Today we’re getting into the weeds of a topic that is central to the operational success of PACE programs across the country, the transportation department. With nearly 200 programs nationwide and growing the PACE care model supports older adults age in place while still receiving the high quality care we’ll all one day need.
Unlike the traditional healthcare model, PACE has declared transportation a central function of a participant’s experience, so much so that it’s a requirement for programs to provide it to all participants. If you’re new to PACE, we’d encourage you to learn more here.
It’s important to first acknowledge that building a transportation program to support the varied needs of PACE participants is complex, time and capital intensive, high touch, and more or less an imperfect science. Scalability is important but a difficult balance to find due to the fact that both inputs are resource intensive, and vehicles and trained drivers are capital intensive and require additional support. To inform our findings, we’ve surveyed PACE programs across the country (feel free to contribute), and have supported that with our knowledge of operating the largest private ambulance service in the Bay Area.
Ok before we dive in, let’s pull up for a quick intro. We’re Onward! Onward is a total transportation solution serving PACE programs, Health Systems, Transit Agencies, Health Plans, and more. We perform 3 core functions: We bring all of the transportation ordering, tracking, and reporting into one easy to use and integrated tool, we build and manage networks of EMS and NEMT transportation partners, and lastly, we deploy our signature CMS compliant Door-Through-Door rideshare alternative, Companion Rides.
Let’s kick things off with department structure. The traditional transportation department consists of drivers, dispatchers, fleet managers, transportation directors and sometimes more, with auxiliary support from recruitment and HR teams. Departments scale with participant counts with drivers and dispatchers taking the lionshare of the positions.
In larger organizations with multiple facilities that span outside of a localized geography, we’re finding dispatch teams grow, sometimes with hierarchies of their own, reporting up to a Transportation Director.
In our most recent survey, we asked programs to help us understand their department’s staffing ratios to help better support their growth while maintaining costs and a high quality participant experience. The general consensus was that the size of the department grew with the number of participants served. Additionally, we found that most programs based their hiring needs on the total participants served at a facility, but the ratio of participants to drivers and dispatchers varied by the age of the program.
Driver Staffing Ratios
The most common ratio for larger, more established programs, urban programs was 25:1 (participants to drivers) with smaller and programs supporting rural participants carrying 15:1 or 10:1 ratios. Additional considerations existed for programs serving multiple rural counties, with lower ratios present in these instances.
Dispatcher Staffing Ratios
While the driver to participant ratio is fairly straight forward, the dispatcher ratio has an additional consideration that teams should review when staffing departments. Participant count, as well as total monthly transport volume showed correlations when dispatch team hiring decisions are being made. This number also changed when programs were operating with a scheduling software, vs manual spreadsheets. Programs with lower participant and monthly transport volumes were less likely to use software to support dispatch team members, but also carried significantly higher participant to dispatcher ratio (20:1). The larger programs that used scheduling software reported dispatcher staffing ratios of up to 1500:1, but with most reporting 500:1 participant to dispatcher ratios. This finding suggests that significant human capital costs may be avoided with the introduction of software to support dispatch teams.
Fleet Managers & Transportation Directors
Transportation management and leadership ratios were less reported but early findings suggest a 500:1 ratio for transportation managers, with the position initially carrying an expanded role in new/smaller programs. Many programs reported hiring department leadership before hiring a manager, and fleet managers were often hired to support multiple regions.
What’s everyone buying?
The last question that we asked was about vehicles - We get this question a lot - Everyone seems to be curious about what vehicles everyone is purchasing, here’s what we found:
If you’re a Fleet Manager or Transportation Director at a PACE program and have 3 minutes to contribute to our ongoing study, we’d greatly appreciate it, and if you have topics that you’d like us to dig into and learn about, feel free to send us a note!
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