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.
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.