Over the past decade, the U.S. healthcare system has shifted from incentivizing volume of care to rewarding value-based, patient-centered care. Given the emphasis on value, healthcare organizations are incorporating population health management—the process of improving health outcomes of a group of individuals through improved care coordination and patient engagement. Population health management creates the foundation for a resilient health system and promotes public health while mitigating risk in a value-based paradigm.
Especially for the Medicare-aged population, health plans should adopt population health strategies that promote comprehensive care and risk management—like promoting health and wellness, implementing programs based on identified risks, integrating community resources, and monitoring health and quality-of-life outcomes. Nearly half of all eligible Medicare beneficiaries are already enrolled in a Medicare Advantage plan. And, as the 65 and older population grows rapidly, enrollment in Medicare Advantage plans is projected to increase 61% over the next decade.
Meeting the Population Health Management Demand
In 2023, the average Medicare beneficiary will have access to 43 Medicare Advantage plans, and in certain counties, beneficiaries can choose from 75 or more plans. As the Medicare Advantage market is becoming increasingly more competitive, plans must offer a variety of programs that meet, or even exceed, the needs of their member population. The plans with five-star ratings are improving the member experience and quality of life, all while keeping premiums to a minimum.
For a Medicare Advantage plan to differentiate itself from dozens of others, its programs need to be valuable to members—this involves offering benefits outside of traditional care settings. Supplemental benefits not only increase member satisfaction but improve health outcomes for the Medicare Advantage population.
While almost all Medicare Advantage plans offer vision, dental, fitness, and hearing benefits, only 43% of Medicare Advantage plans have added a non-emergency medical transportation (NEMT) benefit—a cutting-edge transportation program could set a plan ahead in 2023. An NEMT program can help support a few of the key components of population health management:
Supporting members with multiple chronic conditions. According to the National Council on Aging, 80% of older adults has at least one chronic condition, and 68% have two or more. Yet members who require chronic condition management, such as dialysis or chemo, are at the highest risk of missing appointments.
Consistently missing health services leads to the mismanagement of chronic conditions and poor health outcomes. Consequently, transportation issues create costly downstream effects on health plans, healthcare providers, and their members. The lack of access to transportation contributes to the $150 billion price tag of missed appointments in the U.S. every year. By making reliable NEMT more widely available, health plans can help improve health outcomes and reduce costs.
In our latest webinar, Kristen Hueske, Director of Account Strategy & Communications at KelseyCare Advantage, shared that 20% of their members that use the transportation benefit are managing a chronic condition.
"We need to remove transportation as a barrier for our members to get in to see their providers on a regular basis. KelseyCare Advantage has a very robust population health group that manages members with chronic conditions, members with high readmission rates, and the frequent flyers. There's no reason that a member should not make it to their appointment and receive the care they need because they don't have transportation available. The thing about a ride is that it costs 30 dollars versus the cost of missed appointments that lead to disease management issues."
Keeping the vulnerable safe. A key sub-population of Medicare members are elderly adults that can’t, or prefer not, to drive. Also, once at a medical facility, this population may need extra help finding the best drop-off point or getting to the check-in desk.
Chase Lafferty, President at H&M Transport, also shared in our recent webinar that reliability is a key consideration when it comes to supporting member experience.
"Member experience starts even before the pickup with a friendly customer service representative who's calling to confirm trip details, double check there's nothing that we may need to know to get a member in and out of the home safely, and provide a professional and enthusiastic driver on time... It's always been our standard procedure to walk the patient into their appointment, make sure they know where they're going, and ensure there are no issues before we leave. That way we don't have a stranded member who didn't get to their appointment and now they're waiting on us to come back and pick them up."
Limited access to NEMT contributes to 3.6 million people missing or delaying care each year. Barriers to care include vehicle access, cost, location, inclement weather, infrastructure, and illness. While everyone may experience an occasional travel mishap, transportation barriers disproportionately impact the nation's rural, disadvantaged, and elderly populations.
Promoting wellness. Population health management includes the promotion of a healthy lifestyle including regular exercise and nutrition. While getting to and from medical appointments is critical, on-demand transportation to and from a gym, pharmacy, or grocery store could also allow members to prioritize wellness while maintaining independence. As we’ve seen with services like Instacart, having access to many of life’s necessities depends on the ability to get yourself, or a product, from point A to point B.
Reducing hospital admissions. Nearly one-third of the population aged 65 and older visit at least five doctors per year—this greatly highlights the importance of proper care coordination, a core population health management intervention. Plans should focus on getting members to their preventative care appointments to avoid downstream costs like emergency care and readmissions. As members age into plans (driving overall plan growth but becoming higher risk), they increasingly rely on health benefits, like transportation, to access care.
Targeted Transportation Programs Can Improve Population Health
Prioritizing population health management strategies has helped Medicare Advantage plans manage a complex population. When surveyed, Medicare Advantage organizations reported reduced initial hospitalizations, ER visits, and readmissions as a result of implementing targeted interventions.
Currently, transportation is an underutilized intervention that improves access to care and reduces overall healthcare costs. Unlike traditional transportation solutions, NEMT technology provides data collection, reporting, and analytics—allowing health plan administrators to identify efficiency improvements, remedy any wasteful practices, and drive results to the bottom line. In addition, with NEMT technology, it's easier to scale a transportation program as a health plan's member population grows.
Competition in the Medicare Advantage market is fierce. At SafeRide, we partner with Medicare Advantage health plans to keep members healthy, happy, and independent. Is your transportation program helping you compete or holding you back?
To learn how SafeRide can help Medicare Advantage plans gain a competitive advantage, watch our recent webinar on-demand.