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By Sara Merken
For some patients, the next trip to the doctor could involve Lyft-style ride-sharing services or innovative trip-tracking technologies.
These innovations could make sure patients get needed care and cut down on transportation fraud in public health programs, according to industry and legal sources contacted by Bloomberg Law.
States are required to provide nonemergency medical transportation (NEMT) services to qualified Medicaid beneficiaries who lack the ability to independently go to a medical appointment. Some Medicaid and Medicare managed care plans also provide the benefit in different forms. State Medicaid programs can choose to manage authorization of NEMT coverage, or can contract with other entities, called transportation brokers, to manage the fleet of cars and patient communication.
At least 3.6 million people miss or delay medical appointments each year because of a lack of available or affordable transportation, a 2005 Transportation Research Board study estimated.
A variety of new and already-established companies are breaking into the NEMT space to provide and coordinate rides, and although each company uses diverse models and technology, the ultimate mission for all is the same: to enhance data collection and transparency of rides given by transportation providers to enable a healthier population and eliminate the ability to get reimbursed for fraudulent claims.
“The existing centralized state level broker model is ineffective, and does not meet the needs of patients, or their health care providers, or the subcontracted drivers in a sufficient way,” Imran Cronk, co-founder and chief executive of New York-based Ride Health, told Bloomberg Law. Ride Health manages automated coordination among transportation providers, patients and health-care providers.
“Ride-sharing has the opportunity to transform NEMT,” Gyre Renwick, vice president of Lyft Business, told Bloomberg Law in an email.
Transportation services to doctor appointments are necessary to maintain a healthy population, because patients that miss appointments ultimately delay care, which results in worse and more costly conditions, the innovative transportation coordinators and providers said.
“It’s really hard to understate how critically important transportation is,” Ann Hwang, director of the Boston-based Center for Consumer Engagement in Health Innovation, told Bloomberg Law.
Low-income individuals or those with chronic health conditions often face transportation barriers, and many have a difficult time getting to the doctor because they lack access to a car, Josh Komenda, president of Veyo, told Bloomberg Law. Veyo is a San Diego-based NEMT broker that works with state governments and managed care organizations.
Medicaid spends about $3 billion on NEMT annually, less than 1 percent of total Medicaid expenditures, according to the Transit Cooperative Research Program, a federally funded program. The result of missed or delayed care, though, can lead to more Medicaid and patient spending down the line as health conditions worsen, Komenda said.
Innovation in the NEMT space “will allow more Medicaid beneficiaries to take advantage of the transportation benefit.” Anna Grizzle, a member of Bass, Berry and Sims PLC’s Nashville, Tenn., office, told Bloomberg Law Dec. 6. Grizzle represents health-care clients in fraud and abuse cases as well as other matters.
“Anything that can be done to increase access to health services should result in healthier outcomes for Medicaid patients,” ultimately resulting in reduced Medicaid spending, Grizzle said. Treating a condition before it worsens will result in less money spent to take care of that patient later on, she said.
GPS tracking of drivers and the ability to time-stamp ride pick-up and drop-off times can provide increased transparency and additional data, which can help insurance companies and health-care providers detect and eliminate fraudulent claims, Komenda said.
The enhanced technology gives payers electronic documentation and verifiable evidence of trip details, he said.
“Having digitized payments as well as driver and rider GPS data eliminates potential fraudulent activity, such as charging for additional mileage.” Lyft’s Renwick said. Lyft works in partnership with hundreds of organizations in the continuum of care, such as Blue Cross Blue Shield, Anthem, and UnitedHealthcare, Renwick said.
A common form of NEMT fraud is claiming loaded mileage, or a transportation provider billing for a trip when a beneficiary does not show up. The claim can be prosecuted under the False Claims Act, according to a Centers for Medicare & Medicaid Services booklet for Medicaid NEMT providers. Additional forms of fraud could include billing for rides to nonmedical destinations like a grocery store or shopping mall, or billing extra for long wait times, the guidance says.
Access to time-stamped data can prevent transportation and health-care providers from filing false claims for rides that didn’t happen.
Enhanced data collection and transparency also provide patients with better experiences that can result in higher ratings for managed care organizations.
“Patients experience convenience, reliability, and predictability in getting to their destination for care” with the ability to track the location of a driver and eliminating the need to rely on phone calls or long wait windows, John Lewis, chief revenue officer of Boston-based Circulation, told Bloomberg Law in an email. Circulation partners with Uber, Lyft, and other transportation providers to act as the exchange platform when a patient requests a ride.
As ride-sharing programs increasingly serve the Medicaid population, companies must consider drivers’ abilities to help patients with chronic diseases, and also that beneficiaries with medical impairments may not be able to walk to a car on the curb, Jeff Myers, president and chief executive of managed care trade association Medicaid Health Plans of America, told Bloomberg Law.
Medicaid managed care programs are focused on providing NEMT services to ensure patient satisfaction, a facet of the plans’ contracts with state Medicaid programs, Myers said. A patient’s experience with a plan partly depends on if the individual is able to physically get to the doctor to receive the plan’s medical benefits, he said. Lyft’s app, for example, allows patients to request wheelchair accessible vehicles, Renwick said.
The implication of star ratings for Medicare Advantage managed care programs, which provide a metric for plan bonuses, also encourages platforms with a better user experience, Ride Health’s Cronk said. About 25 percent of Medicare Advantage beneficiaries have a transportation benefit, and Cronk predicts that more than half of MA plans will incorporate the benefit as part of the benefit structure and plans’ strategy to maximize their networks in the next three to five years.
The emerging models will also focus on effective spending rather than a reduction in spending, Cronk said. Instead of a decline in transportation investment, plans and providers are working on identifying the right people to receive the benefit “so the dollars we are spending go as far as possible,” he said. New data-driven models will be able to generate targeted lists of beneficiaries requiring the benefit by using information such as the number and location of beneficiaries requesting transportation to appointments and geographic access to public transportation to optimize where money is distributed, Cronk said.
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