A pilot program by a West Coast managed care delivery system reduced costs and improved waiting times for seniors with chronic conditions by partnering with a ride service to expand access to nonemergency medical transportation, according to a new study.
In a study published Tuesday in the Journal of the American Medical Association (JAMA), Anthem subsidiary CareMore Health Plan demonstrated how it collaborated with the ride service Lyft to reduce patient waiting times by 30 percent (12.5 minutes to 8.7 minutes) and cut per-ride costs by 32.4 percent ($31.54 to $21.32). The study reviewed 479 CareMore member rides in May and June 2016 and showed patient satisfaction rates exceeding 80 percent.
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Cerritos, California-based CareMore is a network-model HMO with neighborhood clinics treating mostly seniors with chronic conditions. The company works primarily with Medicare Advantage and Medicaid managed care enrollees.
Transportation presents an ongoing barrier to accessing care, the study’s three authors noted, writing that the federal government spends more than $2.7 billion annually on nonemergency patient transportation, with national waiting times averaging 60 minutes. An earlier study estimated that 3.6 million Americans were unable to access care because of transportation difficulties, they said.
Federal regulations require state Medicaid programs to provide nonemergency medical transportation for qualifying beneficiaries. In 2016, Medicare Advantage plans offered nonemergency medical transportation benefits to nearly 70 percent of members, the study found.
“Digital transportation network companies, such as Lyft and Uber, have revolutionized transportation services,” the authors wrote. “Compared with taxis and livery services, digital transportation network companies offer improvements across dimensions ranging from cost to user experience.”
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Dr. Sachin H. Jain
CareMore President Dr. Sachin H. Jain said the health plan and delivery system have long understood the role of transportation in accessing healthcare services, particularly for poor seniors with chronic conditions.
“We’ve been keeping frail patients well for 25 years and recognize the importance of transportation to actually making sure that patient can access to our services,” said Jain, one of study’s three authors.
He said delaying treatment to people with chronic conditions can cause those diseases to progress and patients to destabilize, but “connecting patients with multiple chronic conditions to the care they need may actually reduce costs.”
The study cited an earlier report from the National Academy of Sciences revealing that nonemergency medical transportation “was cost-effective for most chronic conditions, and even saves costs for conditions such as congestive heart failure and diabetes.”
Jain said CareMore reached out to ride-sharing programs and found a collaborator in San Francisco-based Lyft, but noted: “The ride-sharing business is built on picking up people from airports, hotels and rest, not healthcare centers. It is not an industry catering to seniors.”
So CareMore provided sensitivity training to drivers to better understand senior patient needs, “The bigger challenge in healthcare today is doing more with less,” he said. “And transportation represents an area of opportunity to lower healthcare costs by partnering with companies like Lyft.”
Jain said he expects the pilot program to expand soon, though it is currently focused on California markets. CareMore also operates clinics and health plans in Arizona, Georgia, Iowa, Nevada, Ohio, Tennessee and Virginia, caring for more than 100,000 Medicare Advantage and Medicaid members.
Jain said CareMore patients receive treatment through neighborhood chronic disease management centers in collaboration with their primary care providers, producing outcomes that exceed national averages. According to CareMore, in 2015 its members had 18 percent fewer hospital admissions and 23 percent fewer hospital bed days than traditional Medicare fee-for-service beneficiaries.
“People with multiple chronic illnesses need more support than other types of patients. CareMore has always focused on non-medical factors in healthcare as underlying drivers of patient conditions,” the insurer said.
Jain remembered a patient frequently readmitted to hospitals with dehydration.
“She didn’t have an air conditioner and it was a hot month. So we recognized that buying an air conditioner would make more of a difference than anything else and was a far cheaper solution in the long run,” Jain said.
“In another instance we realized a patient lived in a precarious housing situation, so we built a ramp to help support that patient. This transportation collaboration is in line with the spirit of our organization and what we’re trying to accomplish.”
While nonemergency medical transportation providers have existed for decades, web-based firms recently have entered the market. In January, Lyft launched Concierge, a platform allowing organizations to request rides for customers.
In April, Circulation started using UberAssist to provide third-party, healthcare-related ride requests. The Uber program also trains drivers to assist seniors and those with disabilities.
Photos: Mike Coppola/Getty Images for Lyft, CareMore
