Published on February 27, 2019
When it’s time to visit your doctor, how do you get to and from your appointment? Do you have a safe, convenient, and affordable method of transportation? How about your elderly parents?
You might have perfectly good answers to these questions, but for a growing number of Americans, transportation insecurity is a burden preventing better health. According to the American Hospital Association, 3.6 million individuals do not access medical care because they experience transportation barriers. Transportation issues are the third leading cause of missing medical appointments for seniors.
Lack of transportation can also exacerbate other social determinants of health. For example, individuals who cannot easily get from one place to another likely cannot easily access a grocery store, which exacerbates both food insecurity and social isolation.
What are consequences of transportation insecurity – for the healthcare sector and for our economy as a whole? To answer this question, our data science team used the Carrot MarketView database of individually identified consumer information to develop the Carrot Health Transportation Needs Index (TNI). The TNI is a numerical score that summarizes a given individual’s likelihood to have a transportation security burden. It synthesizes a range of socioeconomic and lifestyle variables, such as vehicle registrations relative to household size, population density, distance/access to public transportation, income, and net worth.
The map below shows the average TNI, by ZIP Code, for the Minneapolis-St. Paul metro area. The blue areas represent the best-scoring regions, and the red areas are the lowest-scoring:
Average Transportation Needs Index (TNI) Score for Minneapolis-St. Paul
Source: Carrot MarketView™
At an aggregate level, it’s not surprising that transportation insecurity is negatively correlated with socioeconomic status. But when we dive deeper into the data, we find many interesting differences and outliers, such as high-TNI sub-regions that are embedded within wealthier neighborhoods. Just because someone lives in a high-income area doesn’t mean they can drive a car, or easily catch a bus. Analyzing data at the individual level allows us to glean richer and more actionable insights.
To quantify the impact of transportation insecurity, we used the Carrot MarketView clinical and claims database to compare the outcomes of high-TNI individuals with outcomes for the overall population. The results are striking.
High-TNI individuals in the Medicare Advantage population have:
- 79% higher total cost of care (vs. overall population)
- 40% higher Emergency Department visits and 43% higher inpatient hospital visits (vs. overall population)
- a 33% higher likelihood of a “frailty” medical classification (vs. overall population)
High-TNI individuals in the Medicaid population have:
- 459% higher annual Non-Emergency Medical Transportation (NEMT) service days (vs. low-TNI)
- 26% higher total cost of care (vs. overall population)
- 60% higher Emergency Department-related claim spend (vs. low-TNI)
- 185% higher ambulance-related claims and 261% higher ambulance service days (vs. low-TNI)
Given the magnitude of these impacts, there is a massive market opportunity for organizations that can develop interventions that address transportation-related gaps in care. Thanks to recent regulatory changes from the Centers for Medicare & Medicaid Services, health plans now have more flexibility to add nontraditional benefits, such as transportation assistance, that focus on social determinants. As a result, plan benefit design is an increasingly important tool for health plans that are looking to differentiate their product offerings in a competitive marketplace.
A great example of innovative thinking in this area is Lyft, which recently announced plans to expand its NEMT partnership with the Blue Cross Blue Shield Institute, LogistiCare, and Humana. Hitch Health (backed by Blue Cross Blue Shield of Minnesota) is reducing clinic appointment no-shows by using data from Electronic Health Record (EHR) systems to automatically call ride-sharing platforms for eligible patients. Many more solutions will be coming to the market over the next few years.
As with any health intervention, transportation benefits aren’t appropriate for everyone. To be cost-effective and economically sustainable, interventions need to be targeted to the right people at the right times. Using consumer data and predictive models such as the TNI, health plans can identify and target individuals with the greatest needs – and close social gaps in care more effectively.