When someone has a poor experience with a company or service provider, they should feel and be empowered to reach out to that organization—even if it’s just to prevent it from happening in the future. In the healthcare industry, this type of feedback is known as complaints and grievances. They’re important not only because they highlight opportunities for improvement, but also because they can indicate failures or weaknesses that can lead to worse health outcomes.
In the non-emergency medical transportation (NEMT) industry, complaints and grievances can arise from many different scenarios: maybe someone’s ride didn’t show up to take them to their doctor’s appointment or the driver was late. Perhaps it was the wrong type of car, or the driver couldn’t provide the type of assistance the passenger needed. The consequences can be serious: A no-show to life-sustaining care, like a chemotherapy appointment, can jeopardize someone’s health.
Those conclusions are borne out in a 2022 analysis of National Health Interview Survey data in the Journal of Oncology, which found that cancer survivors who lacked reliable transportation were more likely to require an emergency room visit than cancer survivors who had stable access to transportation. They also had the highest risk of mortality among cancer survivors.
The definition of a complaint originated with Medicaid, but it applies to Medicare Advantage plans as well, and it is intentionally broad: A complaint is any form of dissatisfaction. When transportation difficulties lead to complaints, it can have repercussions for the health plan as well as its vendors.
Across the NEMT industry, a common benchmark for complaints and grievances is 1% of services provided; we at SafeRide Health have worked hard to reach a complaint and grievance rate that is far below that. In 2023, our grievance rate was less than 0.25%, and complaints that do occur are resolved within an average of 1.3 days, according to our latest data.
How Complaints & Grievances Affect Medicare Advantage Plans
Medicare Advantage is becoming the prevailing choice for people who are eligible for Medicare, thanks to the extra benefits those plans offer. In 2023, 30.8 million people were enrolled in private MA plans, making up more than half of the Medicare population. At the same time, Star Ratings are on the decline: An analysis by Chartis, a healthcare advisory firm, found that that average plan rating dropped from 4.14 in 2023 to 4.04 for 2024, and just 31 out of nearly 4,000 total plans earned a five-star rating.
Member experience is one of the key factors that go into Star Ratings, and complaints and grievances are one way to measure negative member experiences (while soliciting member feedback can also draw out positive member experiences). Plans that receive high Star Ratings are financially rewarded, allowing them to reinvest bonuses into further improvements and added benefits. Plans that score poorly are less appealing to people who are shopping for an MA plan. When health plans and their vendors give members a positive experience, it is a win for everyone.
Medicaid and Complaints & Grievances
The end of the COVID-19 Public Health Emergency and resumption of states’ redetermination processes brought a new spotlight onto member grievances, as millions of Medicaid plan members have been required to renew their coverage after a several-year hiatus. Some health plans haven't had the bandwidth to handle the volume of member contacts, which has led to long hold times and even dropped calls. The situation is even more challenging for some members who aren't fluent in English: a report from Unidos US found that some English-speaking callers were on hold for an average of 36 minutes, while some Spanish-speaking members waited an average of 2.5 hours.
Member challenges have left people feeling frustrated and helpless; worse, many have reportedly not been able to provide required information and have been subsequently dropped from Medicaid for “procedural” reasons. That can have serious health and cost implications for the entire healthcare system.
SafeRide’s Strong Foundation Improves the Member Experience, Reduces Complaints
Preventing complaints and grievances starts from the ground up, with an infrastructure designed to avoid member challenges. SafeRide Health’s unique platform integrates relevant data points about each member, minimizing friction when it comes to confirming benefits, scheduling rides, finding the right transportation provider, and ensuring those rides are completed in the best way possible.
Our industry-leading technology allows us to actively spot at-risk rides with real-time data visibility while optimizing driver routes and schedules. Our vast data lake allows us to quickly identify ride trends, so if there is a problem, we can immediately identify and address it. GPS tracking enables live vehicle monitoring, while proprietary dispatch technology offers full visibility into the ride experience and seamless facilitation of fleet management and transportation coordination. These innovations help eliminate scheduling, dispatch, and communication errors. Our geo-mapping technology also allows us to constantly improve our transportation operations. For example, perhaps there have been repeated calls about difficulty finding a particular health center; we can proactively adjust the drop-off pin for that provider, so drivers know the exact door location for member drop-offs.
We pair this technology-first approach with specialized customer service representatives that receive thorough and ongoing coaching on best practices for interacting with members and keeping their data up to date. In the rare case that complaints or grievances do arise, either via the health plan or directly from a member, our specialized team acts quickly to resolve them and, importantly, to prevent them from happening again.
The most common complaints and grievances include late provider arrivals, driver no-shows, and overall negative experiences. Creating a strong transportation provider network is an essential first step in preventing these challenges. SafeRide’s foundation is built on an expansive network of transportation providers, encompassing over 1,000 NEMT partners across 48 states. Our network allows us to tailor services to meet the specific needs, mobility, acuity, and preferences of each health plan member.
Key to our foundation is a commitment to helping our NEMT partners grow and develop. Our tiered network offers transportation providers incentives for meeting SafeRide's highest standards. Tier 1 providers receive benefits such as fast-track payments and increased ride volume. Weekly scorecards allow both sides to monitor ride ratings and overall performance, ensuring that SafeRide and our partners mutually uphold high standards.
Learning from Grievances
It’s nearly impossible to eliminate complaints in any industry, but organizations can ensure they respond quickly, optimize communication, and address any recurring issues that create a bad experience for customers. In the NEMT world, that means working with the health plan and members to respond to issues right away. Further, identifying and addressing the root cause of recurring issues can prevent bad experiences from continuing to happen in the future. Finally, creating a positive work environment for employees tends to have positive customer service impacts. Put simply, happy employees can help lead to happy members.