Abstract
While the issue of loneliness is large and complex, we are beginning to understand how critical transportation access can be in helping to remedy this significant societal issue. Recognizing the connection between mobility (or a lack thereof) and loneliness, as well as these accessibility issues, Medicare Advantage programs are becoming more progressive in their transportation benefit programs.
Key Words:
Medicare, Medicare Advantage, social determinants of health, transportation, NEMT, social isolation, supplemental benefits, American Logistics, transportation management, mobility, access to care
One of the biggest health challenges for older adults is loneliness, as researchers say loneliness and social isolation can be as damaging to health as smoking fifteen cigarettes a day (Health Resources and Services Administration, 2019).
According to the U.S. Census Bureau (Administration for Community Living/Administration on Aging, 2017), nearly one in three older Americans and nearly half of women ages 75 and older live alone—many without easy access to transportation. This has contributed significantly to feelings of isolation and loneliness among older adults, putting this population at a significant health risk.
The recent COVID-19 outbreak has only exacerbated the issue of loneliness due to stay-at-home orders. These measures have severely limited older adults’ access to many activities that bring a sense of fulfillment and purpose to their life, and even face-to-face social interactions they are accustomed to enjoying.
While the issue of loneliness is large and complex, we are beginning to understand how critical transportation access can be in helping to remedy this significant societal issue.
The High Cost of Isolation
According to the National Institute for Health Care Management (NIHCM), an estimated $6.7 billion in annual federal spending is attributable to social isolation among older adults (National Institute for Health Care Management Foundation, 2018). Studies have shown that poor social relationships are associated with a 29 percent increase in risk of coronary heart disease, and a 32 percent rise in the risk of stroke (Valtorta, N. K. et al., 2016). And public health professionals expect the financial and public health impact of loneliness to increase as the nation’s population ages.
Many people ages 65 and older do not drive, and therefore struggle to access their family, friends, community, and healthcare. Older adults who do not drive attend fewer medical appointments, go shopping and out for meals less often, and visit less with family and friends, compared to elders who drive. According to a survey conducted by the TransitCenter (2017) in seventeen U.S. cities, 21 percent of Americans older than age 65 do not drive. Of this sample, the majority report that not driving contributes to their feelings of social isolation. This same survey identified that, of individuals ages 65 and older who do not drive, most have not left their home in a week.
Even where public transit options exist, they can present real challenges for older adults. The same survey found that adults ages 65 years and older unanimously find public transportation increasingly difficult to navigate as they age. Moreover, public transportation can be stressful. Eighty-four percent of public transportation riders ages 65 years and older reported worrying about available seating and 99 percent reported having anxieties about shelter at bus stops.
Recognizing the connection between mobility (or a lack thereof) and loneliness, as well as these accessibility issues, Medicare Advantage programs are becoming more progressive in their transportation benefit programs. In 2018, the Centers for Medicare & Medicaid Services (CMS) expanded how it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies, paving the way for insurers to offer benefits such as non-emergency medical transportation.
‘In seventeen U.S. cities, 21 percent of Americans older than age 65 do not drive.’
The insurance industry is waking up to the reality that to support the overall population health of older adults, treatment begins with transportation—no matter whether the destination is to a physician’s office or a senior center.
Rideshare Models: Can They Go the Distance?
For mobility challenged older adults and those living in suburban or rural areas—far from public transportation routes—rideshare services warrant consideration as a potential solution for transportation for older adults.
However, the current rideshare model primarily serves adult, metropolitan-area riders traveling alone or in small groups, and can be expensive for older adults—many of whom are living on a fixed income. Furthermore, rideshare providers can be difficult to access for older adults who have little or no access to a smart phone or who are inexperienced in the use of apps.
Wheelchair-accessible vehicles in rideshare fleets are often scarce, and the traditional rideshare model doesn’t provide the level of assistance needed by older adults to get in and out of the vehicle and into a facility.
Some healthcare insurers have attempted to manage their own transportation benefit programs and-or partnered with rideshare companies to integrate these resources into their transportation benefit programs. While some have been successful, others have become frustrated at the prospect of having to devote extensive time and energy to the business of transportation management, as opposed to their core focus of healthcare management.
Refining the Transportation Model to Meet Older Adults’ Needs
With Medicare rolls adding 10,000 new members daily, insurance and transportation leaders are working together to provide transportation that is accessible and accommodating for older adults. American Logistics is a pioneer in tailoring the rideshare model to deliver a more purpose-built solution with a user experience that meets the needs of older adults and the healthcare plans that serve them.
A key ingredient to this effort has been delivering transportation that blends app-based technology with traditional phone and call center–based approaches. Technology is still very much part of the equation, but the focus is on using technology to empower healthcare plans, transportation service agents, and drivers to ensure they fully connect with and support older adults.
The older adult commercial insurance plan and Medicare Advantage plan members we serve have many options for accessing non-emergency transportation benefits. They can schedule a ride via phone, app, or website. To the member, the experience is seamless—scheduling a ride feels much the same as accessing any of their other health insurance benefits.
A ride reservation is made on their behalf, considering their specific needs to ensure the appropriate transportation modality (i.e., wheelchair accessible vehicle) and to understand any other requirements. A member also can put in place a standing order for a recurring trip—for kidney dialysis, for example. Drivers have been thoroughly vetted and contracted to meet all applicable CMS guidelines, such as HIPAA compliance and other requirements. On the day of the trip, technology tracks the driver’s location on the way to the pickup location to ensure the member is picked up and dropped off in a timely manner. The technology timestamps all key events along the member’s journey, creating a GPS-validated trip record.
During the pandemic, healthcare plans use transportation networks to bring groceries and COVID-19 testing to elders’ homes.
Curb-To-Curb and Door-To-Door services negate the need for older riders to walk long distances to access transportation, and alleviates anxieties associated with public transportation, while other assurances ensure optimal transportation accessibility.
Drivers of wheelchair-accessible vehicles provide door-to-door service, along with assistance to help the passenger in and out of the vehicle. And, there are accommodation for caregivers, family members and medical equipment, such as mobility aids and oxygen tanks.
While the main focus of American Logistics has been to tailor transportation to improve the lives of older adults, the model also has the added benefit of improving the lives of health plan transportation benefit managers. Our model fully extends benefits of our transportation program by leveraging our technology platform, vast provider network, and safety and reliability reputation. Because American Logistics manages all aspects of the transportation benefit program, health plans can conserve resources to focus on other areas of their business.
This also helps organizations scale their transportation benefit programs as needed, without extensive internal management overhead. As a national transportation company supporting Medicare Advantage plans across the country, we specialize in the transport of older adults, at risk, and medically fragile members, and are well-versed in CMS requirements. This allows our health plan partners to rest assured that proper quality assurance measures are being enforced for safe and responsive transportation, and that all new guidelines and requirements are addressed. At present, this includes COVID-19 guidelines and precautions to minimize the risk of virus transmission.
Quality assurance and dedication to customer service through expedient member service resolution also helps to mitigate negative ratings. This is essential as Medicare Advantage plans receive reimbursement based on their overall HEDIS (Healthcare Effectiveness Data and Information Set) scores, which span areas including: effectiveness of care, access or availability of care, experience of care, utilization and relative resource use, and health plan descriptive information.
Partnering to Usher in New Innovations in Wellness for Older Adults
Transportation providers are partnering with healthcare plans to serve older adults in new and innovative ways. For example, organizations can bring in-home healthcare resources—such as a well check or a flu shot—to members in conjunction with a trip to a senior center. By combining medical care with the transportation benefit, this population can be monitored and managed more regularly.
During the COVID-19 outbreak, progressive healthcare plans have leveraged their transportation networks to bring groceries, supplies, and even COVID-19 testing to the homes of older adult members, forging a new best practice for pandemic response and support of older adults.
As new transportation innovations become more available, such as autonomous vehicles, healthcare plans can leverage these new means and ways to drive new transportation efficiencies—when fully vetted from a safety and security perspective.Working together, transportation companies and healthcare plans can make transportation accessibility a reality, with the understanding that it is a vital “prescription” to ensure the population health of older adults.
Craig Puckett is the CEO of American Logistics, in San Clemente, California.
References
Administration for Community Living/Administration on Aging. 2017. “2017 Profile of Older Americans.” U.S. Department of Health and Human Services. Retrieved June 12, 2020.
Bliss, L. 2017. “Older People Will Need Much Better Transit.” CityLab, August 4. Retrieved June 12, 2020.
Health Resources and Services Administration. 2019. “The ‘Loneliness Epidemic.’ ” U.S. Department of Health and Human Services. Retrieved June 12, 2020.
National Institute for Health Care Management (NIHCM) Foundation. 2018. “The Health Impact of Loneliness: Emerging Evidence and Interventions.” Webinar. Retrieved June 12, 2020.
Transit Center. 2017. “All Ages Access: Making Transit Work for Everyone in America’s Rapidly Aging Cities.” Retrieved June 15, 2020. V
Valtorta, N. K., et al. 2016. “Loneliness and Social Isolation as Risk Factors for Coronary Heart Disease and Stroke: Systematic Review and Meta-Analysis of Longitudinal Observational Studies.” Heart 102(13): 1009–16. Retrieved June 15, 2020.
