginia Department of Motor Vehicles



▪ Photo of the driver, driver’s first name, license plate number, make and model of the vehicle

▪ An electronic receipt which includes the route map, time of trip, fare, the drivers first name

and photo, and customer support contact

TNC drivers must be age 21 or older and possess a valid driver’s license. The driver must pass

multi-state criminal records database search prior to driving and once every 2 years. They must

also undergo a driving history report in the driver’s licensed state prior to driving and once a

year. The TNC driver must pass a sex offender check prior to driving and once every 2 years.

There is a zero-tolerance drug and alcohol use policy for TNC operators.

TNC vehicles must be registered as a personal vehicle in Virginia (not for-hire), and receive a

certificate of fitness. They must pass the State vehicle inspection, seat no more than 8 people,

and display TNC-issued trade dress which is visible for 50 feet in daylight.

A TNC driver must maintain 2 sets of insurance: one for when the vehicle is in operation but is not

servicing passengers, and one when the vehicle is en-route to a passenger, carrying a

passenger, or dropping a passenger off. The TNC is required to maintain driver background

information, including criminal background check result, driving record, license record, sex

offender status, proof of insurance, and records that the vehicle meets vehicle requirements. The

operational data for the TNC must be held indefinitely. Any rider information may not be

disclosed, unless as required by law. The state may periodically check on Wheelchair Accessible

Vehicle status for the TNC.

2.2.6 Research Conclusions

As a result of the above research, a set of conclusions was developed to aid in the

development of potential alternatives in subsequent tasks. Each is described below:

▪ Agencies are leveraging partnerships to expand mobility options, not replace existing ones.

This provides users alternatives depending on their needs.

▪ Many programs are started as pilots which scale as demand grows.

▪ Payment processes vary. Examples:

Users pay directly, sometimes at fixed/variable rates

Agency-provided payment method, such as a fare or debit card

User reimbursement by agency

▪ Providing subsidies for local transit options and “travel training” can help address travel

needs with a standalone specialized program

▪ Individual level of need can dictate variable fare rates and subsidies

▪ Joining with multiple entities and larger geographic areas can make large TNC companies

more open to partnership

▪ Third party reservation companies help to mitigate technology barriers

▪ Grassroots efforts are more effective than others at engaging senior and low-income

populations

▪ Communication gaps and barriers exist between transportation and healthcare providers.

Bridging of the gap can help to understand user needs.



▪ Healthcare providers have identified non-emergency transportation as a treatment barrier

with financial ramifications to their operations and look to address the issue

2.3 Recommended Future Research/Outreach

As a result of the avant-garde nature of the research, the project team discovered a lack of

conclusive or representative components for program evaluation. These gaps identified below

are recommended for tracking in the future, as data and other information may be published in

the future. These should be considered as an implementation plan is developed for the selected

alternative moving forward.

2.3.1 Data Availability and Contact with Major TNC Companies

A significant gap in research is the availability of TNC data within the Prince William County area

as well as the openness of TNCs to discuss partnership with public agencies. Typically, ridership

and trip density is retained by the TNC for information protection as well as competitive

advantage within the private market. As such, no TNC ridership information is included within this

report. Only limited reporting metrics is required by the state of Virginia as described in the TNC

regulation section of this report.

Partnerships between TNCs and public entities is often subject to scrutiny from regulators and

legislators. In the past, TNCs have been asked to accept increased regulation resulting from

partnerships (prospective and otherwise), however this impacts the business model and

competitive nature of the TNC operations. Note that some public agencies have required TNCs

to share data as part of operational agreements. As such, TNC data may become more

available in the future, through the TNC themselves or through partner organizations and

agencies.

2.3.2 Non-paratransit Partnership Examples with TNCs

Many of the ongoing partnerships with TNCs have been related to providing or supplementing

paratransit service. Human service transportation programs were included in research as part of

this study; some of the various models used are provided in the research notes. However, many

of these do not use TNC partnerships in favor of staff-operated vehicles and volunteer services.

2.3.3 Documented Costs and Success of Pilot Programs

Data results of pilot programs is seldom available. The use of TNC and other solutions in a public-

service role is a relatively new concept, and therefore results in minimal publication of outcomes.

However, success may be implied from the extension of these pilots, or by the continued

experimentation by transit companies nation-wide. Any description of programs as part of this

report were primarily qualitative in nature.



3. ALTERNATIVES DEVELOPMENT

The transition from the research stage of the project to the alternatives stage of the project was

guided by the review of existing programs. The development process consisted of the following

steps:

1. Evaluation Measures and Criteria Development

2. Preliminary Alternative Program Development

3. Scoring Process and Results Analysis

Each of the above steps is discussed within this section.

3.1 Evaluation Measures and Criteria Development

The set of alternative evaluation criteria was developed as a result of the research and

conclusions developed during the first part of this study. Four core components of evaluation

were identified as mobility, accessibility, program delivery, and funding. These components are

further broken down for use in a detailed scoring process. Each is summarized below and Table

14.

For a more detailed description of each of the evaluation measures, see Reference C.

3.1.1 Mobility

Mobility entails the extent of the service. Essentially, mobility describes who is able to use the

service, where the service operates geographically, and what service options are available for

users.

3.1.2 Accessibility

Accessibility is the level of convenience or ease of understanding that the customer has when

interacting with the service. Accessibility also describes the overall equity of a service – is it

usable for all individuals regardless of personal condition or needs.

3.1.3 Program Delivery

Program delivery entails the required assets, administrative requirements, and performance of

daily operations as part of the program from the perspective of PRTC.

3.1.4 Funding

Funding describes how the program and service will be paid for. Generally, the alternative

evaluations assumed some level of funding is available and is not constraining program design.



Table 14: Evaluation Measures Summary

Mobility

Population

Served

The number of eligible individuals who can use the service, compared to the

existing Wheels to Wellness program.

Capacity The maximum number of individuals which can be served under the service

model. This number of individuals may be served by one or more providers.

Service Area The geographic reach of a potential alternative.

Mode Choice

& Options

Available modes and choices for use by the service, as well as transfer

opportunities or requirements.

Accessibility

Booking Trip booking method ease-of-access.

Payment

Service compensation by the user. This may also include how the payment is

passed through to the responsible agency, particularly if it is the responsibility

of the customer.

Vehicle Accommodations for various levels of physical ability, as well as the ability to

navigate different street types.

Program Delivery

Staffing and

Oversight

The number of PRTC employees and level of involvement required to

maintain and operate the program.

Program

Structure &

Partnerships

Complexity of the program, required partnerships, transfer of funds, levels of

approval, and difficulty of maintaining day-to-day operations.

Liability The level of PRTC-assumed insurance required for program operations.

Startup The process in which the proposed program begins operations. Includes

transition, effort required, cost to begin operations, training and coordination.

Scalability Program resiliency to changes in level of service, geographic area,

performance, funding, mode choices, and partnerships.

Funding

Applicability Applicability to existing available grant programs.

Level of

Capital Cost

The required monetary investment at the onset of a program, before the start

of operations.

Level of

Operational

Cost

The level of programmatic funds which sustain daily operations.

Sustainability The continuation of operations for an extended amount of time, without

requiring significant efforts to secure and maintain funding.

3.2 Preliminary Alternative Program Development

The following section summarizes the four preliminary alternatives developed for the study. Each

is based on a model similar to those identified during the research phase, but includes

considerations specific to PRTC needs. The alternative model is noted within the description. A

matrix of elements and features also was created as part of the alternative development

process. This matrix and more detailed descriptions of each of the preliminary alternatives is

included in Reference C.



Table 15: Summary of Preliminary Alternatives

Alternative A – Reservation Company

• Contract with one or more reservation companies for:

o ride scheduling

o booking (call center and website)

o payment for customers

• Utilizes various service providers, which leverages existing transportation network

companies in the area

• User pays the TNC at a pre-negotiated rate and reservation company handles PRTC-

subsidy funds

• Accessible rides available via a TNC that provides that service directly or using existing TNC

accessibility provisions (such as delivering that service through a third party)

• May or may not be restricted by jurisdictional lines

• Capital support may be needed for the booking platform development

• Operational costs include contracted rate for booking company and ride subsidy

Comparison: GRTC – UZURV/Roundtrip

Alternative B – Transportation Network Company Partnership

• A contractor TNC would maintain a mobile application interface designed to

accommodate the PRTC program

o Fares based on a negotiated structure

o PRTC reimburses TNC following the trip

• Fare payment may be required to go through a PRTC-established account or a PRTC-issued

debit card

• Accessible vehicles would be provided based on the TNC existing service structure (such as

livery company agreement)

• Restricted by jurisdictional lines

• Capital support may be needed for the booking platform development

• Operational costs include contracted rate for TNC and ride subsidy

Comparison: MBTA – Uber/Lyft



Table 15: Summary of Preliminary Alternatives (Continued)

Alternative C – Wheels-to-Wellness Expansion

• PRTC maintains wheels-to-wellness at reasonable scale to provide high-need trips and to fill

in service gaps

• Invest in a grassroots organization to promote growth of a volunteer network

o Leverages existing small-scale services

o Partner with adjoining jurisdictions such as Fairfax County

• Requires community involvement and significant outreach

• Includes a ride training (On-the-Go program) expansion

• Capital support may be needed for the volunteer organization grants and booking

platform development

• Operational costs include services such as driver training programs, background checks,

and volunteer vehicle inspection

Comparison: Fairfax County – NV Rides

Alternative D – Need-Specific Programing

• Offer a variety of service programs which meet individuals’ specific needs

• PRTC coordinates service for:

o Medical-related trips

o Standard paratransit trips

o Low-income trips

• Funding is secured for each program separately based on the need of the participants

from different grant organizations (committee for aging, benevolent funds, health

foundations, etc.)

• A PRTC trip coordinator would assign trips based on which service could fulfil the intended

trip need (at an individual level)

• Minimal capital costs

• Operational costs include continuous grant renewals for individual services

Comparison: Pinellas County – Transportation Disadvantaged Program



3.3 Scoring Process and Alternatives Analysis

To compare the four preliminary alternatives, the described previously evaluation measures

were applied to each alternative. Scoring was performed by the project team, assigning a

value from 1 to 5 (5 being the most preferable, and 1 being the least preferable). Calculations of

the scores were conducted in two ways:

1. Each of the components is weighted equally, and totaled out of a maximum 80 points

(combined score)

2. Each of the four major elements are weighted equally, and averaged out of 100%

(unweighted average)

The independent scoring of each alternative was then averaged across the four-member team.

Combined results from the scoring process are shown in Figure 3.

Figure 3: Combined Alternative Scoring Results

Results from the scoring process show that Alternative A scored the highest, followed by

Alternatives B, C, and D, respectively. The project team generally scored Alternative A the

highest and Alternative D the lowest, with mixed evaluations of Alternatives B and C.

14.75 13.75 11.5 11.5

18.5 17.75

13.58.25

12.59

9.25

10.25

17.25

12.25

12.513.75

79%

65%59% 57%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

10

20

30

40

50

60

70

80

Alternative A

Reservation Company

Alternative B

Transportation Network

Company Partnership

Alternative C

Wheels-to-Wellness

Expansion

Alternative D

Need-Specific

Programing

Un

we

igh

ted

Av

era

ge

Co

mb

ine

d S

co

re

Alternative Scores

Funding

Program Delivery

Accessibility

Mobility

Unweighted Average



Several considerations for the scores shown in Figure 3 are described below:

▪ The scores assume that the agreements or funding for the program is available, and is

considered independently of any funding constraints.

▪ Implementation of a TNC service generally assumes there are already TNC operations in the

area, and drivers who are contracted with the TNC are willing to accept trips in the areas of

need. Similarly, volunteers are assumed to be willing to accept trips when requested.

▪ The value of each of the evaluation elements is slightly weighted in scenario 1, but is equal in

scenario 2, with no single component being more significant than another.

▪ The majority of the evaluation measures presented are positive and a higher score indicates

a benefit for PRTC (i.e. a lower capital cost would receive a higher score than a high capital

cost).

Complete scoring results and discussion are provided in Reference C.



4. RECOMMENDATIONS

Following the scoring of the preliminary alternatives, the project team held a workshop to review

the results of the scoring process. This review informed the development of a preferred

alternative, comprised of the key elements and best features of the preliminary alternatives. This

report describes the final preferred alternative and steps required in order to prepare for

implementation. Included in this description are barriers and risks to implementation, as well as

consideration of strategic implications.

4.1 Workshop

The preferred alternatives workshop was held on April 24, 2018. The project team (PRTC and

Kimley-Horn) was in attendance to discuss the preliminary alternatives, review the scoring of the

alternatives, and develop a preferred alternative using the preliminary four as guidance and

framework.

Discussions during the workshop revolved around the four preliminary alternatives and the

interaction of the users with the alternatives. PRTC provided a prospective of operational

implications for each alternative to supplement the scoring process and inform the selection of a

preferred alternative. Key points of discussion are outlined below:

▪ Approaching the preferred alternative as a mobility service is a more effective way of

thinking about the project goal.

▪ The integration of volunteers into a mobility service can help to expand beyond jurisdictions

and increase capacity at little to no cost.

▪ Reducing the PRTC staffing need will aid in implementation and provide significant

operational efficiencies from an administrative standpoint.

▪ It is generally assumed that a majority of the user population would be able to operate a

smartphone or application-based service, given limited alternative booking support such as

a call-in booking number.

Lastly, the matrix of elements developed for the preliminary alternatives was used to establish

the core or critical components of the preferred alternative. The critical components are

included in the table in Reference C. Each critical component was identified for inclusion in the

preferred alternative, and supported by optional components (which may or may not have

been critical components of preliminary alternatives) which the project team felt were of

significant benefit.

4.2 Preferred Alternative

The preferred alternative was developed from the framework of Alternative A, supplemented by

features of the other three evaluated alternatives. This was a result of the unanimous agreement

following the scoring outcome for Alternative A.



4.2.1 Description

The preferred alternative is framed around a reservation company partnership with PRTC, as

described in preliminary Alternative A. This alternative served as the foundation of the preferred

alternative, supported by various features of the other three alternatives. The added features

include the following:

▪ Volunteer network component

▪ A mobility platform

▪ Use of existing PRTC transit services

▪ The ability to cross jurisdictional boundaries

The partnership between a reservation company and PRTC would operate through a

contractor. This contractor would utilize a mobility service platform in which a patron would be

able to specify a pick-up and drop-off point to begin a trip reservation. After the individual has

applied to and is enrolled in the system, the digital platform would have the capability to check

if the user is eligible for a discounted trip, the rate of the discount, and the best set of options to

complete the trip. The platform would ideally be available for smartphone as well as on any

computer using a website and log-in. Third parties (other than the user) should be able to

schedule and book a ride.

The set of mode options could ultimately include all forms of transportation available from PRTC

and any agreements formed between the reservation company and service providers. This may

include, but is not limited to, standard fixed bus routes, TNCs, volunteer organizations, Taxi/Livery

companies, or paratransit services. A

hierarchy of service provider preference is as

follows, in order of most likely to be assigned

to least likely to be assigned:

▪ PRTC bus service

▪ TNC

▪ Livery Company

▪ Volunteer Organization

▪ Paratransit

This hierarchy is created in order of least cost and greatest efficiency to highest cost and least

efficiency. The inclusion of the PRTC bus service item first encourages the use of existing public

transit at little cost for the user, depending on subsidy qualifications.

Note that the service provider preference order above would reflect an increase in cost for the

first three options, with the volunteer and paratransit options standing as a last option for users

who are most in need. Cost would vary based on the mode choices above and the subsidies

available for the trip. The reservation company would be responsible for creating the

infrastructure required to perform this style of trip-processing, as well as requesting the subsidy

compensation from PRTC at regular intervals. Volunteer-provided rides would likely be at minimal

to no cost for the user, based upon the individual level of need and volunteer availability.

A KEY OPPORTUNITY FOR GROWTH

OF THIS MODEL IS THE OPTION TO

CROSS JURISDICTIONAL

BOUNDARIES.



The trip fare or voucher may be presented on a mobile device if the user desired to utilize a

service which was not integrated with the mobility platform. This may include a digital taxi

voucher or bus pass. It is assumed that these vouchers would be delivered to a mobile device

(within the mobility platform, emailed, or texted) regardless of how the trip was booked.

A key opportunity for growth of this model is the option to cross jurisdictional boundaries. While

any fixed-route bus service or PRTC-provided service will likely be required to remain in the

bounds of Prince William County, TNCs and volunteers have the ability to travel beyond the

operational limits of PRTC. This may be of significant benefit to residents who must travel out-of-

county for medical purposes.

Activities required prior to service operations include the establishment of the application and

user enrollment process, the agreement between PRTC and the reservation company,

supporting operational fare reimbursement structure, and the reservation company’s

agreements with service providers. Jurisdictional partnerships would not likely be needed prior to

operations, unless mutual support of a volunteer network is anticipated when starting operations.

Capital costs for the reservation company program would include contracting with a reservation

company/provider and support for booking platform development. The contracted company

may require startup funding to establish staff and operations in the area. Additionally,

development of open-source transit-vehicle tracking data for PRTC provided services may be

required to integrate all modes into a common platform.

Operating costs would include the contracted value for the reservation company, and the

subsidy funding for trips. Possible additional operating costs may include technical support for

the platform, or costs associated with PRTC provided service integration for a mobility

management service.



A summary of the preferred alternative is provided in Table 16.

Table 16: Preferred Alternative Description

Preferred Alternative – Reservation Company with Supplemental Support

• Contract with a reservation company for:

o Mobility management platform

o ride scheduling

o booking (call center and website)

o payment for customers

• The mobility management platform would be designed to provide multiple mode options

for users to select from

• Utilizes various service providers including PRTC services and volunteer networks, which

leverages existing transportation network companies in the area

• User pays for the service at individual need-based rates and reservation company handles

PRTC-subsidy funds

• Accessible rides available via a TNC, taxi company, or volunteer driver (based on

hierarchy) that provides that service directly or delivering that service through a third party

as appropriate for the service provider

• Volunteer and TNC components of the service are not restricted by jurisdictional lines

• Capital support needed for the booking platform development

• Operational costs include contracted rate for booking company and ride subsidy

Comparison: Alternative A and Alternative C

4.2.2 Process Flow

The process for completing a trip using the preferred alternative generally flows through the

following four steps:

▪ Pre-Service

▪ Service Assignment

▪ Service Delivery

▪ Post-Service

Pre-service describes everything required prior to requesting or booking a trip using the service,

including advertising efforts and eligibility determination. Service assignment entails all the

required effort to schedule a trip, including identification of the best service provider for the user

needs. Service delivery describes the completion of the user’s trip. Post-Service entails the

activities which occur to complete any subsidy and sustain operations following trip completion.



The process flow for the preferred alternative is summarized in Figure 4.

Figure 4: Preferred Alternative Process Flow

4.2.3 Scoring of the Preferred Alternative

As part of the development of the preferred alternative, the same scoring methodology used for

the preliminary alternatives was applied to the preferred alternative. This scoring was performed

to ensure the preferred alternative is expected to perform as well as possible, resulting in the best

outcome for PRTC and the service users.

The scoring process shows that the preferred alternative outperforms the preliminary alternatives

in all but one category: Program Delivery. This is due to added complications of including a

volunteer network as part of the service. However, the addition of volunteer service improves the

performance of the other categories. This results in a generally higher score.



Figure 5: Combined Alternative Scoring Results (with Preferred Alternative)

4.3 Discussion of Scoring and Benefits

The core components of the preferred alternative combine the level of service of Alternative A

with the value in volunteer involvement of Alternative C. The integrated mobility platform

component leverages the service efficiencies of Alternative B, which includes a degree of

overall program complexity (contributing to the lower program delivery score). The rider-training

component of Alternative D was included for the preferred alternative, boosting the accessibility

and mobility for individuals who chose to use the service.

The largest benefit of the preferred alternative is providing an easy-to-use service for users in

need which provides flexibility in both mode and cost. This is an improvement over the existing

wheels to wellness program which is limited to only livery companies. The preferred alternative

also compares and shows the differences in cost based on the inclusion of eligible subsidies,

specific to the person in need.

Another direct benefit of the preferred alternative is the option to reserve in advance as well as

select a trip on demand. This flexibility improves the access of non-emergency medical trips

15 14.75 13.75 11.5 11.5

18.25 18.5 17.75

13.58.25

12.75 12.59

9.25

10.25

18.75 17.25

12.25

12.513.75

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Alternative Scores

Funding

Program Delivery

Accessibility

Mobility

Unweighted Average



which may be the result of changes in availability for individuals who rely on others for

transportation.

An additional benefit to the preferred alternative is the simplicity of a single mobility interface.

This configuration aids users to find the best ways to reach their destinations, without missing the

opportunities available for those in need. This is particularly important for unfamiliar users, those

who have difficulties accessing resources or those who have difficulty navigating online

information.

Users of the preferred alternative are likely familiar with the style of the service, easing the

integration of new users or the transition of existing users. Those who use or have used an online

trip planning service such as Google Maps or MapQuest would likely feel comfortable with the

reservation service, especially if the design follows a similar interface. For those not familiar or

comfortable with the trip planning services, a phone option is available.

The collection and aggregation of data from the service could be of substantial benefit for PRTC

and partners. Tracking the trip requests by origin and destination may aid PRTC in determining

the locations of greatest need. For example, if a neighborhood has a high rate of demand-

responsive trips at a certain time of day, there may be a case for installing a deviated-route

shuttle to serve the needs more effectively. This information may also be used to develop a ride

sharing component to the service, further reducing the cost to the user.

Lastly, the benefit of partnering with a volunteer organization grows the influence of the

program to serve Prince William County and local area residents outside the existing PRTC

service area. This opens up trips for specialized medical visits or services which are not available

within the county. This service also aids in developing partnerships between jurisdictions and

human services to improve wellness for residents of different counties.



4.4 Barriers and Risks

As with any transportation project, risks and possible negative implications from the preferred

alternative exist. This section describes the barriers and risks considered as part of the preferred

alternative, as well as potential methods to mitigate or overcome the issue.

Table 17: Preferred Alternative Risks and Mitigations

Risk Mitigation

Segments of the population

who are in-need may not have

the ability to use a mobile

device for booking or payment.

An alternative call-in number may be provided for

individuals who prefer to call, or those who are not able to

use a smartphone. Alternatively, a third party may be able

to book a trip for the user.

If the contracted reservation

company ceases operations,

the service may be in jeopardy.

The mobility platform would belong to PRTC, such that

another contractor may be able to continue to operate

the service.

TNCs and other service

providers may not be willing or

able to operate in the rural and

surrounding areas of Prince

William County.

The mobility platform would enable PRTC to develop a

business case for the operation of contractors in the area,

providing confirmed rides in advance of the need. The

reservation structure allows operators to anticipate

demand, resulting in guaranteed fare without loss due to

expanded service area. This structure also allows multiple

other options if TNC service is not available.

Incorporating volunteers into a

PRTC service may impede the

ability and the willingness of

volunteers to continue work as

desired.

Volunteer services would only be upon request, as the last

option in a hierarchy of services. Volunteer services would

only be used for high-need trips, where the user may be

unable to pay for a trip or use standard PRTC-provided

options otherwise.

Users may not desire to operate

through a mobility platform.

Design of the platform will follow a familiar style such that

users would need minimal effort to navigate the interface

and reserve services. Alternatively, the voucher service

could continue to operate within the service, as desired by

PRTC and partners.

The user ride request goes

unanswered by service

providers.

The trip plan is up to the users’ preference input. If the

specific plan requested does not meet the users’ needs,

PRTC deviated flex route service may still be able to provide

the service.

A user’s payment method may

not be accepted for fare

reimbursement.

PRTC and the contracted reservation company should

establish an agreement that protects both the user and the

service provider. One possible arrangement may allow the

reservation company to pay the fare for trip completion,

then restrict further trip reservations until the fare is paid by

the user in full.



5. NEXT STEPS

The development of the preferred alternative is only the beginning of the improvement for

healthcare transportation within the Prince William County area. Many more steps must be

made for the installation of the service. Additionally, the development of an improved

healthcare access service creates opportunities for PRTC to grow service for other users as well.

5.1 Implementation Steps

In order to implement the preferred alternative, several tasks are required to lay groundwork and

prepare for implementation. This includes the transition from Wheel-to-Wellness to a broader

program as described previously. Table 18 describes the next steps for PRTC and its partners to

move the Preferred Alternative forward towards implementation. Note that it is divided into core

steps (components of the preferred alternative which are required for the commencement of

service), and optional program enhacements (which are not mandatory for the

commencement of service). Additionally, responsibility of the action step is designated by a

filled circle (leading responsibility) and a hollow circle (supporting responsibility).



Table 18: Implementation Action Steps

Implementation Action Step PRTC Staff PRTC

Leadership

Service

Partners

External

Support1

Core Steps

Form program leadership team and

implementation task force

Develop program charter and finalize

service framework

Research potential reservation

company partners2

Develop criteria for program eligibility

Issue request for proposal and award

contract to reservation company

Prepare existing Wheels to Wellness taxi

partners for program transition

Identify potential service providers and

partners

Issue request for proposal and award

service provider partnership contracts

Develop and activate marketing

program

Begin service

Optional Steps for Program Enhancement

Discuss compatibility of reservation

system with current PRTC mobile

application development

Prepare PRTC transit system AVL3 data

and infrastructure for integration into

reservation system

Research and integrate alternative

forms of fare payment

1 External support refers to consultants, partner organizations, partner agencies, or external stakeholders. 2 May involve conversations with peer agencies which use a reservation service, such as GRTC 3 AVL – Automatic Vehicle Location

LEAD

SUPPORT


Given the above tasks, the project team outlined a theoretical timeline for program implementation. Given the current operational

funds for the Wheels to Wellness program, funds are expected to last through summer of 2019. It is anticipated that the Preferred

Alternative will be able to near substantial completion for the deployment of the mobility platform in the Fall of 2019.

Figure 6: Implementation Timeline


5.2 Opportunities

The healthcare access mobility platform as described in the Preferred Alternative serves the

purpose and need of this study. The framework from which the service is built also has the

potential to serve other needs as identified within the PRTC service area. The host of services

offered by PRTC including paratransit, local and commuter bus, and ride matching services has

the ability to follow the framework presented for the preferred alternative, and integrate into the

mobility platform as described.

Furthermore, the mobility platform has the base framework such that total mobility management

of PRTC’s services may be considered for integration. This may develop such that the healthcare

mobility and access service described in this study becomes a component of a more

comprehensive service. As such, efficiencies in trip options and/or assignment may be realized

from meeting the individual needs of the users. This is commonly referred to as “Mobility as a

Service” or “MaaS” for short. MaaS describes the process of transportation from the perspective

of a user-trip, rather than focusing on one specific mode. Various mode options and

combinations are presented to an individual on a trip-by-trip basis, using a digital trip planning

tool.

Using the mentality of the Healthcare Access Platform, PRTC may be able to realize a larger

system efficiency across the entirety of its services. This would align well with the direction of

current transportation trends, and would aid PRTC in advancing the following goals from its

strategic plan:

▪ Transitioning from being seen as a bus company to more of a mobility agency to improve

mobility and quality of life

▪ Investigating new service models that allow for the development of easily scalable demand

based service

▪ Expand local transit by leveraging partnerships with TNCs/other service models

The healthcare access mobility platform as described in the Preferred

Alternative not only serves the purpose and need of this study,

but advances the strategic goals of PRTC


MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY References

6. REFERENCES

Reference A: Inventory of Data Collection & Research (Project Task 1)

Reference B: Current State of Practice (Project Task 2)

Reference C: Alternatives Development Memo (Project Task 3)