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Health Equity

Data Dive: Transportation challenges plague dual-eligible Medicare and Medicaid patients

Gabriel Perna | March 31, 2021

Credit: Lyft Healthcare and Evidation

For patients living in underserved and vulnerable areas, transportation can be one of the most detrimental social determinants of health. 

It especially has a long-term impact on patients who are on Medicaid and Medicare, according to a new study from Lyft Healthcare and Evidation. The companies polled 9,000 people across the country and found that 31 percent of dual-eligible beneficiaries missed provider appointments or ran out of medicine because they could not access transportation. These individuals were more likely to suffer from chronic conditions and mental illness, come from low-income households, and be under the age of 65, according to the research.  

“A missed appointment or delayed care reduces the chances for early detection and prevention of health conditions before they worsen, threatening the long-term health of the individual and resulting in more costly interventions later, such as higher utilization of the emergency department, ambulances, and urgent care,” says Megan Callahan, Vice President of Healthcare at Lyft. 

Lyft found that Medicaid and dual eligible beneficiaries miss appointments at double and triple the rates of Medicare beneficiaries and run out of medicine at triple and quadruple the rates of Medicare beneficiaries. Nearly half of dual eligible patients were putting off appointments due to lack of transportation and 32 percent ran out of medicine. Almost half of transportation insecure individuals surveyed are late to or needed to reschedule more than 10 percent of their health care appointments. 

Health Evolution spoke to Callahan about the implications of these transportation challenges, what ROI can be expected from programs that address non-emergent care and how this problem factors into COVID-19 vaccine appointments. Below are excerpts from this interview.  

For health care CEOs in the payer and provider world, what are some of the takeaways from the survey Lyft Health care did with Evidation? 

It’s clear that one of the most common barriers to accessing health care is transportation, and the survey data adds new perspectives to the issue of transportation insecurity that can aid policymakers and key decision makers to develop action plans for this critical social determinant of health. The more data we can collect on how it affects specific communities and their needs, the more we can help in a very real way.  

31 percent of beneficiaries surveyed missed appointments or ran out of medicine because they did not have transportation, and many of these individuals are more likely to suffer from chronic conditions or mental illnesses that require comprehensive care and consistent medication. And only 29 percent of Medicaid beneficiaries, for whom NEMT is a required benefit, are aware of their benefit. This tells us there’s a huge need for education among this population. This is especially important in a COVID-19 context, as more and more populations become eligible for the vaccine and low-income communities and seniors will face challenges with accessing transportation to vaccine sites. 

What are the implications of 48 percent of dual eligible beneficiaries putting off appointments for non-emergent care? 

This is a health equity issue, as those experiencing transportation insecurity are more likely to be lower income, people of color, people with disabilities, or the elderly. Medicaid and dual eligible beneficiaries are often the most vulnerable and can be the sickest adults in the health care system. A missed appointment or delayed care reduces the chances for early detection and prevention of health conditions before they worsen, threatening the long-term health of the individual and resulting in more costly interventions later such as higher utilization of the emergency department, ambulances, and urgent care. 

What kind of ROI can be expected when health care organizations put into place programs to ensure Medicare and Medicaid efficiencies don’t fall into these transportation issues? 

Transportation to and from appointments is a critical part of the care continuum, and when transportation is unreliable or unavailable, it often leads to delayed care and dissatisfaction with the health care experience. We’ve been working with our partners to study the impact of rideshare-based NEMT on health care access and quality for quite some time, and we know that Lyft can play an important role in helping communities live healthier lives. Organizations like AmeriHealth Caritas DC, Centene, and Amerigroup TN have reported improved health care utilization, better member satisfaction, and increased access to primary care. For example, after the implementation of Lyft within their NEMT program, AmeriHealth Caritas DC reported a 40 percent decrease in emergency room utilization, 15 percent decrease in low acuity non-emergent (LANE) ER utilization, 12 percent decrease in ambulance utilization, and 45 percent increase in compliance rate for 42 Health care Effectiveness Data and Information Set (HEDIS) measures. 

These programs are even more important amid the COVID-19 crisis when demand for a particular health care service — the vaccine — is extremely high and public transportation is reduced or not advised.

Megan Callahan, VP of Lyft Healthcare

What are the implications of this trend for communities of color in terms of health equity? 

Millions of people lack access to basic resources that are essential — including health care — simply because they can’t get a ride. This remains a significant challenge across the U.S., but particularly for communities of color. Our survey found that those who identified as transportation insecure also primarily identified as Black, Hispanic, or multiracial. To layer onto that, racial and ethnic minorities get sick and die of COVID-19 at significantly higher rates than the general population. It is essential that health care organizations and the federal and state governments target the hardest-hit populations and connect them with the transportation they need. 

How does this crisis factor into COVID-19 vaccine appointments? 

The COVID-19 pandemic has exacerbated this problem as tens of millions of Americans will face challenges with transportation to vaccination sites – not only once, but twice for the vaccines that require two doses. We believe that beneficiaries of public insurance like Medicaid and Medicare may benefit the most from expanded rideshare coverage under their NEMT benefit, and we are heavily engaged with federal, state, and local officials on proactive planning for other vulnerable populations to access vaccination appointments. We’re happy to see that our proposed language was incorporated into the recently signed American Rescue Plan Act, which directs the CDC to award grants to states and local public health departments for vaccination distribution, including transportation to and from community vaccination centers and mobile vaccination units for underserved populations. 

How can health care CEOs combat this challenge in the next few months to ensure vaccination rates don’t slip in vulnerable areas of their community? 

Transportation access to vaccinations has been widely overlooked in preparation for the arrival of the vaccine, and if it is not adequately addressed, the U.S. will have a slow and inequitable COVID-19 recovery. One of the most critical actions for health care CEOs is to consider these vulnerable populations in their plans for vaccine distribution – from accommodating micro-mobility options at mass vaccination sites for populations who do not own a car, to allocating funding and operational support for last mile transportation to and from vaccine sites. 

What is your advice to health care CEOs who are considering investing in programs that will help increase non-emergent care transportation among Medicare and Medicaid beneficiaries? ,

The data supports rideshare-based NEMT can help members achieve better outcomes, create a better customer experience, and be more cost effective than traditional transportation options. McKinsey’s 2019 Consumer Social Determinants of Health study showed that respondents with an unmet transportation need were 2.6x more likely to have multiple ED visits and 2.2x more likely to report multiple inpatient stays over 12 months. This supports investing in transportation programs. 

These programs are even more important amid the COVID-19 crisis when demand for a particular health care service — the vaccine — is extremely high and public transportation is reduced or not advised. It’s exposed weaknesses in our health care system that contribute to health disparities, lead to poorer health outcomes, and increase health care costs. Something as basic as a ride should never stand in the way of access to care. 

Homepage image: Canva.com/Jacob Lund

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email or on Twitter at @GabrielSPerna