Transportation Benefits Improve Care Access but Not Total Costs for Medicare ACO Members

Nonemergency transportation services provided to members of a Medicare accountable care organization were associated with increased care access but not reduced total costs, according to new findings.

“Nonemergency medical transportation benefits, often using smartphone application-based ridesharing services, are increasingly being offered as part of population health management programs,” wrote Seth A Berkowitz, MD, MPH, University of North Carolina (UNC), School of Medicine, and coauthors. “However, the impact of these programs on health care use and costs remains understudied.”

The mixed-methods study was conducted with 2 cohorts of beneficiaries who were members of the UNC Health Alliance ACO, a Medicare accountable care organization, from 2017-2019. One cohort used the transportation benefit, while the other cohort did not.

The benefit “facilitates nonemergency transportation to and from ambulatory settings, outpatient settings, and pharmacies,” authors noted. Patients requested services by phone, email, or an online portal, and there was no cost sharing associated with the program.

The overall sample included 11,833 people, out of which 173 participants used the transportation program.

Unweighted analyses showed the cohort who used the transportation program had comparatively more inpatient hospitalizations (1.31 vs .46, P<.001), emergency department visits (2.45 vs .6, P<.001), and outpatient visits (109 vs 50, P<.001) per person. Spending was also greater, with a total cost of care per person of $37,249 for beneficiaries using the benefit vs $15,123 for individuals not using it (P<.001).

Weighted regression analyses were then used to adjust for follow-up and index date. The transportation program was not linked to any differences in inpatient admissions (.1 hospitalizations per person per year; 95% CI: -.2, .4; P=.71) or emergency department visits (.3 visits per person per year; 95% CI: -.3, .9; P=.29).

Authors also did not find different costs for inpatient admissions ($1286 per person per year; 95% CI: -2962, 5534; P=.55) or emergency department visits ($47 per person per year; 95% CI: -323, 418; P=.8), nor significantly different total costs between cohorts ($5941 per person per year; 95% CI: -540, 12,421; P=.07).

However, weighted findings showed the transportation program cohort had a greater number of outpatient visits (9.2 visits per person per year; 95% CI: .2, 18.2; P=.04) and associated costs ($4420 per person per year; 95% CI: $722, $8119; P=.02).

“There was no evidence for greater benefit of the transportation program in the second year of follow-up,” researchers said.

Authors also conducted interviews for qualitative analysis. Participants said the transportation program reduced out-of-pocket costs, allowing them to allocate more money to food, medication, and bills. They found the program convenient and safe, and felt like less of a burden on family and friends.

“Related to freeing participants from burdening others was a feeling that the transportation program empowered people to better engage in their health care and provided a sense of independence and control over their life circumstances,” researchers said.

Given the findings, authors recommended stakeholders prioritize access over costs when determining whether to implement transportation programs.

“These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances,” authors said.

Reference:
Berkowitz SA, Ricks KB, Wang J, Parker M, Rimal R, DeWalt DA. Evaluating a nonemergency medical transportation benefit for accountable care organization members. Health Affairs. 2022;41(3). doi:10.1377/hlthaff.2021.00449