Medical Transportation Benefits Management

Contributor: Beverly Bradway, WG’91
To learn more about Beverly, click here.

When the need for medical transportation arises, families often have no time to plan, and it’s the clinician, facility or circumstance dictating who the transportation provider will be.  As a result, patients, their families, and insurers are exposed to inconsistent practices and the unpredictable fees levied by independent and unregulated providers. This is an all too common occurrence in the currently fragmented state of the medical transportation industry. 

The risks in medical transportation are growing as use of air and ground ambulance for medical transport increases.  In response, Alacura, a new medical transportation and benefits management (MTBM) business backed by the private equity firm Vistria, is developing a model that streamlines the transportation process, coordinates benefits management through affiliations with health plans, guarantees market-rate payments to transport providers within 30 days, and provides structured pricing and process transparency for patients and their families.   By coordinating stakeholders, Alacura is establishing an approach to partnership, excellence, and fair pricing that delivers high quality at lower cost.

Medical transportation - including emergent (immediate), urgent (within 24 hours), or non-emergent (scheduled) - is becoming increasingly more important to the delivery of healthcare services. In fact, insurers both large and small include air ambulance/medical transportation in their metrics as more and more members access life-saving, advanced care through travel. Medical transfers may be necessary to return a sick patient to a home state, transport a patient to a special treatment center, get a patient from a rural setting to a major hospital, and more.  When precipitating situations arise, hospital case managers or clinicians usually initiate the process.  In some cases, the community ground emergency teams make the call.  Frequently, the selection of the medical transportation provider happens before the patient or family can be involved.

The medical transportation industry is defined by thousands of independent air and ground providers.  In order to do business, these providers comply with quality and safety standards set by federal and state transportation governing bodies.  Yet, given unregulated pricing in this industry (with the exception of Medicare services), some transport providers take advantage of patients and health plans through high retainers and fees.  How is this allowed to happen?

First, many health facilities do not have provider names or outlined procedures for unscheduled medical transfers.  In the majority of situations busy case managers default to established provider relationships or social media searches to identify a transport company.  Second, the need for medical transportation usually occurs at times when emotions are high and quick decision-making is required. Patients and their families are often not aware of their options or the full financial risk at the time of the agreements.  In many cases, time does not allow for patient/family review and contracting.  Third, providers state they collect from insurers, but patients/families do not realize that unpaid balances become their responsibility.  Insurers usually require pre-authorization and use of in-network solutions. Given the structure of most health plan guidelines, however, when a transport is triaged as emergent, the pre-authorization requirement is avoided. Informal research indicates that emergent coding is overused, and only 20% of current transport is done with in-network approved providers.   Health plan restrictions are insufficient to control abusive pricing practices.

To protect income, the independent providers usually collect a retainer from the patient, proceed with the transport, bill insurance, and then return to the patient/family for unpaid balances.  As more published stories expose the aggressive tactics used by some medical transportation providers to collect balances (including liens on family homes), the case for a fairer and better coordinated system becomes clear. Consumer outrage is only one part of the pain.  Insurers are taking notice, too, as members are unwitting victims to these costly services. “States have been receiving complaints from individuals who have found that there’s a huge balance to pay even after their health insurance pays,” said Bruce Ramge, Nebraska’s insurance director. “These services are very expensive. They’re staggering in some cases. It’s not just an issue in Nebraska. It’s an issue all around.”¹ 

Safety and care are also major concerns.²   Reports of medical transport accidents are not uncommon.³

Alacura brings an important solution to the disconnected and risky state of the medical transportation industry.  With international reach through an Alacura network of experienced, highly credentialed providers (previously operating independently), the Alacura business model streamlines information by acting as a partner to health plans and providers and ultimately protecting the patient/consumer.  Alacura's role extends beyond mediation. Alacura focuses on fair, market-based pricing, quality assurance and credentialing, guaranteed payments for providers, and transparency.

By analyzing data, costs, and member populations, Alacura assists health plans in determining potential risk exposures, contains costs through utilization review, utilization management and triage assessments, and reduces member dissatisfaction by assuring quality, safety, and predictability in pricing outcomes.  The Alacura model also coordinates provider reimbursement within weeks of the transport, helps them lower overhead, and gives them the benefit of an affiliated health plan business. Finally, when health plans are aligned with Alacura, members are only responsible for covering their deductibles.  Patients are not saddled with prepayments or surprise billing. Beyond these hard and soft cost savings, Alacura also offers fully integrated technology platforms to both providers and health plans; maintains active communication with the health plan clinical advisors, facilities (both sending and receiving), and families; and oversees tightly managed, consistent processes with every transport from bedside-to-bedside, including fixed-wing (jets), rotary (helicopters), and ground portions of transportation.

Alacura introduces macro-level advantages, as well.  While the country struggles with the escalating costs of healthcare, the burden for that cost rests with employers, insurers, and consumers at rates that exceed inflation.  By introducing standards to a lopsided cost-value situation, Alacura acts not just as a go-between but as a leadership partner, allowing disparate parties to function within the bounds of transparent, coordinated, and supportive operations.  Additionally, as more industries see Uber as proof that an on-demand economy with efficient assignment, tracking, and management of resources brings value, the Alacura model is even more compelling.

Finally, the Alacura solution creates an opportunity for new alliances to take shape.  Healthcare providers, including physicians, hospitals, rehabilitation and acute care facilities, international centers of excellence, and the proliferating narrow networks can partner in new ways while maintaining cost controls.

It is an enormous undertaking to re-define practices, but the outcome has great value: Preserve and improve the quality of medical transportation while reducing risks and costs.