Overcoming Transportation Barriers to Impact the Big Four: Revenue, Care Quality, Patient Satisfaction and Post-Acute Care

The following is a guest article by Luis Castillo, President and CEO, Ensocare, Omaha, Nebraska.

Driving to a medical appointment to receive care is a fundamental part of life.

But for 3.6 million people who miss or delay medical appointments or medication use every year due to transportation barriers, they can instead look forward to health complications, bad outcomes and rising medical debt. The consequences are particularly dire for those with chronic diseases, lower incomes or who are under/uninsured.

As healthcare providers tackle the social determinants of health, they must understand how the systematic social challenge of transportation access and non-emergency medical transportation (NEMT) factor into patient health and finances as well.

For patients and providers, the barriers to reliable medical transportation are real, with four major issues taking center stage. Thankfully, innovative solutions can help us address these issues.

1. Unnecessary hospital costs

Discharge bottlenecks are a frequent reality for patients and the hospitals who serve them. These delays have the potential to negatively impact both patient satisfaction and outcomes.

Hospitals and insurers typically have multiple contracts with multiple providers of non-emergency medical transportation, a key Medicaid benefit. But fulfilling the contractual obligations of multiple NEMT partnerships can be a complex and time-consuming logistical nightmare. A preferred NEMT provider may contract for 40 percent of the hospital’s business while the six other NEMT providers are obligated to lower percentages. And it may fall to a case manager to organize patient transportation while honoring these contract allotments.

Hospitals and health systems can optimize the discharge process by aligning the arrival of the medical transport. The result is significantly improved patient flow and a shorter discharge window –a big financial win for both the patient and hospital.

The patient moves smoothly to the next level of care, arriving at the right rehab or skilled nursing facility at the right time. Concurrently, costs are reduced as the hospital is able to decrease length of stay with improved bed turnover.

In partnership with Acuity Link, Ensocare offers a comprehensive communications and logistics management platform that links hospitals and payers with NEMT providers and ambulance crew members – for all levels of care and transport requirements. Ensocare NEMT is built to help administrators automate and ensure service level agreement compliance quickly and efficiently.

Ensocare NEMT also removes other discharge-related bottlenecks caused by missing medical necessity authorization forms and helps hospital administrators gain visibility into the performance of their medical transportation partners.

2. Patient care quality

Limited access to reliable transportation impacts care for people of all ages:

  • Many patients living with social and economic restraints do not have access to vehicles nor to people with a vehicle to take them to appointments.
  • Transportation is the third most commonly cited barrier to accessing health services for older Americans, according to the American Hospital Association (AHA) report, “Transportation and the Role of Hospitals.”
  • Regardless of insurance status, 4 percent of children (approximately 3 million in the U.S.) miss a healthcare appointment each year due to unavailable transportation; this includes 9 percent of children in families with incomes of less than $50,000.

Organizations working under a value-based care system have turned to ridesharing services to expand their transportation options and combat this lack of transportation access. Uber and Lyft have partnered with providers, state governments and hospital systems to leverage the growing fleets of Transportation Network Companies (TNCs) to provide NEMT services. Millions of Medicaid patients now have affordable and reliable access to this medical transportation option, enabling them to get the timely, high-quality care they need.

3. Patient satisfaction

Medical transportation plays a pivotal role in patient satisfaction as well. Here’s how:

Performance measuring – In 2018, the Healthcare Effectiveness Data and Information Set (HEDIS) issued new technical specifications to add to its transitions of care measure to ensure a smooth continuum of care for discharged hospital patients. HEDIS now includes a measure that tracks whether older beneficiaries are readmitted to the hospital within 30 and 60 days after discharge into the community from a skilled nursing facility (SNF); in effect, the measure seeks to prevent readmissions for patients receiving care in the post-acute provider community. HEDIS is a tool used by more than 90 percent of U.S. health plans to measure providers’ performance on important dimensions of care and service.

Hospitals that orchestrate a seamless discharge process, which might include medical transport, decrease the risk of errors from poor communication, rehospitalization and patient frustration. A positive patient experience can have an effect on HEDIS measures as well as enhance the organization’s reputation, patient loyalty and workforce retention.

Chronic care – Transportation is a necessity for ongoing treatment and medication access, especially for patients with chronic conditions. Seniors, as an example, are outliving their ability to drive safely by an average of 7 to 10 years, and they often suffer from chronic illnesses and other debilitative factors that affect their ability to drive independently.

Since most providers’ value-based care models include managing chronic disease populations, a chronically ill patient’s assigned case manager can arrange transportation to help that individual get to and from a regular checkup. The action of arranging transportation can feel to a chronically ill patient as an act of caring and compassion. The result is a happy patient who no longer has to worry about missing an appointment.

4. Post-acute care management

Frequently, a patient with exceptionally complex chronic care problems is moved to a post-acute care facility to speed recovery. There, at the skilled nursing, rehab, long-term care or other facility, all the patient’s distinct needs, including medical transportation, can be attended to throughout their stay.

However, for the patient who is able to self-manage a chronic condition and is sent home from the hospital but has no access to transportation, this barrier presents a great burden.

Case in point: A patient who is self-managing coronary heart disease is discharged and sent home to be attended by a visiting in-home care provider. The hospital’s nurse navigator checks in with the homebound patient and licensed caregiver and learns of an unusual weight gain and gradual fluid buildup, a strong indicator of the need for a prescription for a diuretic. To get the prescription, the patient must first be seen by a primary care doctor but has no vehicle or ride to the scheduled appointment nor to the local pharmacy to pick up the medication.

It’s thus in the hospital’s interest to arrange for a driver to transport the patient to both locations, supporting the individual’s adherence to medical treatment and to avoid an unnecessary readmission.

A priority for 2020

Unnecessary hospital costs, patient care quality, patient satisfaction and post-acute care management are key issues that will only worsen if non-emergency medical transportation services are not employed immediately and in a standardized and efficient manner. Technology can digitize the process of communication and contract management with multiple NEMT partnerships. Most important, healthcare organizations can positively impact the lives and outcomes of their patient communities. Let’s continue the momentum to prioritize reliable medical transportation as a disruptive industry trend for 2020.

About Luis Castillo

Luis Castillo is President and CEO of Ensocare, a proud sponsor of Healthcare Scene. Ensocare’s care coordination software and robust suite of technology-enabled services smoothly manage care transitions, enable remote monitoring in real-time and connect all caregivers around a unified goal: to provide services and solutions which enable patients to move efficiently and effortlessly through the care continuum. Prior to joining Ensocare, Luis spent more than a decade working in various senior-level IT sales, service, marketing and business development roles for Siemens Healthcare. He has deep experience in product life-cycle management, supply chain management, customer relationship management and alternative markets and is a sought-after participant in strategic initiatives and global partnership efforts. He earned his Bachelor of Science degree in political science from Haverford College in Pennsylvania.