Improving research on transportation interventions in health care

The current issue's article by Ianni et al. examines the impacts of transportation benefits offered to low-income and disabled Medicare Advantage beneficiaries. The current paper notwithstanding, transportation benefits' design and utilization in managed care systems have been surprisingly understudied, particularly in the context of a growing and consistent literature that documents associations between transportation insecurity and poor health outcomes across multiple conditions and preventive care. Patient-reported data suggest transportation insecurity is a common reason for both missed appointments and delayed care. In short, no one would suggest that transportation insecurity is itself good for health.

Given transportation insecurity's generally negative influence on health, multiple strategies have emerged to address beneficiaries' transportation needs in different healthcare environments. Though traditional Medicare plans have offered only limited transportation benefits, in 2019, CMS expanded the definition of “primarily health related” and thereby enabled Medicare Advantage (MA) plans to include supplemental benefits to better address members' transportation needs. The result has been a near 14% expansion in transportation offerings across MA plans, and plans in counties with high transportation barriers are especially likely to provide nonemergency medical transportation (NEMT) benefits.