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Capstone Task 3: Business Plan By Omarah Clayton
A. Summary
In the primary care office where I work, several elderly patients will miss their annual wellness visit required by Medicare. They will miss their essential follow-up appointments and the simple nurse visits for vaccinations
because they need a reliable way to get to the doctor's office. Transportation barriers lead to rescheduled or missed appointments, delayed
care, and cut or waited medication use. These consequences may lead to poorer chronic illness management and, thus, poorer health outcomes. (Syed
et.al.,2013)
I propose that the institution I work for create a transportation system in which patients meeting specific criteria can catch a reliable way to their appointments without having to schedule their appointments around transportation that have the potential of leaving them stranded and worried. The transportation system will ensure that patients can assuredly get to their
appointments without delay or worry. The patient would call the office and request a ride to, from, or both directions. B1. Anticipated Benefits
Reliable transportation directly impacts health outcomes because it increases access to medical services.
Lack of transportation can increase the
risk of numerous health problems, from depression to cardiac arrest to early death. Furthermore, seniors, people with disabilities, or those without a vehicle who have limited access to public transportation can experience higher social isolation. (Wallace, et.al., 2005)
Depression can have the worst impact on the elderly and chronically ill. Older adults are at increased risk. About 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more
common in people with other illnesses (such as heart disease or cancer) or whose function is limited. (CDC, 2022)
Depression affects healthy people exponentially, so you can only imagine what it can do to those with limited social cues and no transportation to get
out about in the community. (CDC, 2022)
Lack of transportation can cause a
domino effect of a lack of motivation to be mobile, which can impact a patient's health portfolio. Any illness left to fester will only increase the sickness, which will cost more to treat. (National Center for Mobility Management, 2022)
B2. Stakeholders
Some internal stakeholders participating in the transportation initiative will be the CEO, CFO, and RMO of BayCare Health System. The external stakeholders are Wheelchair Transport Services, YMCA, and Mercedes-Benz Vans.
Chief Executive Officer:
The CEO will oversee the entire implementation of
the transportation department adding to the BayCare Health System.
Chief Financial Officer:
The CFO will review all the financial responsibilities
encountered by BayCare Health System. The revenue will be obtained, then the prediction of how long it will take for the department to start paying for itself. Risk Management Officer:
The RMO will research and review the liability to start the transportation department at BayCare Health System. They will interview vendors for insurance companies and insurance plans to implement the new department. The best coverage for the best price and range can have to most drivers. Wheelchair Transport Services:
Collaboration with WTS will allow BayCare Health System to outsource overflow services for patients outside the mile radius who live too far from their primary care office. Our independent contract drivers depend on you for their livelihood and are, therefore, much more sensitive to your needs and strive to make your experience pleasant. Our company mission is, very simply, to provide our clients with the most satisfying experience one can have while traveling in one of our vehicles. (Wheelchair Transport Services, 2022)
YMCA:
Affiliation with the local YMCA centers throughout various communities will provide extracurricular activities for patients that need it or are solely living alone and need companionship. Various elderly programs offer services for different elderly needs, i.e., balance and fitness.
As you age, you may find that you have a new set of fitness goals you want to achieve, such as improving your balance and flexibility. We're committed to helping older adults stay physically and mentally healthy. (YMCA, 2022)
Mercedes-Benz Van: Partnership with a top-of-the-line manufacturer for passenger vans and can even specialize vans for disabled persons would benefit BayCare as they could contract various vehicles for the transportation department. Build your own (Mercedes-Benz Vans, 2022)
B3. Evaluation
Quality and Performance Improvement: The standard process that will improve transportation for healthcare systems, patients, and BayCare Health
would be a basic eligibility process. Patients would have to be on Medicare or
Medicaid. They don't drive and must rely on public transportation or wait on others to assist with getting them to their appointments. They must be an established patient of a provider within BayCare and provide proof of annual income. (Required once a year).
There will be a matrix created to track patient satisfaction. There will be recording devices inside each vehicle that can register any grievances of poor service or even praises for a job well done. There will be satisfaction surveys in each practice office that patients can fill out and put in a locked box for later retrieval and review. Ultimately, results are expected to be on the more excellent side of patient satisfaction, as the transportation department will provide a service that will ease the minds of all who use it and their families. (Syed, et.al.,2013)
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Patents and Copyrights will be issued for all technologies created for the BayCare Transport Department, from scheduling to dispatch. The transportation system will be specified to BayCare Medical Group, the Primary Care and Specialty Group of BayCare Health System. All personnel that will be working in the department will go through a significant background check. (Level 2) Training will be given for approximately three weeks, and there will be license checks every three months to review driving history outside work. The transportation department will also improve the quality of healthcare for patients. It will allow them to get to their appointments on time. Patients will obtain the education and knowledge needed to maintain their health outside the primary care office. The relationship between the primary care provider and the patient will also improve as appointments are kept, and providers can see the patients as scheduled. A "meaningful measure initiative" will be adopted from CMS to measure quality and performance so that improvements can be made where needed. The "Meaningful Measures" Initiative identifies high-priority areas for quality measurement and improvement, intending to improve health outcomes for patients, their families, and measured entities, i.e., clinicians, hospitals, and health plans. Its purpose is to deliver value by empowering people to make informed care decisions while reducing the burden on clinicians and hospitals. (CMS, 2022)
Because transportation touches many aspects of a person's life, adequate and reliable transportation services are fundamental to healthy communities.
Transportation issues can affect a person's access to healthcare services; These issues may result in missed or delayed healthcare appointments, increased health expenditures, and overall poorer health outcomes. Transportation also can be a vehicle for wellness. Developing affordable and appropriate transportation options, walkable communities, bike lanes, bike-
share programs, and other healthy transit options can help boost health. This
guide outlines transportation issues and their impact on health and healthcare access. (American Hospital Association, 2022)
.
The transportation department within BayCare Health System will be a disruptive innovation. Other transportation organizations will lose business as patients become eligible to utilize BayCare's transportation versus their previous usage.
The qualitative analysis of participants' transportation challenges revealed several themes, including availability, accessibility; safety; physical limitations/health concerns/pain; financial limitations; advanced planning and
waiting; and societal attitudes. Table
3
includes challenge themes and illustrative participant quotes. (Remillard, et.al., 2022) (Remillard, et.al., 2022)
B4. Optimizing Care
The transportation department would ultimately be patient-centered care. Measurable Improvements
: The transportation department will increase patients' quality of life as they can get to appointments. Patients' health reports will improve as they get to their appointments regularly and on time, and the patient's need to come to see the doctor will decline. The availability
of reliable transportation will decrease the number of No-Show appointments
daily. Even when it is a same-day acute visit, eligible patients can get to and from their office visits without delay or frustration. The wait times in the office will decrease as providers will be coerced into being on time with their schedule so that all patients on that day's schedule can be seen on time. Patient Perception:
The transportation department would give families peace
of mind knowing that their loved ones have a reliable and trustworthy ride. They can attend work in the middle of the day instead of worrying about getting their family member to an appointment. The department would
ensure that those delicate patients that need the extra in healthcare can get it and have an opportunity to utilize it, even if not requested.
Hospitals and doctor's offices need to uphold a reputation that provides not only excellent medical care but also one that provides a secure and stress-
free patient experience. Patient Experience encompasses all interactions patients have from start to finish in a patient's journey.
(Vyas, 2019)
Operational Efficiency:
Successful collaborations to improve patient access to
healthcare services have emerged in communities across the United States. Understanding these collaborations may benefit other communities interested in improving transportation access to health care. However, the complexities intrinsic to the transportation and healthcare sectors make collaboration challenging. (
National Academies of Sciences, Engineering, and
Medicine, 2021)
Therefore, BayCare Transport will be dedicated to patients within the BayCare Medical Group PRIMARY CARE. Patients will not have to depend on untrustworthy transportation. No-show cancellations will decrease, and patients will have access to freedom. Patient Engagement:
Knowing the target audience: the elderly and chronically ill, low-income or impoverished, those with live family or those that live alone, it is going to be essential to assess and provide transportation services to those in the most need. It may be dialysis patients with disabilities who lack accessible service to reach their three times-per-
week treatments, or it may be non-English-speaking residents who have difficulty navigating public transportation. It is essential to define the target group that needs improved access. Needs assessments may help healthcare providers and transportation agencies understand community members' unmet needs and priorities. (
National Academies of Sciences, Engineering, and Medicine, 2021)
Patient Engagement is key to having this service in the organization, as without the patients, there is no need for the department. The Institute of Medicine or IOM (renamed the National Academy of Medicine
in 2015) defines patient-centered care as: "Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions." (Bau, et.al.,2019)
Patient-centered care is the practice of caring for patients (and their families)
in meaningful and valuable ways to the individual patient. It includes listening to, informing, and involving patients in their care. (O'Neill, 2022).
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(O'Neill, 2022).
In having a value-based care model, patients would be the transportation department's focus and ensure they get to and from their appointments. The
direction would be how well the care is from providers and not so much on how many patients they will see in a day. However, the transportation department will ensure that the scheduled patients who need reliable transportation will have it to make their appointments. The following categories are the ones that will be the focus: Patient cost reduction, Increased Patient Satisfaction, and Society becoming healthier. Value-based care differs from a fee-for-service or capitated approach, in which providers are paid based on the number of healthcare services they deliver. The "value" in value-based healthcare is derived from measuring health outcomes against the cost of providing the results. (NEJM Catalyst, 2022)
C1. Risks and Opportunities
Opportunities
: Job opportunities open for positions within the new department and the organization; it creates jobs in the competing job market. This new department will encourage community participation opportunities; it opens chances for elderly patients to have access to reliable
transportation so they can get to their appointments and other social
activities in their community. Revenue is another opportunity for the organization to consider when implementing a new department. Lastly, reduced cost in healthcare and hospital expenses is an opportunity for patients and executives to delve into advancements. Threats
: The sole threat to the program is that it would be a complete failure.
In the loss, should the finances to start up the additional department not be made available, the department would not even get off the ground. If the patients do not use the transportation system, there aren't any patrons to transport them anywhere. Should there be any additional threats, they would
resolve back to be included in the attribution of failure of the new transportation department. C2. Market Segmentation
Demographics:
Age and Income will be the categories looked at for eligibility in Medicare patients. One benefit of this kind of segmentation is that the information is relatively easily accessible and low-cost. (Lotame, 2019)
Knowing the target population will help with being able to appease those that are in the categories of the target population for utilization of the transportation department. Psychographics:
Analyzing how patients respond to the new transportation department will allow the organization to review the targeted marketing segment. Psychographic segmentation is similar to demographic segmentation but deals with more mental and emotional characteristics. These attributes may not be as easy to observe as demographics, but they can give you valuable insight into your audience's motives, preferences, and needs
. (Lotame, 2019)
Behavioral:
Behavioral data is helpful because it relates directly to how someone interacts with your brand or products. Because of this, it can help you market more effectively to them. (Lotame, 2019)
Analyzing and simply asking patients how they feel about the transportation department and following up with them after their first few rides will give a personal assessment of what works and what does not. Geographic:
The geography of the patients using the department will help gauge areas where most of the target population resides and market those areas heavier than others. A customer's location can help you better understand their needs and enable you to send out location-specific ads. (Lotame, 2019)
C3. Stakeholder Analysis
Stakeholders directly impacted
: The upper executive management of the organization would be the target of scrutiny should the pilot program fail, but
to an abundance of praise should the program prove successful. The external
stakeholders can lose resources should they choose to go with the Transportation Department versus others that may have been introduced to them prior. They can also improve their services and expansion when the program proves glorious. C4. Regulatory and Legal Environment
Regulations:
American Disabilities Act (ADA): according to the ADA, some criteria must be met to transport patients (the public) anywhere. Listed are a few of the requirements that the ADA expects specifications for: o
Schedules
o
Response time o
Fares
o
The geographic area of service
o
Hours and days of service
o
Availability of information
o
Reservations capability o
Restrictions/priorities based on trip purpose (ADA National Network, n.d.)
BayCare transport will be reserved only. The schedule will be Monday through Friday from 7:30 am to 6:00 pm. Response time will be on time as the trips and rides will be reserved ahead of time, and fares will be taken care of by the patient's insurance. The service area will be for patients within
a 10 miles radius of the provider's office. All trips will be picked up 30 minutes early to ensure that the patient is at their appointment 15 to 20 mins early. The organization's website will have an easy-to-use scheduling system and a 20 hours scheduling department. Rides must be scheduled 48 hours before the patient's appointment, as insurance must be verified and approved. State Regulations: The Florida Statutes are Transportation entities controlled per county. Per the CTD, the Florida Commission for the Transportation
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Disadvantaged: Each jurisdiction and funding agency has requirements for transportation providers. You may need to do the following: o
Register with the county or city in which you plan to do business.
o
Provide evidence of vehicle insurance.
o
Provide registration of your vehicle(s).
o
Provide photos of your car(s).
o
Have your vehicle(s) inspected.
o
Have your maintenance files checked.
o
Have your driver files reviewed.
o
Perform drug and alcohol testing.
o
Provide driver's license identification.
o
Provide proof of driver training.
o
Provide more than one employee for some services.
o
Provide a roster of personnel.
o
Have documented policies and procedures.
o
Report your annual operating statistics, revenues, and expenses.
(Florida Commission for the Transportation Disadvantaged, n.d.) BayCare Medical Group will abide by all regulations of each county it serves. The Florida statutes and rules will be the foundation of the transportation department. FLORIDA STATUTE: 316.87 Nonemergency Medical Transportation Services;
Subject to compliance with state and federal Medicaid requirements, a transportation network company that: (a) Is under contract with a Medicaid managed care plan; (b)
Is under contract with a transportation broker under contract with a Medicaid managed care plan; (c) Is under contract with a transportation broker under contract with the Agency for Health Care Administration, or (d) Receives referrals from a transportation broker under contract with a Medicaid managed care plan or the Agency for Health Care Administration
.
(Online Sunshine, n.d.)
C5. Human Resources
i.) Resource need- People, Insurance, Valid Driver's Licenses, Clean Driving Records, Department office. These categories are just the beginning of what will be needed to start the transportation department. As the department expands, more items will be added for production and progress. ii.) Technology and equipment need- Vehicles, Maintenance, Gas Contracts, Car Wash maintenance. More Technology will be necessary as GPS systems and Tracking markers will be required for each vehicle. Cameras will be installed to protect the drivers and riders while in transit. iii.) Possible sources of financial support- Contracts with vendors for discounts and bargaining tools. The organization will create a specified budget for start-up, negotiations with insurance companies, and Medicare/Medicaid. Also, fundraisers to help finance the new transportation department. C6. Challenges
a. Resources- Having the patients start utilizing the program and having the employees get behind the vision of the transportation department. If there aren't any patrons to ride, it defeats the whole department's purpose.
b. Technology- There are quite a few programs that are going to be needed. A localized GPS and organizational program to track all vehicles and log all trips. A location to store the cars in maintenance. If the specific program needed for the transportation department cannot be created, it could make for a slow start, if a start at all. c. Finance- Over budget or no financial availability will be a real challenge to the transportation department. If the organization cannot sustain or create funding, it will create a severe hindrance. It will create a domino effect that could be catastrophic to the transportation department. C6A. Measure of Success
Goal setting will be the initial measure of success. Completing and exceeding
expectations will also be the measure of success. Continued usage of the transportation department and improvements to the program will measure the department's success.
Goal #1: Initiate the transportation department's participation and assess the first 90 days of utilization. 87% of the involvement from Medicare patients within 10 miles of the primary care office is the goal. Goal #2:
Increase utilization after analysis of the 90-day review. Technology having complete upgrades and 100% utilization without any additional developments needed is the goal. Goal #3:
Create incentives for patients that utilize the transportation department, so that word of mouth can gauge more patients to opt for an application. Significant financial increases in revenue by 62% increase is the goal. D1. Resources
The following resources will be needed to start the transportation department.
1. Insurance company to cover drivers and liability.
2. Background check agency for applicants.
3. Marketing agency for advertisements
4. Surveying company to assess potential patrons to use the transportation department.
5. Analysts to go through patient files for chronic illness and maintenance.
6. Interviewers for patient inquiries on services. 7. Budgets for expenses, i.e., gasoline, oil changes, and liability insurance.
D2. Impact on Revenue
The transportation department will increase the revenue for BayCare. The more income that comes in, the more expansion can be had for the department. More vehicles, more locations, and more revenue will be increased at each primary care location until every primary office has the transportation department working out of each office. Medicare does not cover transportation to doctor visits. Some Medicare Advantage Plans may offer transportation to approved facilities as an extra benefit with certain restrictions. (Medicare plans, 2022)
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Optimal investments in transportation infrastructure should maximize the present value of users' benefits, net of capital, and maintenance costs, while efficient operations should minimize expenses. (Winston, n.d.)
D3. Financial Risks The most considerable financial risk would be the reimbursement from the insurance companies or if they will pay for the service for the patient through
their plan. Will the patient be willing to pay for services if their insurance does not? Another risk could be if insurance companies are willing to pay for the transportation service for the patients, will they be willing to pay for what
is asked? That will be a critical risk to the department. Most companies must contend with four broad categories of financial risk.
Market risk happens when there is a substantial change in the marketplace in which a company competes.
Credit risk is when companies give their customers a line of credit; also a company's risk of not having enough funds to pay its bills.
Liquidity risk refers to how easily a company can convert its assets into cash if it needs funds; it also refers to its daily cash flow.
Operational risks emerge from a company's regular business activities, including fraud, lawsuits, and personnel issues.
(Maverick, 2022)
D4. Measurements
The amount of revenue comes in from patients' usage of the transport and the daily logs that are kept per trip, not to mention the schedules that are made daily. These measurements will gauge the number of trips made in a quarterly report. Any challenges that arise will be reviewed within 30 to 45 days for review and reconciliation. What is financial health? Some of the most prominent researchers and proponents define financial health around these critical elements:
• Smooth short-term finances, including the ability to meet ongoing financial obligations and consumption needs
• Preparedness to meet and recover from financial shocks
• A longer-term perspective that involves meeting goals and maintaining or improving well-being.
(Rhyne, 2020)
E1. Health Outcomes
Reliable transportation directly impacts health outcomes because it increases access to medical services.
Lack of transportation can increase the
risk of numerous health problems, from depression to cardiac arrest to early death. Furthermore, seniors, people with disabilities, or those without a vehicle who have limited access to public transportation can experience higher social isolation. (Wallace, et.al., 2005).
Depression can have the worst impact on the elderly and chronically ill. Depression affects healthy people exponentially, so you can only imagine what it can do to those with limited social cues and no transportation to get out about in the community. Lack of transportation can cause a domino effect of a lack of motivation to be mobile, which can impact a patient's health portfolio. Any illness left to fester will only increase the sickness, which will cost more to treat. (CDC, 2022)
Healthcare will improve on many levels. Healthcare costs are reduced, premiums are less, and hospital costs become less as emergent services stop being utilized as regular appointments. Patient participation can enhance patient livelihood quality as they keep their annual wellness appointments. Patient experience may also be used as a balance metric for improvement work.
(Tinker, 2022)
E2. Factors
Several factors contribute to the transportation challenges of the elderly and chronically ill. The main factors in South Pasadena, Florida, are the availability of wheelchair-accessible vehicles. (DOEA, 2022)
The financial responsibility may plague patients living on fixed incomes (Data USA, n.d.)
, and it may hinder them from keeping or even making annual appointments or follow-ups needed for medication refills. The timeliness of the transportation seems to be an issue as well. Those patients can only get a meeting between certain times of the day that are usually more popular to those with regular transportation and need help getting the much-needed time slot. The qualitative analysis of participants' transportation challenges revealed several themes, including availability, accessibility; safety; physical limitations/health concerns/pain; financial limitations; advanced planning and
waiting; and societal attitudes. Table
3
includes challenge themes and illustrative participant quotes. (Remillard, et.al.,2022)
(Remillard, et.al.,2022)
E3. Measuring Improvement
The data collected on the recidivism of patients using the emergency room as a routine doctor's visit instead of going to the primary care doctor for regular care will tell if there is an improvement. Patients who can make appointments and complete their visits will be a measurement of improvement. Finally, patients' healthcare improvement will also be a measurable item to show improvement. F1. Leadership
Decision Makers: Chief Executive Officer:
The CEO will oversee the entire implementation of
the transportation department adding to the BayCare Health System.
Chief Financial Officer:
The CFO will review all the financial responsibilities
encountered by BayCare Health System. The revenue will be obtained, then the prediction of how long it will take for the department to start paying for itself. Risk Management Officer:
The RMO will research and review the liability to start the transportation department at BayCare Health System. They will interview vendors for insurance companies and insurance plans to
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implement the new department. The best coverage for the best price and range can have to most drivers. Responsible Individuals:
Upper Management:
Directors will be responsible for gathering all the policies and procedures, reviewing, and understanding them to the fullest so that they can effectively relay said policies to their employees. Middle Management:
Office managers will be responsible for learning all the policies and procedures to direct their subordinates effectively and successfully without delay. They are also responsible for training all employees that work in their office, including any floating employees. Employees: Employees will be responsible for carrying out policies and procedures, working within all regulations of BayCare Health System, precisely BayCare Medical Group policies. Any challenges that arise with an approach operationally in any office will be brought to the office manager, who will then bring it to upper management. Managers make sure the work gets done; leaders make sure the job gets done differently and better. Managers work within an existing paradigm; leaders help people move from one paradigm to another. Managers focus on doing things right; leaders focus on doing the right things. Managers work hard to maintain improvements; leaders work hard to create improvements. Managers manage processes; leaders lead and develop people. (ASQ, n.d.)
Organizations need excellent managers and leaders—improvements that aren't sustained become worthless, and ideal processes that never improve become mediocre over time. Most organizations need people who can both manage and lead. In many organizations, the percentage of time spent on each activity, according to one's role, loosely follows the pattern in Table 1. (ASQ, n.d.)
Table 1: Management vs. Leadership Activities
(ASQ, n.d.)
F2. Structure Changes
Operational changes that will take place will be at all primary care offices. They will have to create parking spaces for a wheelchair-accessible vehicle and a company sedan. There will be additional personnel in each office and more traffic coming in and out of the offices. Patients will be at their appointments 15 to 20 minutes early; therefore, enough seating in each office will need to be available. Organizationally, a maintenance garage will need to be erected so that all maintenance requirements are met on time and any repairs that need to be addressed can be done promptly. Executively, BayCare may consider creating a position for the person who is going to be overseeing the entire department on an executive level who which upper management will report. This position will alleviate other functions to continue their workload without the added department. F3. Culture
Organizational culture affects your business, from punctuality and tone to contract terms and employee benefits. When workplace culture aligns with your employees, they're more likely to feel more comfortable, supported, and valued. Companies prioritizing culture can weather difficult times and changes in the business environment and become stronger. (Wong, 2020)
I strongly believe in taking care of the employees in an organization. They are the backbone of any company providing a service to the community in which they live or work. Cultivating an environment that will keep all personnel in a good position, including incentives for jobs well done, will
keep recidivism to a minimum. Keeping the turnover minimal will allow the organization to excel at providing excellent patient service. F4. Workforce Management
A department head or executive officer will need to be positioned to oversee the day-to-day functioning of the department. There will need to be a contact
person if any conflict or grievance may arise. There will need to be an in-
office designee to intercept situations in the office that need addressing. Other than the additional person in the office, management would not need much adjusting.
F5. Factors to Monitor
The factors to monitor will be anticipated vs. actual on-time appointments completed daily, weekly, monthly, and yearly. The mileage, fuel costs, and tire quality on each vehicle will have to be monitored closely; also, oil changes will need to be ensured to maintain regularly. Another factor to watch will be patients' grievances about everything. The potential risks of this need not being addressed could be detrimental to the quality of life of the patients that suffer through not having the transportation needed. Not having a proper ride affects the healthcare outcomes that occur from missed appointments. Social activities become a thing of the past, and after a while, isolation becomes a reality for these patients. Loss of hope becomes a potential death sentence as health declines and care diminishes. (American Hospital Association, 2022)
Reliable transportation directly impacts health outcomes because it increases access to medical services.
Lack of transportation can increase the
risk of numerous health problems, from depression to cardiac arrest to early death. Furthermore, seniors, people with disabilities, or those without a vehicle who have limited access to public transportation can experience higher social isolation. (Wallace, et.al.,2005).
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