In our last post Managing Multiple Chronic Conditions (MCCs) Is an Urgent Health Challenge for Individuals and Their Loved Ones, we discussed the impact that chronic conditions can have on individuals, communities, and our health care system and how learning to better manage care for multiple chronic conditions (MCCs) is an urgent health challenge today. In managing MCCs, it is also important to consider certain obstacles people face that keep them from getting the medical attention that they need; these are called barriers to care.

At UPMC Health Plan, we are committed to reducing barriers to care, and we develop and test innovative ways to support individuals living with MCCs, including how to overcome these care obstacles. In 2018, we started the Integrated Care Study to learn more about which type of integrated care for MCCs work best for which patient and under what circumstances.

For over 10 years, our UPMC Health Plan Community Team has worked directly with members who have multiple chronic conditions to help find solutions to some of these challenges. To better understand these barriers to care for our study participants and other members experiencing chronic conditions, we sat down with care managers from the Community Team serving six counties in western and central Pennsylvania to discuss what challenges people frequently face in their communities. Discussed in this post are the top six barriers to care that they listed and examples of how UPMC and the Integrated Care Study are working to address these barriers. Stay tuned for our next post, which will focus on how we are working to address these barriers.

Transportation

Care managers from all counties cited transportation to and from appointments as a major barrier to care for the people they serve. Many people who, for a variety of reasons, are unable to drive rely on friends or family members to take them to and from appointments. However, those friends and family members might have schedules that do not allow them to be available for doctor appointments during the workday. Some people look for public or private transportation services for support. But, especially in rural areas, it can be difficult to find transportation options that will go the distance to specialist visits, which are often in the city. Not to mention, the driver must also be available for the return ride after the appointment. Even if a transportation provider can provide a round-trip long-distance ride, it is not always affordable. In urban areas where transportation options tend to be more available, patients can still experience challenges accessing transportation. Available vehicles might not accommodate the needs of patients. For example, a small car might not be appropriate for someone who uses a wheelchair. 

Housing

Where a person lives has a huge impact on their ability to access care, the care managers explained. For example, some people who have a hard time walking may not be able to go to doctor appointments on days when no one can help them down their front steps.

Other patients may lack a safe place to live, and therefore, prioritize finding a safe home over seeking medical care. Individuals who live in community shelters or who move often may have difficulty receiving reminders or other information mailed by their providers. 

Administrative burden

Administrative burden—things such as setting up appointments and filling out necessary paperwork—is another key challenge keeping people from accessing the care they need. Patients who see multiple doctors sometimes receive conflicting information. It can be a lot of work to keep track of multiple appointments, new prescriptions, and treatment orders from multiple providers. Care managers also explained that even when benefits are available (such as low-cost transportation), the applications to receive service can be complex, adding an additional burden to people working to manage their health conditions.

Appointment availability

Patients often run into problems scheduling appointments. This challenge was exacerbated by the COVID pandemic which left many areas with fewer medical providers¹ and more people needing to be seen. If the patient needs to reschedule an appointment because of unreliable transportation or illness, they may need to wait several months for a new appointment.

“There is a lot of frustration. I had someone who had to wait three months to see a psychiatrist. Having one bad experience can make it very difficult to open up, trust, or to give behavioral health services another chance.” 

-Care Manager, Washington County

Additionally, those traveling from rural areas to the city for appointments may try to make multiple specialty appointments on the same day, but that may not be possible for each clinic’s schedule.