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Rural Health Information Hub

Partnering for Rural Transportation, with Alisa Druzba and Steve Workman

Date: April 5, 2022
Duration: 41 minutes

Steve Workman Alisa Druzba An interview with Alisa Druzba, director of the New Hampshire Office of Rural Health and Primary Care, and Steve Workman, director of Transport New Hampshire, discussing the development of the New Hampshire Mobility Management Network and how it provides options for rural patients. They explain the importance of collaboration with local, state, and federal agencies to ensure long-term sustainability moving forward.

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Organizations and resources mentioned in this episode:


Andrew Nelson: Welcome to Exploring Rural Health, a podcast from the Rural Health Information Hub. My name is Andrew Nelson, and in this podcast, we'll be talking with a variety of experts about providing rural healthcare, problems they've encountered and ways in which those problems can be solved. This is part two of a three part series about transportation in rural America. Today I'm talking to two people who are involved in developing the New Hampshire Mobility Management Network, Alisa Druzba, a Director of New Hampshire Office of Rural Health and Primary Care, and Steve Workman, Director of Transport, New Hampshire. Thank you both for joining us.

Alisa Druzba: Thank you.

Steve Workman: Thank you.

Andrew Nelson: Steve, I'll start off by asking you this. What problems was this Mobility Management Network created in order to address?

Steve Workman: Sure. I think I'd start with what is mobility management? It's a term that's been out there for quite a while. It's been implemented throughout the country, but it's really about coordination of transportation options and it's supposed to be user centered. So in other words, let's create a system for people that actually meets their needs and where they're at. So in New Hampshire, we separate our state into transportation regions. And so what we decided would be effective was to assign a mobility manager to each region who could focus on pulling together what we call community transportation services. And those services in the transportation world are often referred to as 5310 funded services.

This serves older adults and it also serves people who are living with various disabilities. And so this creates an opportunity to focus in on their needs and to build out the system. While we do that, it also incorporates other modes. So when you think public transit, which might be buses or trains in other parts of the country, that's part of the equation as well. Walking and biking facilities, those are part of the equation. So the idea is to use whatever options will work for a consumer to help them live their best life, whether that's medical appointments, whether that is social interactions, whether that's getting to a job or other services they need.

Andrew Nelson: Can you each tell us about your role in the process up to this point and going forward?

Steve Workman: Sure. My capacity is statewide director. I work across all kinds of agencies, transportation agencies, different providers. And then I also intersect with our state and federal government components. And so my role for this project is I serve on our State Coordinating Council for Community Transportation. And at that level, we are really focused on coordinating services. There's a federal model for this that I think a lot of your folks may be familiar with and it's called CCAM. It's the Coordinating Council on Access and Mobility. It was actually created by the federal government by executive order in 2004. But its goal is to bring all the different federal agencies that fund in some way transportation. And it says, "We need you all to work together." So we don't want to duplicate resources, we want to be innovative and we think we can do this better.

So in New Hampshire, our state coordinating council is really a state model for CCAM. We've started a new level with that. We were incorporated about 10 years ago, the SCC, and now we've got to a point we're actually able to build out a more sophisticated network. So in my capacity I was asked to help facilitate that process. So we've been working on that for just about two years, I think. It takes a lot of work to move these projects, to bring everybody together, to get them to understand how we can work between sectors and things. And we're now at a point where we have adopted our blueprint and we are moving finally into implementation.

Alisa Druzba: It's very unusual to talk about health systems and the health of communities and not have transportation come up, whether it's directly related to patient access or to workforce, or generally as an economic driver or related to social isolation issues and things. And I think that we saw that really come to a head during the pandemic. A lot of us have been very aware of the gaps, but having those access issues related to testing and mitigation and vaccine efforts really highlighted that. And so I had started participating, really just listening, to those SCC meetings each month and really starting to sort of get a sense of what was happening in New Hampshire, what the structure was and looking for opportunities.

And every project I've ever done in my work with the Office of Rural Health has been through partnerships and collaboration. And we really try as an office to respond to the needs of the community, not tell them what to do. So we often look at our funding sources and try and say, is there something that we could bring as a resource, either through staff expertise, data or actual funding that would help this program launch? And so as the mobility manager network developed and I followed along in April of 2021, the state of New Hampshire and every state in the country was sent CDC funds for COVID disparity with a carve out for rural.

And so this project really seemed to align with that carve out. And so we decided to work together to figure out if it made sense, if it made sense timing wise and expansion wise and expectations on these regions as they launched. And so our opportunity initially was with the mobility manager position itself. The federal transportation funds and state funds were funding the project position at a halftime level. And so the first thing we talked about was whether it would be helpful to fund that as a full benefited position to really be able to have one full FTE devoted to launching this idea of a mobility manager. Everyone agreed that was a great idea, so we started with that.

And along the way, we also developed some project funding for each of the regions, but also some state level capacity. So there'll be one statewide contract in addition to the five regional contracts that we will put out that will be very focused on coordinating and supporting those regions, coordinating the network as it comes together, and really focusing on assessing transportation needs and also perception by the public. We really want to understand what's happening in the regions and what people who are either consuming transportation or aren't even aware and could possibly take advantage of those resources, think about that so that we can focus on doing some education around that.

And we have a number of other, we think, sustainable projects around making sure that people know how to access resources and what's available by region. And so we'll be building up some of that work as well. So it really, like I said, it dovetailed beautifully with this grant opportunity. We don't often get to be really creative with the work that we do. We focus a lot of energy on health systems, which is completely appropriate, but everyone knows that social determinants are very, very critical and transportation is a huge one that also then aligns with some of those other determinants. And so we were really excited to be able to make an investment in transportation in a very well thought out project with incredibly passionate, committed partners. So it was really sort of a perfect storm for us as far as the project goes.

Andrew Nelson: Sure. Doubling back a little bit, were there any specific things you saw, Steve, that made you aware of the importance of developing a network like this?

Steve Workman: Yes, there were. One of the things, and this is reflected nationally, so it's not just about New Hampshire, is all of the different sectors that have any intersection with transportation started doing needs assessment. And often the number one issue or within let's say the top five was transportation. Typically what it showed was there were great many barriers, and I think more so our rural agencies had more substantial barriers as well. And so we saw that there was a need to start addressing this, and it doesn't make sense to solve a problem when half the players aren't talking to each other.

So as each agency in New Hampshire, for example, each state agency started to realize that transportation was a big issue and they had a small piece of it, or perhaps they actually had no idea sort of how it operated in our world, they started to see the need to reach out. At the same time, we positioned ourself to try to be more open, to understand the needs of the different providers out there who rely on transportation services that our providers handle. So again, I think that's reflected nationwide. You hear those stories, but what you need to have is a deliberate system put together to actually start doing this.

Andrew Nelson: Can you just share with us how a mobility management approach can be useful in meeting the transportation needs of rural folks in your state?

Steve Workman: Sure. I also want to talk about another one of our federal partners that has contributed significantly to our own development work in Hampshire, and that's the National Center for Mobility Management. Our state has worked extensively with Judy Shanley to learn about mobility management. They are funded through FTA and they are sort of an authority on what works for mobility management across the country. So in working with them, we were able to start to understand and explore the fundamentals of it.

And then as our plan took shape, we started to see the areas that were deficient in planning. So we're actually working with NCMM right now to address things like long term sustainability of mobility management, and also performance indicators. As we all know, funding and policy decisions are driven by data. If we do not have meaningful data, we are not going to be able to make the case for changes in funding or policy. So I think mobility management has an eye toward that, but at the end of the day, it's really about coming together in coordination. So I talk about it as being completely human centered.

I told you I'll talk about process. I think we have to understand that when you ask people to come together to work together from different sectors, we have to get through a lot of sort of human stuff. We have to understand what the other party is talking about, what's going to be asked of us, and we have to develop a level of trust and a working relationship, and mobility management really is about that. It convenes people, it talks about the issues and it shows us a path forward for how we could coordinate while still retaining our individuality, if you will. So how we're delivering our different services.

Then on a more logistical level, mobility management really starts to delve into things about opportunities for braided funding, and this is why this project with Alisa's is so key because it's a perfect example of it. We have a federal state funding pots that are supporting this project in coming together. That's an example of braided funding. Those opportunities exist. And I think it's important, again getting back to the trust and the human element, you have to have a serious conversation around how braiding these fundings is actually increasing your capacity and not taking something away from your organization. And I think it's fair to say we need to work carefully through those type of issues, because this is really about getting people to rides.

I mean, folks like us really get caught up in how we're going to build the system and the policies to support it. But at the end of the day, our users, it's about living their life. So we try to make it easy for them. Many of our most vulnerable users are already dealing with significant life issues. They don't need to suddenly be tasked with figuring out a complete maze of transportation services out there. So a good mobility management program is going to have a searchable database where you have all these options and will have already worked out how those agencies work together to deliver for the consumer.

Alisa Druzba: Yeah. No, I mean, how often do you come across a project that just really is built the way that you would hope it would be built, the way that you would build it if it was your project as well? And I think to Steve's point, like the level of trust. So when I came in, everybody was really, really open. They didn't know me, but they were very open to hearing what I had to talk about. And I think that over months of conversations with both the SCC members and the leadership, we really understood that we were all about the people and we were all very passionate about the ultimate goal, but that, yeah, we also understood the importance of clarity with all of the process, understanding process, understanding scope, understanding responsibility and roles.

And so they already had that open culture of communication established before I got there. So it was really easy for me to sort of like show up and talk and then ask them for feedback and then to try and incorporate that feedback and to show them I heard you, we've adjusted in this way, we are able to be flexible in this way, we can't be flexible in that way. That's what I was really there for was to really support the work that they had already done.

Steve Workman: I want to add too that, to actually stress how valuable it was, Alisa brought a knowledge and skillset to this project that we quite frankly didn't have at that point. I know for me as I was sort of navigating the transportation side and the mechanics of the plan, I couldn't necessarily think... I knew that we had to connect with these other agencies, but I couldn't necessarily think through how we had to do that. So it really is essential, for this to be effective, is to have key partners who do have expertise and then they can operate and we can really work together for that. That's what's made this project so incredibly exciting and enjoyable for me.

Andrew Nelson: Yeah. It's great to have kind of complementary people on your team. What opportunities do you think the New Hampshire Mobility Management Network is going to offer specifically to sort of improve healthcare access in population health? What's that going to look like?

Alisa Druzba: That's a great question. I think that what we want to do is we want to create awareness of what exists and we want to also help people understand how that system currently operates and how it's funded. And I think what that does is it sets the foundation for having conversations about gaps and what can be done to ameliorate that. I think that from a health perspective, we have a tremendous amount of different social and health service agencies operating in rural New Hampshire who are all solving this problem themselves. And I don't think it's because they're not trying to collaborate, but I think it's very difficult sometimes. When you have a person in need immediately in front of you, in many, many cases, you want to spend a lot of energy meeting that person's needs and often you don't have the resources or capacity to talk about being proactive in meeting many needs in one coordinated fashion.

And so I think that this project really sets a model for that. It creates some partnerships and some relationships that I think exist beyond this project but also will allow us to have those additional conversations. I think that sometimes having people in different agencies that are aware of what's happening. I know this happens a lot for me as a state office person, I will hear about a hospital considering something and then a different hospital considering something, and I'll bring them together so they don't have to reinvent the wheel. And so sometimes people just need those dedicated staff to have the conversations, to write the things down, to send them out an email, to set up the next meeting, like all of that nuts and bolts logistical kind of stuff, and to really help facilitate those conversations. So I see a lot on the health side of lasting impact.

The other thing that we've asked in these regions is that each of them participate in at least one project that collaborates with their local public health network. We have centralized public health here in New Hampshire. So it's all happening mostly in the building I'm sitting in. And then we have these community level agencies who are our funded public health networks. And so this will help strengthen partnerships that exist or perhaps create ones that don't to really think about it.

I just think that transportation and health, any version of health that you use, any definition of health, they have so much in common and there's so much that could be gained by them leveraging their expertise and their funding. And so bringing these people to the same table, even if it's for one specific project with a specific timeline, I think really will set the tone and foundation for future conversations. I can't think of a single place that this doesn't touch. Throughout our agencies, if we really want to think about advancing the health and wellbeing of our residents, then that's the level of conversation that we really need to be at.

Steve Workman: I think a lot of your folks, Andrew, are going to appreciate something even more basic about this. Think about the cost of missed healthcare appointments. So there's a vested interest right there within the medical provider world and the transportation provider world. We have an opportunity to decrease that. That's just one small piece and that makes economic sense for everybody, so a better delivery of service.

The other thing that excites me about this is I told you that from our transportation perspective, we are sort of in that 5310 community transportation services, so older adults and other vulnerable populations. But I very much believe in a rising tide concept. So if we are tightening up the system, expanding conversations, working better across government sectors, we are going to create a transportation system that is going to be more effective and is then going to be more accessible down the road to what I would call folks that have a choice.

They don't need to be car dependent. They can drive if they want to, but they would opt for using these services more. You have more folks using the service, the service is going to be more sustainable. So you can see how even though we're focused right here for this period of time on public health disparities and how to get this off the ground, it has far reaching implications.

I also think I'd be remiss if I didn't go way back to how we even took these steps. So as I've had a chance to talk with my peers around the country, they're very interested in what New Hampshire is do. And it really becomes like, I don't know where to begin. So let me address that a little bit. The first thing is that New Hampshire had a good system in place, and that was our statewide coordinating council. So that was our state CCAM effort. So we were already trying to have those conversations with varying degrees of success up to this point.

But as part of our work with New Hampshire DOT, and then something in our state, which is our 10 year transportation plan, that plan gets reapproved every two years. So there's this comprehensive process that involves the Governor of New Hampshire, the New Hampshire Executive Council, New Hampshire DOT, and the legislature, and it goes through that. So during that process, in the last cycle, we came together as providers and said we have some serious funding problems and a whole load of unmet needs. We know what the needs are but we don't have the capacity to actually address them. Coordination became one of the key issues.

Well, New Hampshire DOT heard that message and they found a way. Through Federal Funding Streams, there are provisions that allow a transfer of funds amongst projects. They're highly regulated, but there was an opportunity for us to transfer $2.2 million roughly per year to support some expanded community transportation and public transit services. So that ultimately was the seed money that Alisa talked about earlier, which was funding halftime positions and a statewide mobility manager housed at New Hampshire DOT. So that's the first thing, because the reality is you do need to have a little bit of money to support this. I think that incentive is required to bring folks to the table, but it's really hard to talk year after year about potential unless you're able to translate that into some concrete action.

So once that got moving, it's sort of the snowball and then enter Alisa and it just, it got larger and larger. So that would be the takeaway for other folks trying to figure out how to do this is first you have to convene and start having the process conversations, but then try to figure out how you can get some seed money. And then I think you're much better positioned to launch and then consider things about long term sustainability, because Alisa and I are really focused on, we've got some really good performance measures that we've outlined both for the CDC side of the funding but also on the transportation side. We expect to have rich data that will help us make the case for why this is an effort that should be sustained long term.

Andrew Nelson: Are there any other organizations you've been working with since you kind of started developing the mobility management network?

Steve Workman: There are. So it has increased participation, especially within the Department of Health and Human Services in New Hampshire in general. So we've done separate but related work. For example, we worked with TANF counselors. Their task is to get a lot of their users who are transitioning off public assistance to get them to jobs, and often they don't have the capacity to own a car. So we started having conversations about that. Then enter the division of public health, where this funding, and we're able to do that. So that has definitely expanded.

I could say more about other statewide agencies that are helping to feed the process and getting interested in this. But I also want to talk about the federal level. FTA or the Federal Transit Authority is watching what we're doing in New Hampshire and they are very much excited by that, as well as our regional DHHS. They're looking at this as a test project and a model that may work for other parts of the country. And we are actually, on the ground level we are starting to do the work that those folks have been trying to get us to do for quite a long time. So they're constantly getting updates on this and meeting with us. So we get their expertise, we get their insight about funding and potential flexibility around funding streams. And as I already said, we're working with the National Center for Mobility Management.

I went from being this standalone director of transport in New Hampshire to working with this network of people with expertise that blow me away. I've learned more in this process than perhaps I've even contributed to it I think. So it's out there and the folks at the federal level, I have seen nothing but a willingness to work with us. And I think that's important because transportation has been very mechanical.

Alisa Druzba: The way the CDC funding worked was sort of different than normal grants. Normally you would get some sort of funding opportunity announcement, you would respond to it, you would have this fully fleshed out plan or pretty close, and evaluation and measures and things like that. And then you would submit and hear back and get your notice of award. Well, the CDC needed to get this funding out as soon as possible. So instead they told the states, "Here's how much you're getting. We need a work plan and a budget. We'll figure out performance measures and things like that later on."

So we sort of had to, as a division, tee everything up and submit it. So I had just enough to kind of like lay out a basic framework for this particular project. But after we got the funding, we ended up having a zoom call with them and the SCC leadership to sort of tell them about our project and just get their thoughts on the project. And then any ideas they had about resources, existing performance measures or things that we could kind of look into. And so that's been really helpful.

As Steve was saying, they were just really interested in the fact that we were going to try and do this and really supportive of it. They weren't prescriptive about it in any way. They're curious and they want to keep in touch and hear how it sort of progresses out. So I think that has been exciting as well. I know working with HRSA, particularly with the Federal Office of Rural Health Policy, which we are funded by as an entity and they fund a tremendous amount of community work, they've always been super collaborative and very interested in innovation and pilot and sustainability and things like that.

And so I think culturally I've been working under that for a really long time, but I recognize that many other federal agencies are not like that. So it is great to hear that they're open to that and that we can develop that kind of culture with other federal funding partners. There may be a point where we can bring HRSA in along with the CDC to some of these other very high level transportation conversations so that we can continue to work together and to literally be on the same page about strategic priorities and how those are going to align with what everyone's doing and how those are actually going to play out on a state and community level.

Andrew Nelson: Sure. Speaking of existing health disparities, how has the pandemic affected those?

Alisa Druzba: In every way you can think. Like I said earlier in this conversation, we know that just generally, nevermind if you actually have any other kind of like social determinants issue, but just accessing care during the pandemic, whether it was specific to COVID symptoms testing or vaccine, or whether just regular care, that was incredibly challenging. Did telehealth stand up? Yes, it did. Do we all just realize how few broadband coverage areas we all have in our states? Some of us already knew, but yes, it became incredibly clear both from an educational standpoint and a health standpoint.

Telehealth is a wonderful tool, don't get me wrong, but I think that what we want to do with healthcare is what we want to do with transportation, which is we want to deliver options. And then we want the consumer or patient and the provider or clinician to decide what is the quality interaction that needs to take place? How can that be delivered? Okay. If there's a choice around that, let's make a choice. And so having telehealth does not remove the need for people to travel and go and do things. It's helpful.

And then of course the outcomes for all of our folks who had chronic health complications layered on top of mental health issues, layered on top of equity issues either around racial disparities or regional disparities and geography, those just became magnified to a very, very high extent. And we definitely, as a public health department, mobilized, and we tried to literally meet people where they were, bring them the things. But once again, that is not the way that you address people's needs. Not everything can be addressed that way.

And so I think that using transportation as a way to tell a story that is really something that everybody can resonate with. I feel like everyone during this pandemic probably has a story about themselves or their family or someone they care about where access and transportation were an issue for them, the same way that broadband has been highlighted as a huge issue. Those stories, and now with data, are what are compelling policy makers and funders to make these investments, to set aside this portion of funding, and then to allow the states and then hopefully the communities to use that in a way, because we've been thinking about this for years.

I'm not saying we have all the answers, but we definitely had a lot of thoughts and ideas and we were just short on resources. So I'm really excited about having this infusion of resources, somewhat overwhelming at times to get out and to use, but to really be able to talk about what's happening, talk about what our approach is and why we think that's our approach, and then to launch, evaluate, and continue those conversations.

Steve Workman: I agree. On the transportation side, the pandemic hit pretty hard. We were essential services, but one of the ways, and I suspect your rural states are going to key into this right away, in New Hampshire, our volunteer driver programs are part of this equation. Those are often small operations by faith communities or hospitals or senior centers sometimes will do it. Those networks exist throughout most states and they form this sort of patchwork.

Well, a volunteer driver program, most of the volunteer drivers are older adults who also in the case of a pandemic turned out to be some of the highest vulnerable folks. Therefore you saw those programs shut down almost completely. Then you saw ridership issues. So our public transit buses, all of those things scaled. I think we lived it, so we all know how this all went. But that has significant impacts for the future. We're fortunate that the federal government did pump out significant funds and a portion of those funds helped support public transit and community transportation throughout the country, and that's great, but they were stopgap measures. They were filling in gaps in revenues.

We fund transportation federally, state, local money, charitable money. All of that took a hit when our world stopped working. So the agencies needed to be able to just maintain their existing capacity so that when we got through the initial phases of the pandemic, we would be ready to come back out. But then it raised a serious question. What about the folks that needed these services for lifesaving procedures? I think of kidney dialysis. We couldn't stop. So what was great? I heard this throughout the country is our transportation providers stepped up to the front lines and they started being innovative. And then they were left with understanding like, "Wow, we weren't quite prepared for this."

So now New Hampshire and this project is going to help us do a better job of this. But in the transportation side of things, we are also studying the impacts and lessons learned with future recommendations because the next time we have a large, long term service interruption, I certainly hope it's not a pandemic again, but either way a service interruption, we want to be better equipped to respond. I think that we're going to make significant progress just with this project in figuring that out for New Hampshire.

Andrew Nelson: Yeah. I suppose COVID-19 might have been the biggest one, but what are some of the other challenges that you will overcome in getting to the current stage of launching the network?

Steve Workman: So it definitely goes back to the processing, the human component. I think every state, regardless of its size, and New Hampshire is relatively small, which has also helped us to attack this at a state level. But I think that the... There are different approaches taken throughout the state. I think what you first have to do is get people to listen to understand what you're talking about, why they're coming forward, assure them that this is part of a shared dialogue and not something that's going to be imposed on them sort of with a top down approach. And then bring them together to talk through this.

I know our chair, longtime chair of the SCC, Fred Roberge, I believe one of his best days chairing the SCC since its inception was in the spring when we made a very difficult decision and it had to do with the initial DOT funding. So that funding, we knew that we had 550,000 to distribute amongst the regions, but we had to find an equitable thing. So we started with a typical funding appropriation formula for 5310. But what that did was that left a number of our regions with barely any money at all to hire.

So everybody went back and we had to make a shift. We know that when you're representing an agency, your primary job is to think about your agency; it's longevity, sustainability, all of the things connected to that. But there's also a need for us to about the big picture. And so folks had to come to grips with that dynamic and decide, okay, if I give up some money that I could claim if we just use this formula piece and allow that money to fill in and make whole or partially whole one of these other regions, we're going to have a more effective system. We are going to get better capacity across the board.

We saw that happen in the spring during a vote. It was probably the most contentious vote that the SCC had had to work through. But at the end of the day, we unanimously adopted an equitable distribution of that first pot of money and that changed the game. People realized they were serious and people then had committed themselves to working together.

Andrew Nelson: Yeah. What are some of your long term goals with the network?

Steve Workman: Long term is really about sustainability. This is a project I'm working on directly with the National Center for Mobility Management is how to sustain these mobility management networks. And right now we're working with FTA and several other partners to draft a sustainability tool. We're calling it the Mobility Management Sustainability Self-Assessment tool. This is basically a tool that individual agencies or regions or even statewide could take to assess where they're at long term.

The specific tasks that we've outlined in this project all have an eye toward long term sustainability. So the sustainability tool, we've already incorporated that future tool that's not released yet, it's still being developed, but we've incorporated that into our network planning and requirements is that we're going to use that tool so that we can think through these issues. What it does is it breaks down our operation into different dimensions and it allows us to grade ourselves, honestly, on where we feel we fit at any point in time. And it's a simple level 1-4 grading system, four being the most sophisticated, if you will, one reflecting probably more of a startup or emerging system.

So that will lead you through considering what challenges or outright threats may exist to your long term sustainability. If we don't keep this sustainable, then we really do run the risk of having done a lot of great work, spent a lot of money in two years and things start to drift back to normal or go back to fragmenting. We are not prepared to do that. So that's one of the key long term things is finding out a way to sustain the system itself.

The other thing is to sort of change the conversation, to get policy makers and residents alike to understand the role that these type of public transportation services can play in our communities, both our livability, our overall health, our economic wellbeing, and to talk about it in a different way than perhaps we have approached it in the past. So as we increase these partnerships, we're learning about the needs and the languages of different sectors, and then we're trying to see where that intersects with our language and needs so that we can continue to expand that overall capacity. Then there's just a ton of... You could go from there in terms of our long term goals, but I think those are the broad ones.

Andrew Nelson: Are there any other things I haven't touched on that you want to talk about?

Steve Workman: No. I would just like to urge your listeners to take advantage of the resources that are out there. Contact your regional FTA offices. That is a perfect place to start when you're thinking about public transportation and community transportation systems. Engage them in a discussion. You may have opportunities that you just simply aren't aware of, and they can help facilitate that.

The other thing, I've mentioned the National Center for Mobility Management. Judy Shanley and her peers, they are all about helping. That is their purpose for existing is to help all of the different states do this and they have resources that can help you think about how to get this started. And then of course, New Hampshire remains willing to share our experiences if they can help anybody out in the state. So I'm certainly happy to follow up with folks across the country to see whether we might have something that could help them, and I'm always interested in learning what we could take back for New Hampshire. So that's my takeaway for listeners.

Alisa Druzba: And I would say the same thing from the rural health side, that if you are not engaging with your Office of Rural Health and you're a transportation person or someone who is interested in a transportation project, to engage with them. And I would say to the state offices, I'm a tiny state office and we've figured it out. So I don't think you have to have a tremendous amount of capacity or funding to at least dip your toe in. It's like so many other projects where you can be at the table with your voice and your perspective for relatively little commitment and just encourage folks to sort of engage with this partnership.

I think that there are probably a lot of HRSA focused funding opportunities that could be used to advance these projects as well. And having that relationship with your state offices who's very well versed in those funding opportunities, they could at least get you started, get you some data and get you moving forward, connect you with some partners on the health and social service side if you don't have that, and at least launch and get you started. So I think at least developing a relationship between the transportation folks and the Office of Rural Health folks would be the first step.

Andrew Nelson: You've been listening to Exploring Rural Health, a podcast from RHIhub. Today, we talked to Steve Workman, Director of Transport, New Hampshire, and Alisa Druzba, the Director of the New Hampshire Office of Rural Health and Primary Care. Look in our show notes for more information about their work and visit for all things pertaining to rural health. Join us next time for the final episode in our three part series on transportation in rural America here on Exploring Rural Health.