Having healthcare insurance means nothing if you’re unable to use it – or have no way to get to your healthcare provider. The Code of Federal Regulations “requires States to ensure that eligible, qualified Medicaid beneficiaries have non-emergency medical transportation (NEMT) to take them to and from providers.” Non-emergency medical transportation not only helps Medicaid recipients get to and from their appointments and lowers the percentage of missed appointments but ultimately reduces costs for both the recipient and Medicaid provider.
NEMT services aren’t offered to everyone. According to CMS.gov, to qualify for NEMT services, you must fall into one of these categories:
- Those who don’t have a valid driver’s license
- Those who don’t have access to a working vehicle available in the household
- Those who are unable to travel or wait for services alone
- Those who have a physical, cognitive, mental, or developmental issue
The State of Indiana contracted with a third-party to provide a brokered non-emergency medical transportation model. A NEMT broker contracts with a health plan or State Medicaid Agency to manage patient transportation in a designated area. This means that the third-party works with individual NEMT providers and routes requests to those providers in their service network. Prior to this model, NEMT eligible Medicaid recipients facilitated their own transportation with NEMT providers who then billed Medicaid.
Specifically, this NEMT broker was having trouble figuring out how to limit their number of missed trips.
The CSpring team was tasked with creating an executive-level dashboard that would provide dynamic information about non-emergency medical transportation performance. This dashboard would include the geographic distribution of provider-initiated missed rides, complaint analysis, individual provider performance, trip frequency, and member level detail.
Leveraging Tableau, the CSpring team delivered a fully functional dashboard to the Secretary of the Agency and the Chief of Staff allowing them to access trip statuses in real-time. CSpring’s consultants identified the cause and number of missed trips using the third-party’s operational data. A mapping was determined in order to simplify why a trip was missed into three categories shown on the executive dashboard.
After assessing the current situation in the state of Indiana, CSpring created a Tableau dashboard that highlighted 5 key areas identified by the Executives and Legislators:
- Created a new NEMT (Nonemergency Medical Transportation) dashboard to allow Executive and Legislative users to view Non-emergency medical transportation data
- Created a Non-Emergency Medical Transit Missed Rides Risk Heat Map dashboard view using the geospatial features in Tableau
- Created a Member Complaint Log Summary dashboard view to quickly discern patterns and frequencies in member complaints
- Created a Trip Frequency vs Outcome dashboard view
- Created a Provider Scorecard dashboard view to be able to assess how well a provider was meeting the requirements of their contract with the State of Indiana and provide a “grade”
Appointment no-shows cost the overall healthcare industry an estimated $150 billion a year. By having easy access to information regarding missed trips, customer complaints, trip frequency vs. outcome, and a provider scorecard, executives and legislators can now make informed decisions on how to decrease the limit of missed trips from non-emergency medical transportation providers, provide a higher level of satisfaction for their riders, and calculate the ROI of NEMT services in the state of Indiana.
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