The Important Link Between Managed Care and Medical Transportation



The Important Link Between Managed Care and Medical Transportation

Managed Care Organizations (MCOs) have turned to Transportation Brokerages (Brokers) to manage and administer the Medicaid Non Emergency Medical Transportation (NEMT) benefit for the last 30 years. However, over the past decade there's been a trend for MCOs to bring the NEMT benefit back in house to further enhance their suite of transportation services.  As a result of this shift, emphasis has been placed on MCO's to have greater service compliance standards, including:

  • better performance metrics
  • credentialing
  • solid quality assurance (QA) monitoring of transportation providers

KPIs Tell the Full Story

Performance metrics, typically comprised of key performance indicators (KPIs), are one way for MCOs to determine how transportation services are being delivered to their members. The importance of setting service goals and having the proper data to decipher service outcomes, goes a long way toward determining positive trends for those outcomes. This is critical for good KPI management. The best way to ensure KPIs meet service needs is by utilizing reliable transportation software like TripSpark's NEMT software, to manage the chosen data points. For example, one KPI could be to have no more than 1% trips missed during a designated period (a missed trip is when a member was not transported for a scheduled ride). Another KPI could be to ensure 25% of trips are grouped (shared) to decrease administrative costs for trip operations.

Credentials Validation

A second area of compliance for MCO transportation services includes credentialing. Validating transportation provider credentials is crucial for ensuring members are transported by appropriately trained and screened drivers, vehicles, and provider companies. Credentialing for a driver can include a review of driving record, a valid driver’s license, and defensive driving training. Credentialing for a vehicle can include a mechanical inspection (done on a stated routine), auto liability insurance coverage limits, and licensing. Credentialing for a company can include obtaining information on general liability insurance, local and state business licenses, and the company's financial stability.

Quality Assurance

The final area to review includes quality assurance measures. While these can be pulled into KPI measurements, QA measurements are often more specific to member interactions with drivers and vehicles. Some quality assurance measures are related to utilization. An example is determining how often a member uses an urgent care clinic after hours rather than attending an appointment with a primary care physician. Complaint tracking, investigation and response are often factors included in quality assurance activities. Not surprisingly, many quality assurance measures are linked to KPIs.

The Whole Package

A good transportation management software package can track and maintain all crucial data for MCOs to perform their required compliance activities and ensure positive member health outcomes. Many packages can track customer records, trip details, plus schedule and assign trips to providers. Not only is a package like this crucial for delivering the best possible NEMT services, but it's also key to ensuring member satisfaction.



About the Author

Kris Lyon's avatar
Kris Lyon

Kris, Senior Manager, Business Development-NEMT, has nearly 14 years of experience in the NEMT industry and is looking forward to sharing that knowledge with TripSpark's customers. Previously, she worked as the Human Services Transportation Coordinator for Lane Transit District.

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