Transcription
Non-Emergency Medical Transportation ServicesPresentation by LeFleur TransportationforThe State of ConnecticutDepartment of Social ServicesMay 2016
Introductions
About LeFleur TransportationLeFleur Transportation: Member-Centric and Data Driven NEMTSolution Call Center OperationsTransportation NetworksTechnologySafety and TrainingReporting and Compliance3
Background & Experience 23 years transportation experience 19 years Medicaid NEMT experience Experience operating in multiple Medicaid NEMT environments withvarying reporting, compliance and performance requirements 3 Major Call Centers and industry-certified personnel to manage CTCall Center implementation Approximately one million lives in current NEMT plans, up to 10,000trips per day Approximately 650 employees to draw on as implementationsupport personnel as needed4
Program Strengths Diverse Provider Network supplemented by LeFleur-owned vehicles willguarantee network coverage and enhance on-time performance. Outreach programs will enhance benefit awareness and encouragepositive outcomes. Network vehicles will be equipped with tablets and real time technology. Members will have access to a client portal that allows self-servereservation management and real-time ETA with mapping. We offer extensive experience with multiple pricing models and varyinglevels of financial risk (ASO, PMPM, Fee For Service)5
Select Client EngagementsLeading organizations have partnered with LeFleur TransportationTX HHSC Texas Health andHuman ServicesCommission (TXHHSC)ADHS Arkansas Departmentof Human Services(ADHS)As a prime contractor withthe Texas Health andHuman ServicesCommission (HHSC),LeFleur provides an AssetBased NEMT brokerageoperation for the Texas’Health and Human ServicesCommission’s MedicalTransportation Program.LeFleur has served as anAsset-Based Broker forNEMT services in Arkansas'Region 1 since February2012, after we were selectedthrough a formalprocurement process overthe incumbent nationalbroker. As a ManagedTransportationOrganization (MTO),LeFleur currently coverstwo regions that consistof 60 counties, 65,000square miles and morethan 700,000 lives. Within 90 days afteroperations began, ADHSmade program changeswhich more than doubledthe number of tripsprovided. LeFleur’spositive relationship withour TransportationProviders and our assetbased model enabled usto quickly and efficientlymanage the increase in6trip volume.
Additional ClientsWe handle business throughout the U.S. serving our clients . American Cancer SocietyAmerigroupCapital Metropolitan Transportation AuthorityMinnesota Department of Human ServicesMississippi Department of Human ServicesMississippi Division of MedicaidNorth Carolina Department of Social ServicesOhio Department of Job and Family ServicesOklahoma Department of Human ServicesSendero Health PlansSeton Health PlanSouth Carolina Department of Social ServicesTexas Gulf Coast Center/Connect TransitUnited Health Care Community Plan: Texas
LeFleur’s NEMT Model Full Risk (PMPM) Pricing Model PMPM Encourages vendor to reduce costs PMPM provides budget certainty to the state PMPM enhances transparency Asset Based NEMT Model Guarantees access to care Reduces stress on NEMT network Mitigates gaps in NEMT network Enhances performance of NEMT network8
Network ndentDriversFixed RouteMileageReimbursement(Friends &Family
Building the Network: Five Phase ApproachPhase IDetermining NeedsPhase 2RecruitingPhase 3Consultation, Training and CredentialingPhase 4Transportation Provider OrientationPhase 5Executing Contracts
Reimbursing Transportation ProvidersNegotiating Rates withNEMT Providers Individual rate negotiation with each TransportationProvider based on scope of services and volume of workPaying NEMT ProviderClaims Daily reconciliation 100 percent trip validation through review of Driver LogMileage ReimbursementEnsuring TimelyReimbursement Pre-populated claim forms mailed each dayrequiring Medical Provider Signature for payment Most paid within 10 days 95 percent of clean claims to be paid within two weeks 100 percent of clean claims to be paid within 30 days11
Transportation Provider MonitoringParamount to the success of any NEMT program is monitoring of theTransportation Provider Network and enforcement of program rules.Driver & VehicleCompliance Performance MonitoringPreventing Fraud/Abuse Web portal system for documentation to ensure driversand vehicles meet all credentialingTechnology ensures credentialing documentsremain currentField Supervision: Supervisors spend 70% of timemonitoring contract compliance and inspecting vehiclesComplaint AnalysisTablet technology for inspectionsCollect performance data in real timeAutomated CredentialingPost-Transportation Validation with MedicalProviders100 Percent Review of Driver LogsReal Time Data12
Call Center OperationsEstablish a Call Center Connecticut Call Center upon Contract AwardCloud-based Automatic Call Distribution (ACD), Self-ServiceInteractive Voice Response (IVR), Reporting and Agent OptimizationSolutions; Redundant Fiber ConnectionsEligibility Process Monthly and Daily Eligibility ImportsTables of Enrolled Medical Providers
Call Center OperationsCall Center: TrainingRequirements Four-week Training Program that Includes both TechnicalTraining and Sensitivity TrainingPartnership with Leading Call Center Training ConsultantBenchmark Portal
Member Satisfaction Complaints, Grievances& Appeals Customer SatisfactionSurveys LeFleur has a transparentcomplaint process to quicklyinvestigate and resolve anyissues.LeFleur will grant access tocomplaint andinvestigation/resolution data.LeFleur maintains aninternal goal of ensuring atleast 95% satisfactionamong Members, asmeasured by MemberSatisfaction Surveys.Based on a recent survey,reports indicate that currentMember satisfaction withinour NEMT units is at 95%. LeFleur’s internal goal isto achieve a complaintrate of less than .5percent.We are proud that in ourhistory, we haveconsistently achievedthis goal.These survey results areinvaluable to ouroperations and help usto maintain a proactiveapproach to customersatisfaction.15
Fraud and Abuse: Types and Strategies Member– Rides to Non-Authorized Locations combatted through educationand Appointment Validation– Falsifying Medical Necessity combatted through Level of NeedVerification through Healthcare Provider.– Misrepresenting Available Transportation combatted throughproper screening Transportation Provider– Billing for No-Shows– Recording incorrect pick up and drop off times– Both Combatted through Real-Time Technology and verifyingsigned, travel logs16
Information Technology Profile17
Trapeze Software Fully Integrated Functionality– Client Eligibility– Authorization of Services– Passenger Portal– Network Management– Scheduling– Real-time Dispatch– Mobile Data Terminals– Provider Web Portal– Claims Management Custom Screen Design and Security Matrix 10 Years of Collaboration and Development18
Real Time Data CollectionReal time data is now a necessity when coordinating the delivery of services.Transportation networks are comprised of a diverse set of providers utilizing avariety of systems. Our industry faces a challenge with the consolidation of realtime data across a network.
Passenger PortalThe passenger portal gives clients ease and confidence in trip managementthrough a secure web portal.Client BenefitsStaff BenefitsProgram Benefits Book, review, confirm, and cancel trips Automatically generate return trips Real-time ETA with map integration Reduced strain on call center More time dedicated to improving service More accurate data from clients Fewer no-shows and shorter driver wait times Improved customer satisfaction Customer service 24 hours a day20
Reporting CapabilitiesReporting is a critical asset that requires a team with hands on experience andinvolvement throughout the process.837 EncounterData Experience withnumerous 837Pformats ICD – 10 compliant 99.9% acceptancerate In-housedevelopmentCall CenterReports IndustryStandard reportsAd hoc reportingtoolsReal timedashboard thatcan becustomized bythe userTrapeze-NovusReports In-applicationqueriesStandard,Custom, andCrystal ReportsReports specificsecurity matrixSQL ReportingServices ReportautomationBlendingmultiple datasourcesStatisticalanalysisExceptionreporting21
LeFleur provides an Asset-Based NEMT brokerage operation for the Texas' Health and Human Services Commission's Medical Transportation Program. As a Managed Transportation Organization (MTO), LeFleur currently covers two regions that consist of 60 counties, 65,000 square miles and more than 700,000 lives.
