Imran Cronk

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Every day across America, hundreds of thousands of patients wake up knowing that they will need support navigating care. Not just the support that care managers provide, but actual navigation in the form of transportation across diverse settings: their homes, community health centers, medical centers, skilled nursing facilities, rehabilitation centers, and more. At stake is nothing less than adherence to critical care-cancer and dialysis treatments, cardiac rehab, opioid use disorder recovery, and more-for the most complex, high-risk, high-cost patients.

Managed care organizations are increasingly recognizing that, just as food can be medicine or poison, transportation can help or hinder patient access to care and experience.

As leading health plans work to encourage care adherence and good health among their members, these organizations can apply the same diligence to ensuring members can get to and from care settings. The challenges they face are profound but there is reason to hope that a better transportation future is right around the corner.

The solution can already be found in places like Penn Medicine in Philadelphia, a large academic medical center that has been arranging rides for patients from their homes to appointments and from the hospital to home. The initiative has contributed to reduced costs related to patient transportation in the outpatient setting and driven an average six-hour reduction in length of stay for patients qualifying for service within the inpatient setting.

Transportation services can also be found in places like Virtua Health, a five-hospital network in Southern New Jersey, where a system-wide transportation assistance policy implemented in 2018 has generated increased patient satisfaction, improved bed turnover, a greater-than 50% reduction in the average cost of rides––from $42 to $20––and a significant reduction in primary care no-shows. Overall, Virtua reports up to a seven-fold return on investment in its transportation program.

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Similar successes can be found across the country in health systems and health plans that have elected to help make transportation for patients affordable and easy.

Getting here hasn’t been easy or fast, though. Transportation’s essential role in providing access to care for vulnerable populations was first recognized in 1965, when Medicaid identified transportation as an assured benefit. Over the years, states have evolved how they manage Medicaid transportation, but the solutions they have deployed share many faults.

The most common model involves centralized, call center-based, low-technology brokers that primarily focus on managing utilization and costs while consistently underperforming on – or failing to properly track – measures of member experience, responsiveness to emergent needs and overall care adherence.

Hospitals have also started creating transportation programs based on new OIG Safe Harbor guidelines that took effect in January 2018. In addition, Medicare Advantage plans have created transportation benefits in response to new CMS rules for 2020 that allow plans to include supplemental benefits in the medical loss ratio.

These programs fill crucial gaps that traditional Medicaid benefits do not address: same-day and next-day needs such as emergent visits or hospital discharges, those who are elderly and need assistance with mobility, but do not qualify for Medicaid, and those who might have temporary or longer-term disabilities, but also do not qualify for Medicaid.

For managed care leaders, this emerging transportation landscape is complex, and not only because of evolving programs and benefits or the entrance of services like Uber Health, Lyft Concierge, or Ford GoRide. The complexities run much deeper: Health plans frequently find that although transportation accounts for less than 1% of spend, it accounts for as much as 60% to 70% of member complaints and grievances. Such high rates of dissatisfaction with a memorable part of the care journey can have a direct impact on member assignment in RFPs and plan star ratings.

Why is transportation challenging to get right? The difficulty lies in creating a consistent and reliable member experience across diverse transportation models and systems such as public transit agencies, app-based ride-hailing services, wheelchair-accessible vehicles, and more. Add in the fluid dimensions of geography, time, and weather, coupled with inevitable changes, cancellations, and other uncontrollable life situations.

However, managed care was built to handle complexity and bring order from chaos. In this, as in many other areas of care management, the tools available to help are evolving quickly to meet the need. Technology now exists to capture real-time, event-based trip status updates and GPS location tracking, enabled application programming interface integrations with transportation provider dispatch systems, to let patients know in real-time that their ride is on the way.

In addition, technology exists to enable convenient digital pass distribution and payments for public transit, which is a cost-effective and environmentally sustainable form of transportation, so we can link both public and private providers of transportation in an integrated service.

Lastly, technology exists to make member communication accessible whether they have a smartphone or a landline, whether they speak English as a preferred language, and whether they navigate rides independently or with a caregiver. It exists to enable the automatic detection of disruptions-such as a driver running late or waiting at a pickup spot for longer than usual, which might imply a risk of a no-show-and enable timely human or automated interventions, which can mean the difference between a missed appointment and a positive outcome.

Small differences in system design can mean the difference between a poor experience that leads a member to disengage from care, and a good experience that fosters trust and better health outcomes. On the scale of hundreds of thousands of experiences per day, nationally, the quality and reliability of the system coordinating the interactions of all of these stakeholders––patients, family members, drivers, dispatchers, care managers, clinicians, and administrators––matters a great deal.

If transportation is medicine, then managed care leaders share a responsibility to ensure the technological advances emerging in mobility-including increasingly connected transportation networks and even autonomous vehicles-get translated into meaningful outcomes for low-income, elderly, disabled, and other vulnerable populations.

Together with committed providers, managed care leaders have the opportunity to turn transportation from a pain point and cost center into a differentiated and strategic asset to ensure access to care for their members.

, providing smarter transportation for every patient need.

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Imran Cronk

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