Medicaid Managed Care - U.S. Senate Special Committee on Aging

170 Communicating the Quality Message
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to pay for the ride, keep the receipt, then turn it in to a county financial officer (along with
a completed form) for reimbursement. Many <strong>Medicaid</strong> members did not have the cash.to
pay for a ride up front; others found the process of filling out and mailing the forms too
daunting. The service, therefore, was seldom used. Provide-A-Ride removed those obstacles
by setting up a system in which Medica Health Plans, not the <strong>Medicaid</strong> members, paid for
the rides and then applied to the state for reimbursement.
Provide-a-Ride has proven to be a huge success. In 1995, the program gave more than
84,000 free rides to <strong>Medicaid</strong> members. Since the inception of the program, more than
174,000 rides have been provided. No-shows at some of Allina's clinics have decreased by
50 percent or more, which has made it very popular among providers. The state has continued
to fund the program, although Medica Health Plans is now reimbursed on a capirated
basis. This has reduced the paperwork involved, but has also placed the financial risk
of the program squarely on Medics Health Plans' shoulders. Still, Medica Health Plans is
committed to keeping Provide-a-Ride going because of the great benefits it offers not only
to its members, who are now less likely to delay seeking health care, but also to its
providers, who can now be more confident that a <strong>Medicaid</strong> patient will show up at the
appointed time.
In an effort to keep costs down and prevent abuses of the program (most notably, the
use of the taxis for nonmedical trips), Provide-A-Ride has undergone some revamping over
the years. Documentation and auditing of member abuse of the transportation benefit has
been strengthened.
Today, when a member calls requesting an immediate ride to a doctor or emergency
room, the access representative sets up a three-way conference call between the member; the
representative, and a registered nurse from Nurseline, Medica Health Plan's 24-hour telephone
helpline. The nurse does an on-line triage, asking questions of the <strong>Medicaid</strong> member
to determine whether his or her medical condition truly does require a trip to the emergency
room. Unless needed to interpret, the access representative does not participate in this conversation,
but simply stays on the line to call for transportation should it be necessary. More
often than not, the situation turns out to not be an emergency, and the nurse, after reassuring
the caller, recommends that the member make an appointment with his or her doctor.
The access representative-who is still on the line-then takes over to help the member
arrange the appointment and transportation.
Medica Health Plans has found that cultural differences play a big part in why some
<strong>Medicaid</strong> recipients don't make appointments with doctors, but instead go straight to the
nearest hospital emergency room when they or their children are ill. Hmong immigrants, for
example, were accustomed in their villages to visiting a healer-without an appointmentwhen
they felt ill and to wait in line all day, if necessary, to see him. The Hmong, therefore,
looked upon the primary care clinic, or emergency room, as a healer's home-a place to go
when you are ill and wait for care-frequently appearing early in the morning. Medica
Health Plans' challenge has been to educate the Hmong-and others-about when to use
clinics and hospital emergency rooms, and when to call a doctor. Once again, Medica
Health Plans has found that the best method of doing this education is through one-on-one
discussions.
WELCOME CALLS
To better communicate the breadth and availability of all its services to Medica Choice <strong>Care</strong>
members, Medica Health Plans initiated a new member outreach program in 1995. Medica
Health Plans' access representatives contact each new Medica Choice <strong>Care</strong> member either
by phone or, if that is not possible, by letter, shortly after the member enrolls in the plan. (A
letter is used only as a last resort; at least four attempts are made to contact new members
by phone.) If possible, this welcoming contact is in the member's own native language.