VA Appointment Wait Times Shrink Shorter Than Private Sector

Average appointment wait times went down from 22.5 days to 17.7 days at the VA, research shows.

By Sara Heath

January 25, 2019 - Appointment wait times at the Department of Veterans Affairs (VA) are getting better, despite a negative public reputation to the contrary, according to new data published in the Journal of the American Medical Association (JAMA).

The study, which was conducted by VA researchers using data from 2014 and 2017, compared appointment wait times in VA facilities and the private sector (PS) in 15 major metropolitan areas. The researchers looked at wait times for primary care, dermatology, cardiology, and orthopedic settings.

Appointment wait times are an important indicator of a positive patient experience, the researchers noted. Research confirms that long appointment wait times are a drain on patient satisfaction. Additionally, long wait times can cause delayed access to necessary clinical care.

VA has a long history of long appointment wait times, the VA researchers acknowledged, but has since implemented new strategies to close the gap between VA and PS wait time averages.

In 2014, wait times in VA facilities averaged at 22.5 days, compared to 18.7 days for private sector providers, a difference VA suggested is negligible. By 2017, average VA wait times were 17.7 days. In private clinics, wait times increased to 29.8 days.

“Since 2014, VA has made a concerted, transparent effort to improve access to care,” VA Secretary Robert Wilkie said in a statement. “This study affirms that VA has made notable progress in improving access in primary care, and other key specialty care areas.”

These wait time improvements happened in primary care, dermatology, and cardiology settings. In orthopedic settings, wait times continued to cause issue, the researchers found.

Wait times in orthopedic settings remained shorter in private settings than in the VA in both 2014 and 2017. However, during that time period VA did reduce wait times by 5.4 days; the private sector remained static.

What’s more, VA has seen an increase in the number of patients it sees, up to 5.1 million patients by 2017, the agency said.

“Concurrently, there was an increase in the number of unique patients seen, volume of encounters, and an improvement in CAHPS access score ratings within the VA, further supporting the finding that access to care has improved over time within the VA,” the researchers wrote.

The VA researchers acknowledged that further analysis is necessary to understand appointment wait times and patient access in other setting types.

“An analysis of access to mental health services and of access in rural areas in the VA and PS would be useful to pursue in further research,” the researchers explained. “Although the results reflect positively on the VA, we intend to continue improving wait times, the accuracy of the data captured, and the transparency of reporting information to veterans and the public.”

All of this comes as VA handled a care access and wait time PR crisis that occurred in 2014.

“In 2014, reports indicated that veterans were waiting too long for care and that scheduling data may have been manipulated at a United States Department of Veterans Affairs (VA) facility in Phoenix, Arizona,” the researchers recounted. “This incident damaged the VA’s credibility and created a public perception regarding the VA health care system’s inability to see patients in a timely manner. In response, the VA has worked to improve access, including primary care, mental health, and other specialty care services.”

Since then, VA said it has implemented many patient-centered care access strategies, such as the Veterans Choice program, online appointment scheduling, and other tools to make it easier for patients to access treatment in a reasonable timeframe.

To help target further efforts, the healthcare industry must pinpoint what is an acceptable patient wait time, the researchers concluded. In doing so, VA and other healthcare facilities will have a benchmark by which to measure its patient care access successes or shortcomings.

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Medicare’s New “What’s Covered” App Adds to Outreach but More Work Is Needed

The Centers for Medicare & Medicaid Services (CMS) has released a free mobile app for iOS and Android users. The app, “What’s Covered,” is designed to provide Medicare beneficiaries and their families with a general overview of covered services, coverage requirements, costs, and additional information. While the app is geared towards beneficiaries in traditional Medicare, it notes that Medicare Advantage (MA) plans are required to cover the same benefits as those in traditional Medicare. Additionally, the app states that MA enrollees should contact their plans for information about covered and additional services.
Although the Center for Medicare Advocacy’s (the Center) review of the app is ongoing, it does add to outreach and education. However, CMS could improve the app by addressing the barriers to care that beneficiaries and families commonly experience. For instance, the Center still regularly hears from beneficiaries and families about the termination of skilled nursing and/or therapy services based on an erroneous “Improvement Standard.” Based on our initial review, however, the app does not address the Jimmo Settlement in any of the relevant sections (home health services, skilled nursing facility care, physical therapy, occupational therapy, and speech-language pathology services) to inform users that, contrary to ongoing misconceptions, Medicare does in fact cover skilled maintenance care or skilled care to maintain an individual’s condition, or prevent or slow decline. This is a missed opportunity to fully educate app users at critical moments, such as when a beneficiary receives his or her Notice of Medicare Non-Coverage.
Moreover, we also regularly hear from Medicare beneficiaries classified by hospitals as outpatients on observation status. Although these beneficiaries may be in a hospital for days or weeks, and receive the same care and services as inpatients, Medicare Part A will not cover their stay in the hospital or in a skilled nursing facility. As of March 2017, hospitals are required to give beneficiaries the Medicare Outpatient Observation Notice (MOON) within 36 hours if they are receiving “observation services as an outpatient” for 24 hours. Hospitals must also orally explain observation status and its financial consequences for patients, although beneficiaries have no right to an appeal. The apps’ relevant pages (outpatient hospital services and inpatient hospital care) do not discuss the possibility that a beneficiary could be in the hospital for days without being an inpatient or that a patient should expect to receive a MOON if he or she is classified as an outpatient on observation status. Again, this is a missed opportunity to fully inform beneficiaries and help them navigate another consequential problem in Medicare.
The Center will continue to monitor the “What’s Covered” app.  We hope to work with CMS to improve it.

Congressional Hearings Explore Rising Prescription Drug Costs

On January 29, 2019, the Senate and House held separate hearings on prescription drug prices. The Senate Finance Committee’s hearing, Drug Pricing in America: A Prescription for Change, Part 1, explored the rising cost of prescription drugs and potential solutions to the ongoing crisis. In his opening testimony, Ranking Member Ron Wyden stated that “[m]ore than a decade of evidence shows that private Medicare Part D plans often do not do a good enough job of negotiating drug prices downward.” Senator Wyden added that “Medicare ought to be able to use the collective bargaining power of 43 million seniors to get better deals for patients and taxpayers.” In addition to allowing Medicare to negotiate drug prices, witnesses testified about additional policies that could lower overall drugs costs, including measures to improve the Medicare program. The hearing touched upon reducing the Part B add-on or moving to a flat fee payment, using reference pricing for setting reimbursement rates, drug rebates, and other initiatives.
Similarly, the House Committee on Oversight and Reform’s hearing, “Examining the Actions of Drug Companies in Raising Prescription Drug Prices,” examined actions driving increasing prices for prescription drugs and their impact on federal and state budgets. Chairman Elijah Cummings’ opening statement noted that “the ongoing escalation of prices by drug companies is simply unsustainable.” Witness testimonies included discussions about market exclusivity, patents, drug innovation and publicly-funded research, price transparency, as well as other measures discussed in the Senate hearing.
The Center for Medicare Advocacy previously submitted comments to the Senate Finance Committee on prescription drug pricing reform. For more information on some of the recommendations discussed in the Congressional hearings and in our comments, please see: https://www.medicareadvocacy.org/center-comments-on-prescription-drug-pricing-reform/.

#MedicarePlatform - Improve and Expand Medicare: Long-Term Services and Supports (LTSS)

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare plans. We previously wrote about limited access to Medigap plans, oral health care, and the lack of an out-of-pocket cap on beneficiary expenses in traditional Medicare.
One long-standing and significant gap in Medicare coverage is the lack of coverage for comprehensive long-term services and supports (LTSS, also known as long term care).  As discussed in a Center Special Report issued in September 2018, recent changes in law (namely the Bipartisan Budget Act of 2018, or BBA) and CMS policy have expanded the scope of both medical and non-medical services that Medicare Advantage (MA) plans can cover.  While MA coverage of LTSS appears limited so far, as noted in an AARP blog, this important extension of coverage leaves behind the majority of beneficiaries in traditional Medicare. 
This month, the Commonwealth Fund issued two companion reports exploring LTSS and Medicare beneficiaries: “Are Older Americans Getting the Long-Term Services and Supports They Need?” and “The Financial Hardship Faced by Older Americans Needing Long-Term Services and Supports”.
As summarized in the key findings of the report exploring financial hardship, 

Beneficiaries with high LTSS needs have higher Medicare and out-of-pocket spending than those without such needs and are more likely to report that medical care makes up part of their credit card debt. Those with high LTSS needs are also more likely to report trouble paying for food, rent, utilities, medical care, and prescription drugs. Many older Medicare beneficiaries using LTSS are vulnerable to incurring substantial costs. Without an affordable, sustainable financing solution, Medicare beneficiaries with LTSS needs will continue to be at greater risk of delaying necessary care, being placed in a nursing home prematurely, and having to “spend down” into the Medicaid program.

The report highlighting the need for such services finds that “[t]wo-thirds of older adults living in the community use some degree of LTSS.”  Noting that the “recent policy change allowing MA plans to offer LTSS benefits is an important step toward meeting the medical and nonmedical needs of Medicare beneficiaries, only the one-third of Medicare beneficiaries enrolled in MA plans stand to benefit.” Looking “[b]eyond the BBA” and policy that only expands LTSS in MA, the report notes that “other proposals could provide more flexibility (as well as broader accountability) in the traditional Medicare program to ensure the health and well-being of most Medicare beneficiaries.”
The Center agrees. It is imperative that beneficiaries in traditional Medicare have access to all the same coverage provided through Medicare Advantage plans. The Medicare program as a whole must be expanded to cover critical long term coverage/LTSS needs.

What Providers Should Know to Improve Patient Access to Healthcare

Ensuring patient access to healthcare is an important piece of the patient engagement puzzle.    

Patient engagement, consumer satisfaction, and patient access to healthcare are three of the most critical pieces of the value-based care puzzle.

As outcomes, satisfaction, and patient loyalty become more important to financial security for healthcare organizations, providers need to emphasize the use of person-centered care philosophies to ensure that patients can easily and affordably engage in the relationships they need to maintain wellness.  

A non-partisan group of senators said it well in a letter urging the Senate Health, Education, Labor, and Pensions Committee to reassess patient access to care:

“We have heard from several patient groups with chronic diseases such as rheumatoid arthritis, inflammatory bowel diseases, and psoriasis, on the difficulties of accessing care and treatment,” the group wrote.

“Accessing the care needed is critical for these patients to achieve optimal health outcomes. Delays in treatment can result in irreversible disease progression and even, exacerbate the cost of care for both the patient and the health system.”

In order to avoid these negative outcomes and  improve patient access to healthcare, industry professionals must work to understand the challenges patients face when seeking treatments and employ innovative strategies for mitigating those issues.

What are the challenges related to care access?

Offering sufficient access to healthcare services can present numerous challenges, especially in the arenas of availability, convenience, and affordability.

Offices that only conduct appointments during traditional work hours, for example, may be inaccessible for those who work during those times. Children going to school full-time may also be unable to see pediatricians with limited afternoon or evening availability.  

Additionally, patients may face availability issues due to a potentially shrinking workforce, compounded by provider dissatisfaction. In a survey from the Physicians Foundation, 53 percent of providers reported low job satisfaction and 62 percent a negative view of the future of the medical profession.

According to the Foundation’s researchers, low provider morale could potentially lead to lower numbers of employed providers. Forty-eight percent of the survey’s nearly 17,000 clinician respondents reported plans to exit the trade, whether through retirement or a career transition.

“The primary public policy and healthcare concern attached to low physician morale is the prospect of physicians modifying their practice styles in ways that reduce patient access, or the prospect that physicians will abandon patient care roles or leave medicine altogether,” the report says.

With regard to affordability, increasing out-of-pocket patient costs have proven prohibitive for patients looking to access medical treatment.

According to a report from InstaMed, 74 percent of providers saw an increase in patient financial responsibility in 2015. High out-of-pocket costs can be prohibitive, causing some patients to skip recommended care. .

According to a seperate Physicians Foundation poll of over 1,500 patients, 25 percent are forgoing care due to cost burden, despite the fact that 90 percent reported high satisfaction with their providers.

Patients living in rural areas are the most likely to face challenges in accessing adequate healthcare, says the Rural Health Information Hub.

“Rural residents often experience barriers to healthcare that limit their ability to get the care they need,” the organization says. “In order for rural residents to have sufficient healthcare access, necessary and appropriate services must be available which can be accessed in a timely manner.”

In addition to facing the barriers patients across the nations face, those living rural areas are confined due to their locations and a lack of available treatment facilities.

“People in rural areas are more likely to have to travel long distances to access healthcare services, particularly specialist services,” the Rural Health Information Hub said. “This can be a significant burden in terms of both time and money. In addition, the lack of reliable transportation is a barrier to care.”

When patients have to travel long distances to receive treatment, as many living rural regions do, they are likely to go without adequate care.

How does care access affect value-based care policies?

Through accountable care organizations – a value-based payment model hosted by both public and private healthcare payers – providers face incentives in offering strong patient healthcare access.

In order to succeed in an accountable care organization, providers should engage in strong clinician outreach to their patients, consistently extending care opportunities.

According to Mark Wagar, President of Heritage Medical Systems, the industry is moving toward a model of extending care services based on patient needs.

“One of our problems with our traditional healthcare system is that people go through too much build-up of their health problems before they seek care,” Wagar said.

“We’re moving far faster than ever before away from a system that is designed to be excellent for the patient when they present themselves because they are sick or injured to a system that basically envelopes them and engages with them non-stop,” Wagar explained.

Going forward with value-based care programs, providers should determine how expanding their care access can improve patient care. Patient engagement plays a central role in both MIPS and accountable care organizations, making care access imperative for their success.

How can providers improve healthcare access for patients?

In order to establish broad healthcare access, healthcare organizations should look at how they make themselves available to patients. This can include an assessment of digital communication strategies, appointment scheduling protocol, office hours, and how many providers are actually available for a visit.

When examining these issues, organization leaders must also keep in mind what their patient populations may want. In an increasingly consumer-centric industry, it will be important for healthcare organizations to offer treatment access in ways that are convenient for the patient.

As the industry landscape changes, providers may consider new services offerings such as telehealth, or alternative methods for getting patients scheduled and in the door such as online appointment scheduling. Those approaches, taken alongside expanding and supporting the provider workforce, could be effective in driving patient healthcare access.

Enlist telehealth to offer remote treatment

Telehealth allows patients to consult providers through video conferencing, connecting two people in different locations and opening up numerous avenues for healthcare access.

Overall, telehealth helps expand access to care for two groups of patients: those in rural areas who live far away from a clinic or hospital, and those who have jam-packed schedules and may not be able to see a doctor during normal office hours.

In Georgia, the Community Health Systems clinic has benefitted from offering telehealth to its patients. Hosted by the Hancock County Healthcare Access Initiative, the telehealth platform allows remote patients to chat with a nurse via video conference using a toll-free number.

“It’s a way to bring some healthcare to people who don’t often see it, but who do need it,” said Dr. Jean Sumner, physician and dean of the Mercer University School of Medicine.

Some rural clinics also have telehealth kits that connect to larger regional hospitals.

At the University of Mississippi Medical Center, this setup allows patients to visit a local clinic, but still receive top-of-the-line care from a larger institution. Nurses in rural clinics can meet with doctors from UMMC’s level-one trauma center, and together they can deliver the best treatment for the patient.

Ultimately, this can enhance the entire patient experience. While patients still receive top-notch care utilizing tools only available at larger organizations, they avoid the hassle of traveling miles to receive emergency care.

Convenience is also a consideration for individuals with busy schedules. Full-time workers can use telehealth to conduct follow-up appointments during the work day. Parents can access providers via telehealth, helping to ease burdens that can arise when a child is sick.

A survey of over 500 mothers conducted by Blue Cross Blue Shield of Georgia shows that nearly 65 percent of mothers find it difficult to bring a sick child to the doctor during the work day. About 70 percent say sick visits take approximately two hours out of the day.

Florida-based Nemours Children’s Health System utilizes telehealth to help solve this problem, with parents reportedly appreciating this added convenience.

“Mom loves it because she didn’t have to pack up all the kids and drive two hours north for an appointment and then two hours back home,” said Nemours Chief Information Officer Bernie Rice. “So it was much more convenient for the patient and the family.”

Improve scheduling processes

When patients do need to access in-person care, they often face complications with scheduling appointments. When contacting a provider’s call center or front desk to make an appointment, patients may encounter busy signals, technological issues, or troubles finding a time that meets both patient and provider needs.

According to Irene Vergulis, a medical call center consultant who has worked with organizations including Mercy Health and Temple University Health System, healthcare organizations should assess their appointment scheduling processes, bearing in mind patient needs.

“People need to understand that patients are still customers,” Vergules said. “People need to really start to take focus on what their access looks like. How easy is it to gain access to their providers, to their services, to their hospitals? I think people are still not really looking at that very critically.”

Providers may wish to consider how many administrative staff members are taking appointment calls, or how many appointments are available during a typical day. Conducting surveys and focus groups with patients will show where they may need to make improvements.

Healthcare organizations can also consider online appointment scheduling software, which allows patients to view and select appointments with their preferred providers, typically via the patient portal.

At MedStar Health, online appointment scheduling has not only boosted convenience for patients, but has allowed patients to see the right kind of doctor for their ailment, an issue the hospital had reportedly struggled with.

“If we don’t have a good mechanism to match the patient’s needs with the doctor’s capabilities, we run the chance of having a patient showing up and being seen by the wrong doctor,” said Michael Ruiz, Vice President and Chief Digital Officer at MedStar. “So what we want to do is kind of inverse that paradigm. If we get it right the first time, we create this win-win situation.”

When a patient with a knee injury books an appointment, he can make sure he sees an orthopedist who specializes in knees rather than one who specializes in shoulders, Ruiz explained.

By making sure patients can make appointments – and with the right doctor – healthcare professionals can help improve their access to healthcare, ultimately driving more patient-centered care.

Expand and support the healthcare workforce

Fundamentally, patient healthcare access depends upon there being clinicians to actually treat them. As mentioned above, many physicians have reported job dissatisfaction and potential plans to leave the field. When there is a workforce shortage, patients ultimately lose out because there are not enough providers to see them all in a timely manner.

However, mid-level and non-physician providers are helpful for lower-priority concerns.

According to a 2014 report from the Medical Group Management Association (MGMA), non-physician provider (NPPs) are extremely effective at driving patient satisfaction, and ease some of the patient volume off of physicians.

According to Michael Brohawn, MGMA member and practice administrator at Orthopaedics East & Sports Medicine Center, NPPs have helped him enhance his practice.

“NPPs are essential members of our healthcare delivery team,” Brohawn said.

“They improve patient care by increasing the efficiency of our physicians which allows them to focus on more acute needs. NPPs also improve patient satisfaction by creating greater access and appointment availability, and they reduce the direct and overhead costs of the practice.”

Currently, the American Medical Association is working to redirect prospective physicians to provider shortage areas. The AMA’s Health Workforce Mapper uses data from the trade group to highlight where medical school students can look for employment opportunities, helping to more evenly distribute the physician workforce.

“Improving patient access to quality care is a core mission of the AMA, and this mapping tool will show physicians and healthcare professionals precisely where their skills can most benefit populations in need,” said AMA President Andrew W. Gurman, MD.

“Knowing where health care services are needed most can help providers make the best decisions on where to locate or expand their practices to reach patients in greatest need of access to care.”

Address patient financial needs to ensure payment

In an effort to make it easier for patients to manage high out-of-pocket costs, some healthcare organizations are starting to offer payment plans. These plans allow patients to pay in increments, lessening the blow of a significant doctor bill.

Family Healthcare Group of Modesto started offering personalized payment plans, unique to the individual patient in need. According to the practice’s billing department manager, Tabitha Hickerson, CPC, payment plans have been met with high patient satisfaction.

“We definitely have a pretty wide spectrum of payment plans available for our patients and they seem to be pretty happy with it,” Hickerson said.

“As primary care physicians, our number one focus is patient care,” she continued.

“With patient out-of-pockets continuing to grow each year, we wanted our patients to be able to have the peace of mind to make treatment decisions based off of medical necessity and not their finances.”

Healthcare organizations can also curb a patient’s sticker-shock by practicing price transparency.

“What we see more of the innovative healthcare companies doing is simplifying the experience,” said Steve Auerbach, Chief Executive Officer of Alegeus. “This means making it easy for the consumers to understand how to save better and how to spend more efficiently.”

Price transparency shows patients that they have options when it comes to their healthcare, and helps them decide which services they should access that will be right for their budgets.

Patient healthcare access is ultimately rooted in meeting the patient’s overall needs. By making oneself available to patients, providers can ensure that patients receive treatment regardless of their circumstances.

Between providing remote care via telehealth and ensuring there are enough physicians to serve high patient volumes, healthcare access fundamentally requires flexibility and availability on the part of providers and scheduling administrators. In an industry that is increasingly consumer-centric, providers should consider adopting more flexible approaches, ensuring plentiful access to healthcare services.

https://patientengagementhit.com/features/what-providers-should-know-to-improve-patient-access-to-healthcare

Overcoming Transportation Barriers to Drive Patient Care Access

Hospitals are at the cornerstone of addressing patient transportation barriers and patient care access, according to AHA.   

By Sara Heath

November 20, 2017 - Hospitals play an important role in addressing transportation barriers, patient care access, and other social determinants of health, according to a recent report from the American Hospital Association.

The AHA paper, “Transportation and the Role of Hospitals,” is part of the organization’s series on the social determinants of health, which are social factors that impact health outside the four walls of the hospital. These issues have a larger impact on patient wellness than genetics or health factors.

“Health and well-being are inextricably linked to the social and economic conditions in which people live,” AHA explained. “Research has shown that only 20 percent of health can be attributed to medical care, while social and economic factors—like access to healthy food, housing status, educational attainment and access to transportation—account for 40 percent.”

Currently, 3.6 million individuals do not access medical care because they experience transportation barriers, and 4 percent of all children miss a medical appointment because of transportation issues. Transportation barriers are the third leading cause of missing a medical appointment for seniors across the country, AHA noted.

Transportation barriers can also limit individuals to varying degrees. An individual who does not have transportation access and has a physical impairment is more limited than an individual without a car but who can ride a bike to the hospital, for example.

Common transportation barriers include long travel distances, lack of vehicle, transportation cost, inadequate infrastructure, and adverse policies affecting travel. Each of these obstacles can keep a patient from accessing her providers, which in turn could impair overall health.

“Transportation barriers can affect a person’s access to health care services,” AHA explained. “These barriers may result in missed or delayed health care appointments, increased health expenditures and overall poorer health outcomes.”

Efforts to overcome transportation barriers can also serve as health enablers, the organization noted. While some efforts should focus on ridesharing solutions and better public transportation, communities can also look into building walkable areas, bike sharing, and bike lanes. These efforts will improve patient wellness and increase physical activity among patient populations.

Hospitals are in an ideal position to spark changes in transportation, AHA asserted. Hospitals are pillars of the community, and can help facilitate change by leveraging their community relationships.

“Although hospitals and health systems traditionally have not focused on transportation issues within their purview of care delivery, there is a growing recognition that improving transportation access and support for patients can help improve health outcomes and lower health costs,” AHA noted.

Additionally, when hospitals support transportation improvements, they may improve their financial bottom line by reducing the number of no-show appointments and the rate of medication non-adherence, a very costly healthcare issue.

There is no singular cure-all solution for hospitals to overcome transportation needs, AHA advised. Transportation programs will be varied across regions, but must remain targeted on unique area needs.

Hospitals can begin designing transportation solutions by looking over their community health needs assessments and integrating transportation needs into organization strategic plans. Hospitals should also evaluate and note individual patient transportation needs.

From there, hospitals can partner with community organizations and other stakeholders to provide direct transportation services. Healthcare institutions can also support policy and infrastructure changes that create safer transportation access.

Efforts should conclude with hospital leaders educating staff about transportation needs and by creating better patient outreach programs that promote transportation options.

Lack of transportation can also exacerbate other social determinants of health, AHA argued. For example, individuals who cannot get from one place to another likely cannot easily access a grocery store, creating food insecurity. Transportation to and from work and school can also lead to other social health issues.

Although overcoming transportation challenges will be a community-wide effort, AHA contends that the hospital must be at the cornerstone of all efforts. There are significant health and financial implications for supporting patient transportation needs. Creating solutions to these problems can help improve patient health by offering healthier transportation options and facilitating better patient access to care.

“By making the commitment to address transportation barriers and building partnerships with community organizations and other entities, hospitals and health systems can improve transportation and health care access for patients and families and create more equitable, healthier communities,” the report concluded.

This report was published as a part of AHA’s series on the social determinants of health. Earlier this year, AHA released a report about overcoming housing security challenges and how organizations can play a role in reducing homelessness.

https://patientengagementhit.com/news/overcoming-transportation-barriers-to-drive-patient-care-access

Lyft Fills Medical Transportation Gaps for One-Third of Riders

Twenty-nine percent of Lyft users have used the tool to get to a doctor's appointment when they faced medical transportation barriers.   

By Sara Heath

January 29, 2019 - Using ridesharing service Lyft to get to medical appointments has made patient care access less of a hassle, emphasizing the tool’s use as non-emergency medical transportation, according to Lyft’s annual Economic Impact Report.

The report, which included survey responses from over 30,000 Lyft passengers, outlined how the rideshare service has impacted the communities in which it is used. Currently, Lyft has been adopted in 95 percent of the US population, the report stated.

Lyft has been a boon not only for individuals getting to work or social engagements, but for patients accessing care, as well. Medical transportation is an important social determinant of health. When patients cannot get transportation to their medical appointments, they often forego care, which can lead to other adverse health impacts.

Rideshare services like Lyft have addressed that issue. Twenty-nine percent of survey respondents said they have used Lyft successfully to get to their medical appointments. Twenty-eight percent of healthcare riders said that without Lyft, they would not be able to make it to their medical appointments at all.

Using Lyft to attend medical appointments can take multiple different forms. First, a patient may call a Lyft using their own smartphone Lyft app, brokering the exchange on their own.

But Lyft has also emerged as a key player in the healthcare market, building community health partnerships with hospitals and health systems across the country. In these cases, a hospital or health system manager can broker the ride on the patient’s behalf. Many state Medicaid programs have similar capabilities.

Finally, Lyft has made partnerships with many non-emergency medical transportation (NEMT) companies. These companies serve as rideshare brokers between patients and providers. If a clinic flags a patient as potentially in need of a ride, that NEMT group will arrange the ride on the patient’s and hospital’s behalfs.

These arrangements have improved patients’ experiences of care, the Lyft report pointed out. About three-quarters of respondents said using Lyft for their medical appointments made care access less of a hassle.

Thirty-six percent of respondents said that after beginning to use Lyft to attend their medical appointments, they went to urgent care less frequently.

This is likely because patients had the transportation means to attend appointments with their primary care or chronic care providers instead of having to mitigate crises in urgent care. This is ultimately less costly for the patient and healthcare industry at large.

What’s more, the use of Lyft has proven effective at making the roads safer, the report acknowledged. Seventy-one percent of riders said they are less likely to drive when impaired by a substance such as drugs or alcohol because Lyft is a transportation option.

Lyft, and other ridesharing apps, have proven effective at addressing driving under the influence as a public health issue.

Separate reports have corroborated this fact. A 2017 working paper out of the University of Kansas suggested that the public safety benefits of Lyft and Uber have resulted in lower healthcare utilization. Specifically, the decrease in impaired driving may have led to fewer ambulance rides.

Ultimately, these survey results indicate Lyft has an emerging public health good. The service is useful for addressing the social determinants of health and connecting patients with necessary medical transportation. This helps create healthier communities as a lower cost footprint, Lyft said.

Some studies have indicated that rideshare companies have mixed effectiveness at addressing medical transportation barriers. A 2018 study published in the Journal of the American Medical Association Internal Medicine indicated that rideshare programs are not, in fact, effective at reducing patient no-shows or missed appointments.

Additionally, rideshare companies such as Uber and Lyft are not always effective at offering transportation to patients with special transportation needs, including those who use a wheelchair or who have bulky medical equipment.

However, the JAMA study’s critics pointed out some study flaws. The researchers primarily looked at patients who already had a relationship with a primary care provider and who had a history of attending their medical appointments.

Lyft and Uber have proven effective at serving patients who otherwise would not attend the doctor. In doing so, these rideshare companies begin to address the fringes of healthcare who in many cases rack up the highest costs.

https://patientengagementhit.com/news/lyft-fills-medical-transportation-gaps-for-one-third-of-patients?eid=CXTEL000000460294&elqCampaignId=8268&elqTrackId=0ff6f8dfbd53490b88c3ad689b6099b7&elq=0660c1ebfe8746c3bda0ba11d38a582e&elqaid=8729&elqat=1&elqCampaignId=8268

Patient Access to Care Five Times Higher for Medicaid Patients

The report found that Medicaid patients are five times more likely and CHIP patients four times more likely to have easy patient access to care than uninsured patients.  

By Sara Heath

April 09, 2018 - Patients with private health insurance or on Medicaid see better patient access to care and preventive services than patients without any type of health insurance, according to a new report from America’s Health Insurance Plans (AHIP).

These results come after a tumultuous political season for Medicare, Medicaid, and the health insurance exchanges set up as a part of the Affordable Care Act (ACA). Over the past year, debate has centered on the fate of patients who do not have health insurance or who could lose health payer coverage as a part of healthcare policy reforms.

This latest AHIP report contends that patients who do not have some sort of health payer coverage, whether it be commercial or through Medicaid, do not fare as well as those with coverage.

An analysis of MEPS survey data for over 38,000 patients during the 2013 to 2015 timeframe showed significant differences in patient access to care for patients with private Medicaid plans, commercial insurance, and no payer coverage at all.

Adult Medicaid beneficiaries were five times more likely to have a regular source of healthcare compared to patients without coverage.

 “Significantly more commercial health plan and Medicaid health plan enrollees were always able to access all necessary and needed care or schedule appointments with their providers compared to uninsured individuals,” the report stated. “In fact, in all cases, adults with coverage had better access to care than their uninsured peers.”

Adult Medicaid beneficiaries were also four times more likely to receive preventive care and other wellness checks than those without insurance.

For example, 85 percent of Medicaid health plan beneficiaries received a blood pressure test during the study period, and 84 percent of commercially-insured patients said the same. Only 54 percent of insured patients received a blood pressure test during the study period.

However, there were some areas for improvement for all three patient cohorts, the report authors noted. Across patients with Medicaid insurance, commercial insurance, and no insurance, few received annual flu vaccines.

Forty-four percent of patients with commercial coverage and 39 percent of patients with a Medicaid plan received an annual flu shot. Only 17 percent of patients without insurance received a flu shot.

The benefits of healthcare coverage extended to pediatric patients, as well. Children on Medicaid, CHIP, or commercial insurance were four times more likely to have a usual source of care. Children were between two and three times more likely to receive preventive care than those without payer coverage.

These results fall in line with other industry data, the report authors noted. Numerous other studies have indicated that those with access to some type of healthcare coverage see easier patient access to care and higher rates of patient engagement in preventive care.

There are also some studies that run counter to the current AHIP research results, the investigators conceded.

“Despite this growing body of literature demonstrating the value of Medicaid, critics have attempted to challenge the value of the Medicaid system by examining studies of outcomes of Medicaid patients compared to commercially insured or non-insured patients,” the team said.

“Although the studies summarized above are cited by the critics of the Medicaid system as evidence of poorer outcomes among Medicaid patients, a conclusion that is questionable given the problems in study design, they do, in fact, point out the importance of access to care and the provision of preventive services,” the researchers continued.

Additionally, many studies that run counter to the current AHIP research results have some methodological flaws, the team said. Several of these studies also use limited or outdated data, the researchers argued.

These study results point to a need to continue to care for the Medicaid and underinsured population, the researchers said. Although many of these patients are high-risk and can be costly, consistent health payer coverage and access to care has helped improve overall health outcomes, the research team stated.

“Despite the unique challenges associated with caring for the Medicaid population, there is steadily growing evidence in the literature that Medicaid patients have better clinical experiences and outcomes than the uninsured and gaps between Medicaid patients and the commercially insured continue to narrow,” the researchers concluded. “The recent literature paints an encouraging portrait of a Medicaid system that is central to providing access to high-quality care and preventive services for the country’s most vulnerable people.”

Although these results also paint a positive picture of commercial insurance, AHIP representatives contend that the study is ultimately a display of strength for Medicaid.

“This new evidence reinforces what insurance providers see every day – Medicaid works for patients and taxpayers,” said AHIP president of Medicaid Policy and Advocacy Rhys Jones. “Medicaid is an important part of America’s safety net and optimizes the use of every dollar invested into the program to ensure those who need help the most get the care they need.”

https://patientengagementhit.com/news/patient-access-to-care-five-times-higher-for-medicaid-patients