Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.
Research has shown nonemergency medical transportation can be essential for patients in rural areas, as well as the poor, elderly, and chronically ill. In a Health Affairs blog post, authors from CareMore Health show how the company has found success with Lyft after a pilot program it ran in 2016.
Poor, elderly, and chronically ill patients who face transportation barriers may use nonemergency medical transportation (NEMT) benefits to access care. Research has shown that NEMT can be essential, and a program with CareMore Health showed the benefits of NEMT in the Medicare population after a pilot in 2016.
In a Health Affairs blog post out September 13, Brian W. Powers, MD, MBA; Scott Rinefort, MBA; and Sachin H. Jain, MD, MBA, all of CareMore, highlighted that additional results after the 2-month pilot in 2016 continued to show the benefits of NEMT in Medicare. CareMore used brokers to arrange for rides using private car services.
By the end of 2017, 91% of the rides CareMore provided as NEMT in all its Medicare Advantage markets were through Lyft, and it was only the absence of Lyft availability in certain counties that prevented the program from being expanded any further.
Through the end of 2017, CareMore had found that Lyft-based rides were more likely to be on time compared with non-Lyft rides (92% of the time vs 74%), and patients experienced shorter wait times for a Lyft-based ride (9.2 minutes) compared with non-Lyft rides (16.6%).
Patient satisfaction with the program also improved compared with the pilot. During the pilot, Lyft rides sometimes confused patients who were not used to Lyft and were looking for a branded vehicle. Now, when a patient calls a CareMore associate to set a pick up, the associate makes it clear that Lyft will be picking them up. In addition, CareMore now has a smartphone application “that allows patients, caregivers, and care team members to track and manage rides.”
In a survey, 96% of patients using Lyft-based rides through CareMore said they felt safe or very safe and 98% said they were satisfied or very satisfied with the timeliness of the ride, the cleanliness of the care, and the professionalism of the driver.
Finally, CareMore has found that using Lyft in this program is more economical. On average, Lyft-based rides cost 39% less than non-Lyft rides, which means CareMore has been able to expand the NEMT benefit.
Despite the success seen by CareMore, rural areas remain underserved by transportation network companies (TNCs) like Uber and Lyft, and not all TNCs can accommodate patients who need extra assistance or specialized transport, such as wheelchair-accessible vans.
“Although these results are encouraging, it is important to remember that TNC-based NEMT is not a panacea,” Powers, Rinefort, and Jain wrote.
In addition, while CareMore has found success in Medicare, NEMT benefits may be on the chopping block for Medicaid beneficiaries. The Trump administration is urging states to use waivers under the Affordable Care Act to trim Medicaid rolls and certain benefits. The NEMT benefit has been part of Medicaid for more than 50 years.
CMS Administrator Seema Verma has not been a proponent of NEMT in the past. In 2016, she wrote in a Health Affairs blog post that NEMT services were not required to be covered in Indiana’s Medicaid expansion, and that transportation availability was not a significant issue for these beneficiaries.