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)
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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
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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
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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.
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▪ 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.
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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
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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.
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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
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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.
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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
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Wheels to Wellness
Table 3: Wheels to Wellness Summary
Program Delivery &
Operations
Funding & Payment
Process
Challenges & Barriers Lessons Learned
▪ 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
Challenges & Barriers Lessons Learned
▪ 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
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Table 5: City of Gainesville, Florida “Freedom in Motion” Senior Transportation Pilot
Program Delivery &
Operations
Funding & Payment
Process
Challenges & Barriers Lessons Learned
▪ 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
Challenges & Barriers Lessons Learned
▪ 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
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Table 7: GRTC Transit System (Richmond) – UZURV/Roundtrip
Program Delivery &
Operations
Funding & Payment
Process
Challenges & Barriers Lessons Learned
▪ 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)
▪ Eligibility is determined
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)
▪ Must use a credit card to
set up fare payments
▪ 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
Challenges & Barriers Lessons Learned
▪ On-demand ride-
scheduling service in
combination with private
operator
▪ Separate from transit
service
▪ Eligibility is determined
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
▪ Must use a credit card to
set up fare payments
▪ 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;
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On-Demand Flexible Transit
Table 9: Fairfax County Human Services
Program Delivery &
Operations
Funding & Payment
Process
Challenges & Barriers Lessons Learned
▪ 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
▪ 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
Challenges & Barriers Lessons Learned
▪ 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
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Table 11: PSTA (Pinellas County) – Transportation Disadvantaged Program
Program Delivery &
Operations
Funding & Payment
Process
Challenges & Barriers Lessons Learned
▪ 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
Challenges & Barriers Lessons Learned
▪ 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/
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MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 13
Aggregate Providers
Table 13: NV Rides
Program Delivery &
Operations
Funding & Payment
Process
Challenges & Barriers Lessons Learned
▪ 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.
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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
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▪ 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
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▪ 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.
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▪ 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.
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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.
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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.
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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
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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
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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
82%
79%
65%
59% 57%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
10
20
30
40
50
60
70
80
Pre
ferr
ed
Alte
rna
tive
Alte
rna
tiv
e A
Re
serv
atio
n C
om
pa
ny
Alte
rna
tiv
e B
TNC
Pa
rtn
ers
hip
Alte
rna
tiv
e C
Wh
ee
ls-t
o-W
elln
ess
Exp
an
sio
n
Alte
rna
tiv
e D
Ne
ed
-Sp
ec
ific
Pro
gra
min
g
Un
we
igh
ted
Av
era
ge
Co
mb
ine
d S
co
re
Alternative Scores
Funding
Program Delivery
Accessibility
Mobility
Unweighted Average
Final Report June 2018
MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 30
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.
Final Report June 2018
MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 31
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.
Final Report June 2018
MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 32
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).
Final Report June 2018
MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 33
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
MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 34
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
MOBILITY ON DEMAND HEALTHCARE ACCESS FEASIBILITY STUDY Page 35
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
Final Report June 2018
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)