Blue Promise: How is Health Care Impacted by Transportation Challenges?

It’s no secret that transportation plays a role in everything we do. Each day, Texans are dependent upon a web of highways, buses, trains and sidewalks. Transportation can also be a factor in our health. Tune in to this episode of Blue Promise to hear from the Texas A&M Transportation Institute’s  Agency Director Gregory Winfree and learn more about the surprising link between transportation and health care. 

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Blue Promise is a podcast and online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. 

Show Transcript

[DAN]: It's no secret that transportation plays a role in everything we do. Each day, Texans are dependent upon a web of highways buses trains and sidewalks. Transportation can also be a factor in our health. And we're going to learn more about it in this episode of Blue Promise.Thanks for joining us for this episode of Blue Promise I'm Dr. Dan McCoy president of Blue Cross and Blue Shield of Texas. Today we're filming this episode in front of a live audience here in Austin and right next door to the state capital. It's all being done in collaboration with the Texas Tribune Festival. Greg Winfree is an expert on transportation. He joins us from the Texas A&M Transportation Institute where he serves as agency director. Thanks for being here. 

[GREGORY]: A great pleasure. 

[DAN]: That's a long title. 

[GREGORY]: It is it is it's a mouthful. 

[DAN]: So it's also a bit of what you do at A&M 

[GREGORY]: Certainly certainly. So the Texas A&M Transportation Institute we have the honor and the distinction of being the largest and most comprehensive university based Transportation Institute Research Institute in the country. We've got seven hundred staff members 400 full time researchers and we literally cover every aspect of transportation from some of the foundational work with pavement and materials to next generation technologies like Uber Elevate automated driving connected vehicles. So we literally have touch points along the entire continuum. 

[DAN]: And this is important because this is a big challenge for Texas right now. 

[GREGORY]: It is. So having driven in from College Station this morning and sitting on the parking lot otherwise known as 290 East to get to the other parking lot which is I-35 we have some significant challenges. One of the other challenges though that underpins that is that we can't build our way out of it. We can't build enough roads and bridges for the influx of population that we're getting in this state. Eleven hundred folks a day coming to Texas. So there's no way we can outpace the growth in our population. So we have to start to utilize the infrastructure that we have now more intelligently utilizing technology and just smarter thinking and engaging with industry universities and other folks that utilize and depend upon our transportation system. 

[DAN]: So I grew up in rural Texas and my dad used to say that if if you broke down out in the country the news of it would get to town before you would because the roads were particularly kind of challenging. So I would take the transportation issues although you describe some major roads they're really challenging for rural Texas. 

[GREGORY]: Absolutely absolutely. So we have a particular focus on the issues affecting the rural parts of the country. We're pleased to announce that the Texas A&M University some of our partners on the academic side recently won a grant from the U.S. Department of Transportation to focus on automated driving issues in a rural environment. 

[DAN]: And that's because there's dirt roads. 

[GREGORY]: Well you know that's what that's what that's the center we call it the Smart Dirt Roads. And I think there's that's a catchy phrase that will capture the attention of not just folks interested in the issue but also certainly legislators as they start to think about how these issues that they hear about being impactful in urban settings can also provide benefit in rural settings so that's what we're focused on particularly since in our state you know 172 of our 254 counties are deemed rural. So that's the majority of the landmass of the state. 

[DAN]: And as someone as I said he has a great affinity for rural Texas you know it's important for our state fuel, fiber, you know all those things tend to come from from rural Texas. So from my perspective having people be able to live, work, raise their children and access health care. You can't build yourself out of a rural health care crisis either. 

[GREGORY]: No. 

[DAN]: And transportation plays a key role in that. 

[GREGORY]: Absolutely and we appreciate BCBS of Texas leadership with the Rural Moonshot you know taking a look at those critical issues in the rural communities with hospital closures with 35 counties that don't have a physician. So there are significant challenges in getting people from point A to Point B particularly for those vexing maladies and conditions like heart attack stroke and trauma. So we're pleased to be partnered with y'all on that. Moving that forward and we think thinking of transportation as an enabler is key because literally in a health care setting the transportation system is the circulatory system of our economy. And if we get a infarction or if we get a you know an issue or occlusion somewhere we feel the impacts throughout the system. So we look at it holistically and we're pleased to be addressing it from a rural health care perspective because there are significant issues out there. 

[DAN]: So let's talk about something you mentioned there early about the economy of Texas. I always tell people you know in Dallas Texas for instance I tell people Dallas Fort Worth Airport. It is a driver of the economy being able to go nonstop 250 places every day from the Dallas airport. But our cities are challenged too. I mean we don't have a very robust internal architecture around transportation. Talk a little bit about the challenges in our urban areas as well. 

[GREGORY]: Well you know I think our urban challenges are certainly constraints on the ability to expand because of not just the price of real estate but the availability of real estate. So a good way to think about and I alluded to it a little bit earlier is using what we have more intelligently. Right? So that means working with with employers to say why don't you stagger your start times so that employees aren't all in the roadway at the same time. Right? That just doesn't work. So why don't we sit and start to talk about how could we on a rotational basis make it so that BCBS starts at 8 o'clock one month 9:00 o'clock another month 10:00 another month and then rotate it and then that way you spread out the stress on the system rather than having everybody in the system or on the light rail at the same time? So these aren't these aren't earth shattering ideas but it just takes some collective wisdom and really collective responsibility to gather those folks at the table and say we need to address this holistically as users of transportation infrastructure because it's a finite resource. The stresses we're putting on it are at the root of the lack of state of good repair. So a lot of the issues that we hear about we're causing you know by by our usage of that finite resource so we need to manage it better and we need to manage our utilization better. 

[DAN]: And it seems like speed to market there would be faster than building a light rail for instance in a city. 

[GREGORY]: Yeah yeah for sure. I mean things like you know getting some of the truck deliveries off the roadway in the daytime and trying night deliveries these are things that other cities have utilized around the country New York being a prime example. You know you. So so particularly with deliveries where they double park you know limiting double parking limiting who gets to use the bike lanes and so that's a challenge in this town with e-scooters and everything else that's going on. We're only going to see more dynamism with mobility solutions particularly last mile mobility solutions so we need to use our infrastructure better so that we can manage access and improve throughput so that it's equitable for all. 

[DAN]: So I know during our last discussion when you look at the Twitter interest in our talk that last mile a dynamism that you talked about. Tell us some of the up and coming channel technologies that you see on the horizon that are really going to revolutionize the way we we deliver ourselves that last mile.

[GREGORY]: You know a lot of these things appear without the ability for regulators and asset managers to factor what the integration would look like. Right? So scooters just showed up and they were a big hit. But they're also creating issues with respect to access should they be on the sidewalks. Should they be in the bike lanes, right? Pedestrians have their answer bicyclists have their answer then that means. 

[DAN]: You know they also you know those that aren't riders end up in the emergency room. 

[GREGORY]: Well you see. Yes yes.  

[DAN]: We've seen it. We've seen a spike in emergency claims as cities that put scooters on the street. 

[GREGORY]: Absolutely. So I can't as I sit here tell you what the next solutions will be. We're starting to see folks dabbling with low altitude flying vehicles. Think of somebody with four big drones tied to him or her flying around so. Low altitude transport is not a figment of the imagination it may not be the Jetsons but we're going to start to see that being integrated into our transportation network. 

[DAN]: So so you know me I'm always going to drag you back into health care. So what's the impact that that's going to have on the way we we change our health care system. What do you see down the road? How that helps out our health care delivery system? 

[GREGORY]: What I'm pleased at the discussion from certain transportation network companies about air taxis because I think that's. 

[DAN]: You know that's scary? 

[GREGORY]: It is scary. 

[DAN]: Today it's scary. Yeah. I don't mean the actual tying the drone do you. 

[GREGORY]: That's right. 

[DAN]: You know air transportation today is it. It bankrupts people. 

[GREGORY]: Well it does. 

[DAN]: It's expensive. 

[GREGORY]: And that's the issue. I mean as I recall from our last conversation I think a standard air ambulance flight cost $50,000 to $80,000. Right? So that's a huge impact on a user. So. And they're growing in number and they're more becoming more common because you can't get in on 290 and 35. 

[GREGORY]: Right. 

[DAN]: You can imagine even a middle level illness at a hospital and couldn't get into a regional hospital here in Austin. So. 

[GREGORY]: But you know some of these smaller air mobility devices could be retrofitted, configured to have an air ambulance component. Right? So there are there are technologies that the military has worked on through DARPA where you have a pod let's say where a soldier who suffered an injury can you know place him or herself in you know robotically telemedicine and otherwise they're able to provide at least near-term comfort until you can get to a health care facility. So why can't that be made it to a flying device so that you can put your family member if you're in a remote community to allow him or her to get to a trauma center or other first level care. So those kinds of solutions I think are really going to unlock the ability to close the distance. Right? And not have the the unavailability of transportation assets be a hindrance to getting that critical care. 

[DAN]: So we've talked a lot today about what what consumers want because people want they actually want the scooters because they want the last they want that you try to take them away. You're gonna have to deal with that. 

[GREGORY]: Exactly. 

[DAN]: And we talked about technology. What role does policy play in and the way that we construct our transportation system today? We're in Austin. So again we have to talk about politics. 

[GREGORY]: Well absolutely absolutely and I'm pleased to say you know we've played a role in that for the past three biennium. At TTI. So we had a transportation policy research center that provided objective data driven information to the legislators to make their decisions. So policy is huge. And the reason I tie in the rural considerations is because if you just look at it from a numbers perspective we won't be able to push anything through if there isn't an agreement between the rural legislators and the and the Urban about what the benefits are. 

[DAN]: You talk'n about things like eminent domain for instance. 

[GREGORY]: Well that's a part of it. Certainly with respect to you know whether or not you're building out the transportation infrastructure. But what I'm talking about from an innovation and technology perspective you know if a farmer in West Texas doesn't see. Well here's a real world issue they have combines, threshers, John Deere devices that are fully automated that can go out in the field and put down fertilizer it can put down nutrients et cetera with millimeter precision and then that same farmer gets in his or her pickup truck and they have to drive it to the post office. Right? So if I have 21st century technology in an uncharted agricultural field why don't I have 21st century technology that can be a driver assistance or you know help take the burden off maybe significant travel to the back of forth to the post office or to medical appointments. So we have to be able to close that gap. And it's a it's a common sense hole right now when you can see what's going on in your field and that technology doesn't apply to devices you use every day. So from a policy perspective we need to get everybody on the same page so that when cities talk about self-driving low speed shuttles with last mile solutions there's a component that says well guess what? We're going to have smart dirt roads and vehicles that can drive in an automated fashion out in the rural parts of the state as well. 

[DAN]: Well as a power driver, I'm glad you're doing what you're doing. 

[GREGORY]: Well thank you. 

[DAN]: And thanks for being here for Blue Promise. And thanks for joining us for this episode of Blue Promise. 

[GREGORY]: Thank you.

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