News

Why NJ Overhauled a Medicaid Transportation Contract

January 24, 2016  |  Courier Post  |  Link to article

CAMDEN – Irene Carrasquillo wastes no breath praising the state Department of Human Services for addressing long-standing complaints about its Medicaid transportation broker, LogistiCare.

Three years after providers, residents and community organizers in Camden and Trenton began pushing for solutions, the state issued new, stricter requirements for its next transportation contract to arrange rides for Medicaid patients to their non-emergency medical appointments.

"It was about time," Carrasquillo snapped, as she sat gingerly on a pillow in a bright sitting room at Abigail House for Nursing and Rehabilitation. "They shouldn't have waited that long. They shouldn't have waited for the way people have been suffering to get to places or left hanging, or people not listening to them."

The journey to stricter contract requirements began in 2013, when Camden Churches Organized for People, Faith in New Jersey and Camden Coalition of Healthcare Providers began collecting stories from patients like Carrasquillo, and hard data from Abigail House and providers. They found a disturbing pattern.

Patients frequently missed important medical appointments because their state-funded rides were late or never showed. When they did make it to the doctor's office, they often waited for hours for a return ride home.

The late or missed rides didn't just inconvenience patients, advocates found. They led to backups in dialysis units, missed chemotherapy sessions and diagnostic tests.

That created systemic problems, with more patients ending up in expensive hospital emergency departments for care they should have received elsewhere, explained Natassia Rozario, associate counsel and associate director of policy and engagement for the Camden Coalition of Healthcare Providers.

"Ultimately, good care means you have to have access to good care," Rozario said.

Since 2009, New Jersey has contracted with LogistiCare, an Altanta-based medical transportation broker operating in 40 states. The company is paid about $165 million annually to conduct background checks on drivers, safety checks on vehicles and confirmation checks to ensure riders are covered through Medicaid. It claims a 99 percent complaint-free rating.

After the state expanded its Medicaid rolls, the company saw its ridership increase, from 4.5 million trips a year in 2012 to nearly 6 million in 2015.

Organizers persuaded Valerie Harr, director of the state's Division of Medical Assistance and Health Services, to conduct on-site visits at apartment high-rises in Camden and Trenton. LogistiCare representatives had already begun meeting with residents and organizers to analyze the problems: patients and vendors often waited at different building entrances, for example, or couldn't find each other because patients didn't know which vehicle was waiting for them.

The company then launched two pilot programs to improve service at Northgate Towers II in Camden and Kingsbury Towers in Trenton.

Lori Bonderowitz, general manager of LogistiCare New Jersey, said the company works "diligently to improve as these programs demonstrate." Bonderowitz began calling advocates and resident managers monthly.

"We've embraced feedback from members and community partners from the start, and initiated the pilot program collaborations that have reduced service issues to less than one-tenth of one percent," Bonderowitz said, through a statement released by a company spokeswoman. The company also expanded its pilot programs to include New Brunswick, Jersey City and Newark.

In August 2014, the state invited the public to comment on its transportation broker contract.

Last spring, residents, hospitals and partners involved in the coalition's Good Care Collaborative lobbied the state for specific contract improvements, including a real-time electronic tracking system to pinpoint the location of drivers, improved complaint collection and response, and additional customer service training. Many of the changes they suggested were included in the state's latest Request for Proposal (or RFP), released just before Christmas.

"We see this as a huge community victory for health care," Rozario added. "We really give a lot of credit to Valerie Harr and her team."

Bonderowitz said the company also welcomed the changes detailed in the 106-page document. The company believes New Jersey is the first in the country to support real-time GPS tracking in vendors' vehicles.

"We're delighted stricter requirements are in the RFP," she added. "They should be — and we welcome those benchmarks."

At the community room at Northgate Towers II on a frigid morning, Ana Castellar and Anthony Phoenix still couldn't believe the three-year advocacy project paid off. The two Camden caregivers helped persuade patients to share their stories, and attended countless meetings in pursuit of challenging the bureaucracy.

Though they were sometimes tempted to give up, the two said, success required persistence and a coordinated effort involving many players.

"Honestly, I'm totally shocked," Phoenix said.

Harr "has essentially become one of our allies," Phoenix added. "We've developed a relationship and a positive rapport with Valerie and with the people in Trenton and many of our stakeholders."

When the new contract begins in July, patients will see the improved service they deserve, Castellar said. And advocates like them will be watching to make sure that happens.

In the meantime, organizers are planning a long-awaited celebration at Northgate Towers II at noon Tuesday, Feb. 2.

"We can finally eat some cake," Castellar joked.