Industry Voices—Transportation benefits are being underutilized. Here's how to better inform plans and providers

In 2019, the Centers for Medicare & Medicaid Services (CMS) increased flexibility for Medicare Advantage (MA) plans by redefining “primarily health-related” supplemental benefits for MA members. 

“[A primarily health-related benefit] must diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization," the agency said.

CMS’ new definition emphasizes an underutilized benefit: transportation.

Not only can transportation be used for critical care services, but also for preventive services, pharmacy visits, massage therapy, fitness centers and other healthcare-related destinations. As a result of increased flexibility, more than 1,900 MA plans are offering nonemergency medical transportation benefits, according to the Medical Transportation Access Coalition. 

CMS ranks MA each year on a scale of one to five stars, with five representing excellent performance and one reflecting poor performance. To assign stars, Medicare analyzes how health plans perform on a set of 30 measures. Some of those measures, like “breast cancer screening rate” and “getting appointments and care quickly,” can be positively impacted by providing members with rides.

How a plan performs against those measures, and its star rating, are becoming more important in the decision-making process with prospective enrollees. According to the Kaiser Family Foundation, in 2021, 80% of Medicare Advantage enrollees are in plans with quality ratings of four or more stars, an increase of 4% from 2020. 

In order to deliver supplemental benefits like transportation at scale, MA plans must use technology and risk-scoring models to engage a member before his or her need arises. In order to do this, organizations need to implement systems to document and track social needs data and develop models that predict transportation vulnerability at an individual level and proactively intervene. 

Addressing a member’s transportation needs after their first missed appointment, missed prescription pickup or avoidable emergency department visit is a reactive approach that represents missed opportunities to both control costs and improve outcomes. Research has shown that $1 spent on nonemergency medical transportation saves $11 in healthcare spend.

There is a strong correlation between being over age 65, not owning a vehicle and the need for transportation. Plans that stratify their members, assign risk scores and proactively connect the member with a care management plan can effectively prescribe a “dosage” of transportation that can remove the barriers to accessing healthcare and likely prevent the member from having an acute encounter. 

Members are attracted to consumer-oriented, high-quality options that include supplemental benefits like nutrition, wellness and transportation. Just offering the benefit as part of the plan is not enough. Delivering the benefit efficiently, without having to scale call center or care management staff as enrollment grows, is the hurdle in front of MA plans today. The plans that can predict member needs and serve up available benefits proactively—and deliver the benefits efficiently—will stand out from the pack and drive toward the best-in-class CMS five-star rating. 

Mark Switaj is the CEO of Roundtrip, a healthcare transportation advocate and a former EMT.