Virginia’s Cardinal Care RFP: Filling the Void for Efficiency, Transparency, and Innovation

The recent Virginia Cardinal Care RFP brings in a new era of Medicaid for the state. Learn how the state will go about achieving these new goals.

Virginia’s Department of Medical Assistance Services (DMAS) is the state agency at the helm of the Medicaid program for the state. Responsible for the eligibility, benefits, and reimbursement policies for two-plus million beneficiaries, the agency has had a tall task to meet the evolving needs of members on an individual basis.

Today, DMAS has taken a major step to improve the quality, access, and health outcomes of all beneficiaries with the launch of the Cardinal Care Managed Care program in a new request for proposal (RFP) process.

Outlined within the RFP, DMAS provides 5 goals centered around health outcomes, member-centric care, accessibility, and innovation of new technologies. To achieve these goals, six methods were provided by DMAS–all of which closely align with SafeRide’s expertise in futureproofing Medicaid managed care non-emergency medical transportation (NEMT) programs.

Methods to Achieve Cardinal Care Goals

1. Emphasis on health outcomes – not inputs

Placing emphasis on health outcomes is paramount for Cardinal Care. According to DMAS’ Medicaid at a Glance 2022 overview, 18% of the Medicaid population made up 49% of total expenditures. This means that the most vulnerable of populations are proving to be the costliest.

The Medicare and Medicaid populations fall into this bucket as evidenced in a report from the Virginia Joint Commission on Healthcare (JCHC), indicating that Medicare and Medicaid individuals end up in the emergency room at a higher rate than other commercial insurance and that the non-emergent visits are most common when a patient is unable to access primary care or urgent care. SafeRide works with these vulnerable populations of Medicare Advantage and Medicaid managed care health plan beneficiaries to better their access to care, reduce their emergency room admissions, and improve their long-term health outcomes.

2. Bold innovations and effective use of managed care flexibilities and resources

In a report from the Joint Legislative Audit and Review Committee (JLARC), an independent providing oversight and analysis on other state agencies, a concerning downward performance trend of NEMT was highlighted. To help correct the course of NEMT performance, JLARC recommended for DMAS to “utilize a statewide GPS-enabled routing and tracking system.”

Not only does SafeRide elevate GPS-enabled routing and ride tracking, but it is all done in real-time to provide every NEMT stakeholder with exact whereabouts. This helps reduce fraud, waste, and abuse risks for managed care health plans while keeping transportation providers accountable for on-time performance of members getting to their critical appointments. Real-time visibility is one of many innovative features Medicaid managed care health plans have come to enjoy with the SafeRide platform.

3. Enhanced focus on health-related social needs (HRSN) to improve health

As value-based care rises in popularity among Medicaid managed care health plans and beyond, the alignment with addressing health-related social needs has become more and more clear now thinking of a person’s health as a whole. This kind of elevated focus on health-related social needs shows in care providers as well with 100% of rural hospitals addressing transportation.

Improving health looks different for every Medicaid member. While transportation may be a major pain point for one beneficiary, it may not be for another. Having customization of benefit structures for Medicaid beneficiaries with a flexible platform like SafeRide helps managed care health plans best address their population’s transportation needs as one of many health-related social needs.

4. Robust and responsive care management and enhanced member engagement

Member engagement has been under the microscope ever since the initiation of the Medicaid post-pandemic redetermination period. With many Medicaid beneficiaries reenrolling for the first time ever or in over three years, the process has been a challenge to get the attention of beneficiaries and have them complete the renewal process. Nationwide, 72% of total disenrollments are due to procedural reasons where contact information is out of date and/or the renewal process was not completed.

While Virginia ranks as one of the lowest rates of disenrollments from procedural reasons at 43% of total disenrollments, it is still a troubling signal to have this high of a rate. With benefit providers like SafeRide, Medicaid managed care health plans can improve member engagement by meeting the social needs of a beneficiary first. By meeting these social needs first and helping understand the availability of benefits to get them to and from care, they are more likely to continue to engage with the managed care health plan broadly, including completing enrollment processes.

5. Strategies to improve provider experience and engagement

For Medicaid beneficiaries to start receiving care it can feel like a gauntlet. Where can they find a Medicaid accepting primary care? Is this primary care accepting new Medicaid patients? How far out are they booking new appointments? Can they get to this appointment? These are just some of the questions and hurdles that Medicaid beneficiaries face when trying to find care.

In Virginia, a troubling over 40% of surveyed primary care practicing clinicians were not accepting new Medicaid members. While these clinicians all had different reasons, 40% said they consider the wastefulness of missed appointments when deciding whether to accept Medicaid beneficiaries.

An innovative partner like SafeRide can not only better help Medicaid beneficiaries get to their care, but it also delights care providers by minimizing missed appointments and allowing them to operate more efficiently. In addition, with SafeRide’s flexible platform, care providers can be delegated access to book and manage rides for their patient directly. This helps bring the identification of ride need as close to the end user as possible and increases the engagement of care providers in the patient care journey.

6. Strategies to improve oversight, strengthen program integrity, and set reasonable profit margins

In a separate report from JLARC, pricey preventable emergency room and inpatient hospital stays show to take a toll on the oversight and efficiency of the program. It was estimated that preventable inpatient hospital stay and preventable emergency room visit payouts to MCOs cost DMAS as much as $18 million in one year.

With SafeRide, managed care health plans get full access to our data and reporting suite to understand exactly how their program is performing. This gives managed care health plans the oversight they need to optimize their operations.

The launch of Cardinal Care in Virginia brings an exciting future for Medicaid across the state. With elevated transparency and member-centric approach, Cardinal Care’s initiatives and SafeRide’s platform help futureproof a crucial Medicaid benefit in transportation. If you’re a Medicaid managed care health plan in Virginia or beyond looking to reimagine your transportation benefit, get in touch with us.

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