Date of Award
2025
Degree Type
Dissertation
Degree Name
Doctor of Business Administration (DBA)
Department
General Business
First Advisor
Sean Edmund Rogers
Abstract
This dissertation examines the behavioral, clinical, and operational drivers of chronic missed appointments within Medicaid non-emergency medical transportation (NEMT) systems. Chronic member no-shows undermine care adherence and introduce operational inefficiencies across Medicaid delivery systems. This two-phased quantitative retrospective cohort study used statewide Rhode Island Medicaid data from 2020 to 2024 to evaluate whether environmental factors (e.g., weather, daylight) influence member missed trips and whether targeted managed care case management interventions reduce no-show rates among high-acuity Medicaid beneficiaries.
Phase I employed a correlational design to assess relationships between monthly environmental conditions and appointment adherence by clinical condition. Results showed no significant association between environmental exposures and no-show rates. However, notable clinical variation emerged that members receiving substance use disorder (SUD) treatment demonstrated significantly higher transportation adherence than those receiving dialysis or chemotherapy.
Phase II used a quasi-experimental difference-in-differences (DiD) framework to evaluate a real-world case management intervention implemented during the Rhode Island Executive Office of Health and Human Services (EOHHS) Active Contract Management (ACM) pilot for NEMT contract oversight in 2021-2022. Results were mixed. Overall improvements in adherence were not statistically significant, but subgroup analyses revealed that younger members were less responsive to outreach, and one Medicaid managed care organization (MCO) exhibited worse outcomes which likely reflect variation in case management approaches.
Study findings suggest that NEMT adherence is driven more by clinical and demographic characteristics and the structure of MCO case management than by environmental factors. This study contributes new evidence on the behavioral and systemic influences on Medicaid NEMT performance. Results support the need for condition-specific, high-touch case management strategies integrated with local NEMT operations. These findings may inform delivery system reforms in states using bifurcated NEMT broker-MCO models.
Recommended Citation
Kraics, Mark Donald, "WILL I GO TO MY APPOINTMENT? CASE MANAGEMENT AND ENVIRONMENTAL DRIVERS OF MISSED TRANSPORTATION IN MEDICAID" (2025). Open Access Dissertations. Paper 4513.
https://digitalcommons.uri.edu/oa_diss/4513