Assessing the Impact of a Transition to Managed Care on Non-Emergency Transportation Services

Background

Transportation has been highlighted as a social determinant of health and is often cited as a barrier to accessing healthcare among Medicaid recipients.  An Integrated Care Program (ICP) was implemented in Illinois to help control costs and improve service quality for members who were aging, blind or had a disability.  The purpose of this study was to examine how the ICP affected Non-Emergency Medical Transportation (NEMT) services for members compared to a Fee-for-Service (FFS) Medicaid comparison group from the same region.

Methods

A Difference-in-Difference (DID) model with propensity score matching was used to compare baseline transportation services to the second year of the ICP using administrative claims and capitated payment data. The two groups were balanced on demographics, previous cost and utilization, diagnosis (CSS codes), and waiver status.  The outcome variables were # of days with NEMT, cost and the ratio of outpatient visits where transportation was provided. 

Results

The treatment effect of the ICP (p<0.001) per member was a 1.37 day increase in the # of days with NEMT, an increase of $84 in spending, and a 4.5% increase in the ratio of outpatient visits where transportation was provided.   Additional subgroup analysis of this ratio showed that the effect of the ICP was greater for some groups, such as members with physical disabilities (7.0%) and substance abuse issues (7.8%) but less for other groups, such as individuals with developmental disabilities (-4.6%).

Conclusion

For most populations, the transition to Managed Care improved the NEMT services provided. Potential factors leading to the improvement will be discussed.