State's new Medicaid transportation firm off to a rocky start
An Arizona-based startup the state hired last year to take over the troubled system for transporting Connecticut residents on Medicaid to their medical appointments has started the new year in shambles, leaving people stranded in waiting rooms, missing crucial doctor visits and on the phone on hold for up to an hour at a time.
The Department of Social Services administers a non-emergency medical transportation program for all Medicaid recipients in the state, and since 2012 held a contract with Georgia-based Logisticare to coordinate rides and reimbursements for the taxi and livery companies.
After passengers and health providers complained for years about late rides and shoddy service, DSS issued a request for proposals for a new subcontractor last year. Logisticare and three other companies bid on the contract, and in June 2017 the state chose Total Transit Inc. and its tech-based medical ride subsidiary, Veyo.
The contract between Total Transit Inc. and DSS, which began Jan. 1, says the deal is meant to "elevate the use of technology, innovation and data to enhance Members' (non-emergency medical transportation) experience, thus contributing to an improvement in their overall health."
The contract gives Veyo about $7 million a year in 2018, 2019 and 2020, in addition to an estimated $140 million over the three years to cover transportation costs at a rate of $4.81 per Medicaid member per month.
"The higher level of technology that will be delivered through this Contract is anticipated to deliver higher levels of reliability, quality and transparency," it reads.
But for many Connecticut residents on Medicaid, Veyo has been anything but reliable: people seeking to schedule rides with the company only were given a phone number, and when they called, they were left on hold as long as an hour at a time.
Many who were able to schedule rides say the sub-contracted taxi or livery drivers never showed up, and when they did, some drivers were unprepared to accommodate the patients' medical needs.
Tricia Volpe said her first doctor's appointment of the year was scheduled on Jan. 3. When she called Veyo from her home in Groton to confirm the ride that morning, she was left on hold for nearly 45 minutes.
"By the time I got a supervisor on the phone, my appointment was in five minutes," she said. "I was supposed to be being picked up as they were picking up the phone."
She was told the ride had mistakenly been scheduled for Jan. 5.
A ride for a separate appointment came on time later in the first week of January and successfully brought her to an appointment to have her shoulder looked at, she said.
Multiple medical associations, social services agencies and nonprofit health organizations have raised concerns about Veyo in the last two weeks as they have seen their clients and patients struggle to get reliable rides or schedule them at all.
At a meeting with Veyo representatives Tuesday, Connecticut Hospital Association Vice President for Advocacy Karen Buckley said she and other industry officials "identified areas of concern that need to be addressed immediately."
"It is critical that patients have access to care, and this requires an effective transport system," Buckley said in a statement Wednesday. "Currently, patients and providers are experiencing significant challenges related to the implementation by the state’s new non-emergency medical transportation broker."
Veyo President Josh Komenda said in an interview Thursday that he was "in deep regret" over the complaints. He said information about rides booked through Logisticare was incomplete or inaccurate and that staff at the company's Hartford call center and overflow call centers outside of Connecticut received more calls in the first days of the contract than they anticipated.
"In no way am I deflecting, or making excuses," he said. "There was external challenges, things that made this transition bumpy ... but we know that we're responsible for this.
"We deeply regret the challenges, the frustration and the pain that people have felt."
Ambulances are called
Lawrence + Memorial Hospital spokesman Michael O'Farrell said multiple patients have missed appointments at Yale-New Haven's Smilow Cancer Hospital Care Center in Waterford since Veyo officially took over the DSS contract on Jan. 1.
Staff at the cancer center have at least twice in the past two weeks resorted to calling ambulances to take patients home after their Veyo rides never came to pick them up. Late rides also have disrupted schedules at the center, O'Farrell said, to the extent they said they had never seen when Logisticare held the DSS contract.
Gino Demaio, the CEO of Sound Community Services, said clients at the organization's mental health clinics in New London and Norwich have experienced similar wait times and inconsistent service.
One patient waited in the Sound Community Services New London clinic for four hours for a ride that never came, while clinic staff worked overtime to find an alternate way for him to get home.
The staff eventually requested an ambulance to pick up the patient, who needed a specific type of vehicle to accommodate his weight.
Buckley said the Connecticut Hospital Association has been in constant contact with DSS officials and Veyo about the rough transition, which she said has "put Medicaid recipients at risk and disrupted their care."
The DSS requested bids for the medical transportation contract last year after it "decided to re-design and re-procure the ... service, which has been challenging and problematic for many years," DSS spokesman David Dearborne said in an email Wednesday.
Bonnie Roswig, an attorney with the Center for Children's Advocacy, filed one of many complaints about Logisticare with DSS after a family told her that their child rode in a late taxi with other passengers to a chemotherapy appointment despite a doctor's orders against sharing rides because the child's immune system was compromised.
Roswig believes her complaint about Logisticare, which she filed with the Department of Justice and U.S. Attorney Deirdre Daly's office, likely played a part in convincing DSS to seek a new contractor.
In response to multiple complaints from agencies and health care groups, the state legislature passed a bill in 2016 telling the Malloy administration to solicit bids for a new contract, and that the request for proposals was to require higher performance standards of the contract than the Logisticare agreement.
Denial of service
Logisticare was providing more than 4 million rides annually across the state before it lost its contract last year, according to a Department of Social Services spokesman.
Roswig said she expected DSS to improve its oversight of the new broker after it chose Veyo through the bid process last year.
"One would have hoped that the department would have worked closely with whomever they chose for this new contract to make sure that all the i's were dotted and t's were crossed when they opened up shop," she said. "Clearly that didn't happen. People are just across the board being denied service. People are just being abandoned at doctor's appointments. Their health is being seriously put at risk."
Medicaid members who had used Logisticare to book rides before Jan. 1 said they occasionally had experienced problems with the company. But the first two weeks of Veyo's contract have not indicated any improvement, they said.
"Logisticare was not perfect," Earle Bailey said. "But I only had to call because they were late a couple of times."
Bailey said he's spent cumulative hours on hold with Veyo from his home in Shelton. On Wednesday, a ride he booked to take him to a medical testing lab never showed up.
A Veyo representative picked up after about 20 minutes, and when Bailey complained about the missing ride, the person on the other end asked if he could arrive at his lab appointment late.
"I said, 'no,'" Bailey said. "'That's why they call it an appointment.'"
No smartphone 'app' yet
Veyo has contracts with private insurance companies to coordinate rides in eight states.
The company has contracts with the state Medicaid agencies in Colorado and Idaho in addition to Connecticut, although it is in the process of ending its contract with the Idaho Department of Health and Welfare over what Komenda, the Veyo president, called "irreconcilable financial challenges" and "non-contractual rules and additional burdens we felt ... did not comply with the contract."
Komenda, who traveled Wednesday to Hartford from San Diego, said the company tried to reach thousands of Connecticut Medicaid recipients to confirm rides scheduled for after Jan. 1 with Logisticare, but were only able to reach a fraction of them.
In a presentation at a meeting of the Medical Assistance Program Oversight Council on Friday, Komenda said the company expected about 4,500 calls from riders to its call center in the first days of the contract.
On Jan. 1, 1,325 called. But then more than 11,600 people called on Jan. 2, and 8,213 people called on Jan. 3. That number fluctuated throughout the week, but by Jan. 9 more than 6,600 people were calling.
The rate of cancellations — rides that weren't completed either because the passenger called to cancel the ride in advance, canceled the ride when the driver arrived or wasn't at the pickup location when the driver arrived — has gone from 83 percent on Jan. 4 to 35 percent on Jan. 9.
By Friday, Komenda told the state officials, legislators and health care providers on the Medical Assistance Program Oversight Council that the average wait time at the Hartford call center had dropped to between one and five minutes.
"We're very confident that we're going to get things fixed," Komenda said Thursday. "I know that's no consolation."
Veyo's contract with the state includes a provision that the company will allow passengers to schedule rides "by telephone, secure online ordering system, mobile application or other secured electronic means."
So far the company is allowing people to schedule rides only by phone, but Komenda said he plans to introduce the smartphone app for Connecticut customers in the future.
The company's business model also includes incorporating independent drivers using their own vehicles into the roster of drivers they hire to give rides to Veyo users, in what Komenda called a "proprietary technology" similar to the way drivers for the ride-sharing app Uber operate.
Passengers and health care organizations say when Veyo workers do answer the phone, often after more than an hour of hold music, they do not have access to any information about customers or their medical needs.
"You can't check appointments, you can't see if it's approved," James Vincent-Czbas said.
Vincent-Czbas waited for hours at his home in Groton for a ride to an appointment at his neurologist in New Haven, whom he sees for chronic migraines. When a taxi company finally arrived, the car didn't come with a seat belt long enough to fit him, so the driver said she couldn't take him to the appointment.
"This is affecting my health," he said. "'I'm sorry' just doesn't cut it."
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