(UPDATED Monday, 1:15 p.m.) HARTFORD, CT — Michelle Chase uses the state’s non-emergency medical transportation service to get her developmentally disabled 3-year-old to her doctor appointments. But since Jan. 1, she’s had to wait two or three hours for the state’s new transportation contractor, Veyo, to arrange her rides.
She’s not the only one.
Chase said many of her daughter’s appointments are with specialists and are scheduled back-to-back. So if you miss one it’s possible you will miss more and then the doctors won’t give you another appointment for six months. Some of the doctors are as far away as New Haven, so it’s not like she can call a friend or relative in the Hartford area to just come and pick her up, she said.
It’s even more dire for patients who need chemotherapy or dialysis.
Tracy Wodatch, from the CT Association for Healthcare at Home and who also is a member of the Council on Medical Assistance Provider Oversight, said at least seven dialysis patients have had to be hospitalized since the state started using the new transportation contractor.
“Whether it’s directly related to the missed transportation I can’t say,” Wodatch told the council Friday at a meeting at the Legislative Office Building. “It’s extremely important to be tracked.”
Dialysis replaces kidney functions for patients with kidney failure or renal disease. The kidneys are supposed to remove excess waste products and water from the blood, so without the help of dialysis patients get very ill, very quickly.
Wodatch said they also heard about “a 95-year-old woman with a hip fracture was going to the orthopedic [doctor] for a follow up and they were asked to get on public transit from a nursing home.”
Rep. Michelle Cook, D-Torrington, said there’s a child suffering from cancer in her district who has missed two chemotherapy treatments in Boston in one week because Veyo, the new contractor for the service, never sent a vehicle to pick her up.
“Who is responsible if something happens to that child?” Cook said, adding that she’s not satisfied with the answers she’s getting from the new contractor. She said she’s happy the dialogue is happening and it’s getting more attention from the news media, but it’s unacceptable for a company to fail to perform under the contract.
“If you’re taking on a contract such as this there should be little error or flaw in a transition,” Cook said.
The three-year contract to provide transportation for the state’s more than 800,000 Medicaid patients to their medical appointments is worth as much as $140 million.
Veyo President Josh Komenda flew in from California for meetings with state officials last week and attended the council meeting at the Legislative Office Building.
“There should be no reason why we have clients who do not get a ride,” Cook said told Komenda.
Rep. Cathy Abercrombie, a Meriden Democrat who chaired the council meeting Friday, said she had warned Komenda about the issues the company is now experiencing in October 2017. She said she feels like her comments were not taken seriously.
“We’re not talking about taking someone to the grocery store,” Abercrombie said. “We’re talking about life and death here.”
Abercrombie said she wants to see a corrective action plan from Veyo within a week. She also warned Komenda that she has corrective legislation ready to go if the problems are not corrected before the start of the legislative session in February.
Komenda said his team knows they have to get the problems fixed and they won’t rest until they are completed.
Veyo was one of four companies to bid on the contract overseen by the Department of Social Services. The company took over operation of the program from Logisticare on Jan. 1. Roughly, the contract provides Veyo with $4.72 per month per Medicaid member for three years.
Komenda said they received an “avalanche” of calls and struggled with information it received from Logisticare, the last contractor, during the transition.
He said told the council that the company received 32,000 calls in the first week, which included the New Year’s Day holiday. He said they averaged about 8,000 calls per day over the remaining four workdays — double the amount of calls they expected. He said they anticipate that the call volumes are beginning to normalize.
However, while the data still indicates a higher than expected call volume, the call data on the handout that Komenda provided to the council on Friday don’t add up. The sheet put the total number of calls in the first week at 32,336 and said they received “over 8,000 calls/business day,” but below that the per-day call totals listed on the same page only added up to 30,806, which is an average of 6,161 calls per day over five days, or 7,701 over four.
In the meantime, Veyo created a dedicated phone line for health care providers to call and are adding additional call center staff from other states. Many times the return trips from the provider were not showing up in the company’s system and many, like Michelle Chase and her child, were left stranded at the doctor’s office.
Following the publication of this article, George Sousa, LogistiCare’s Connecticut general manager, released a statement in response to Veyo’s comments about the information provided during the transition.
“We provided Veyo accurate and current member files starting in November and continued to send them daily through January 5,” Sousa wrote. “This data included volumes, trips, levels of service, complaints, mileage, no-show reports, denials, re-routes and ineligible riders. The claim that we did not provide all of the information needed to successfully transition the NEMT program is categorically false.”
Sousa continued: “Likewise, all of the monthly call volume data was provided for all queues to the department and the current broker. We do believe call volume spiked upon start-up, as we have experienced similar instances during every new transition in the 44 states in which we operate. That’s why we overstaff by approximately 25 percent in every new transition during the first few months. The fact call volume spiked 17 percent in the first nine days is well within the industry’s expectations, and we suggest that does not reflect on the accurate data provided by LogistiCare as the problem. This was a staffing issue on the new broker’s side.”
The statement also said that LogistiCare has “remained in constant contact” with Veyo and remains “willing to support this transition if necessary.” Sousa said he personally contacted Veyo’s transition manager January 10 after learning of the issues to offer additional assistance.
Contract Concerns
Four Connecticut legal service organizations who represent Medicaid patients are raising concerns about the new contract, which requires the company to take on little or no risk for failing to perform.
The contract requires the company to arrange four million rides per year for Connecticut Medicaid patients. In order to do that, they contract with livery services and other private transportation services to get patients to their appointments.
The contract stipulates that Veyo will receive a lump sum per Medicaid patient per month, and payment for all approved transportation services will come out of its pocket. Veyo will get to keep the money even if they don’t transport anyone.
“The concern is that this creates an incentive to the vendor to provide less service so as to generate higher profits,” they wrote in a Jan. 10 letter. “While the department has asserted that this model will allow for greater ‘flexibility’ that is also what the department insisted for many years would occur under the capitated Medicaid managed care organization model it used for Medicaid until 2012.”
Two dozen advocacy groups warned about using this form of contract for transportation services back in April 2016.
The concerns are now heightened given the first two weeks of operation and the recent decision by DSS to dissolve the Quality Assurance Committee for the Non-Emergency Medicaid Transportation (NEMT) program.
The fear, according to a Jan. 11 letter from more than two dozen groups, is that Veyo will not provide the appropriate level of oversight and there will be no one to hold them accountable.
“This concern is heightened by Veyo’s use of unregulated Uber-style drivers,” the groups said in this letter — for example, a driver who is not trained to work with individuals with behavioral health issues. “Oversight is key to ensure that patients are receiving the services to which they are entitled.”
Komenda said they “deeply regret” any missed rides and his team is committed to get this corrected as quickly as possible.
“We understand how serious it is and how important it is that members get to their appointments on time,” he added.
Komenda said they offer transportation services in nine states and do about 35,000 trips per day. However, they only serve Medicaid patients in two of the states, Connecticut and Colorado. Komenda had initially mentioned Idaho, but their contract with that state is ending in March.
Asked why their contract is ending in Idaho, Komenda said the state wanted them to do too much that wasn’t in the contract. But advocates say it looks as if Veyo wasn’t able to serve the Medicaid population, which is medically fragile and often sicker than those who are not on Medicaid.
According to an article in the Idaho Statesman, the company received similar complaints about not showing up to pick up clients or providing the appropriate vehicle or driver to transport the patient. The traditional transportation companies that sought to contract with Veyo to provide the rides complained they weren’t being paid enough.
Komenda said the decision to leave Idaho early was not related to performance.
Regardless of the source of the issues in Connecticut, Komenda said they have ownership of them now and they “expect” to improve their performance and get things fixed.
He estimated that things would begin to normalize by the end of January, but members of the council expressed a desire for things to turn around much quicker.
The Department of Social Services said this type of transportation is “an inherently difficult service that has drawn complaints for many years — in fact, long before the current transition. While challenges are to be expected, our goal is to improve the customer experience overall.”
The state agency said it expects the current situation to improve rapidly.