For millions of Americans, access to healthcare is compromised by a lack of transportation to medical appointments. Millions of individuals cannot access medical care annually because they don’t have transportation to appointments.
Non-emergency medical transportation (NEMT) services are indispensable in bridging this gap, ensuring individuals, particularly those on Medicaid, can receive the care they need. People living in rural areas, persons with disabilities, older adults, individuals with lower incomes and those with chronic conditions who don’t have access to public transportation rely on NEMT to get them to and from their essential medical appointments.
Numerous studies going back at least 10 years have confirmed access to transportation as a social determinant of health and as having a role in ensuring health equity.
The critical role of NEMT providers
Transport providers are the heart and soul of the NEMT industry, on the frontlines of helping to ensure equal access to care and prevent long-term health issues that may arise from missed appointments.
For some patients, such as those needing dialysis, NEMT rides can literally make the difference between life and death. These healthcare providers often form deep relationships with the individuals they regularly carry to and from appointments and can be a resource for the clinician to gain a greater understanding of the person they are treating. NEMT providers may have direct knowledge of the patient’s circumstances, those social determinants of health we know to have great impact on a person’s health and well-being.
NEMT powers many care management strategies by ensuring mobility
The Medical Transportation Access Coalition (MTAC) reports that beneficiaries who utilized NEMT for scheduled medical appointments, such as the clinically recommended frequency of dialysis or wound treatment sessions, experienced improved health outcomes and significantly lower long-term costs compared to those who missed appointments.
Furthermore, NEMT services are highly cost-effective, generating an average monthly savings of $1,300 per person, MTAC acknowledges. Incorporating NEMT into care management strategies for individuals with chronic illnesses more than pays for itself, delivering a total positive return on investment exceeding $40 million per month ($480 million annually) for every 30,000 Medicaid beneficiaries.
Despite their essential services, these transportation providers are often treated like second-class citizens, neglected and underpaid. NEMT providers are small businesses that operate at thin margins and face having to close up shop if they aren’t promptly reimbursed. Their fees are quite small in comparison to ambulance rides, which can cost as much as $800; NEMT providers can be paid as little as $35 a trip, depending on the distance traveled.
Reimbursement rates are an ongoing contentious issue. In New York State’s Westchester County, 10 NEMT transport providers have stopped accepting service requests for Medicaid recipients, citing rising gas prices, labor costs and Department of Transportation expenses.
Transport providers also deal with challenges that impact their efficiency and sustainability. Inefficiencies in scheduling and billing processes lead to delayed rides and increased operational costs, which can harm both the providers and the patients they serve. These providers may pay 5 – 6 percent of their revenue to billing services companies, a significant burden for small businesses operating on tiny margins.
Improving efficiency in NEMT services
While there is widespread agreement that NEMT services are essential, there is equal concern that the system to book these services is broken. Individuals relying on the Medicaid or Medicare Advantage transportation benefits to access the care they need are losing trust in the transportation programs due to long wait times, missed trips, cumbersome workflows, lack of on-demand services, and lack of adequate transportation services. This contributes to delayed care or even absence of care.
The problem that needs solving is much more complex than a simple online ride-booking system. The sector cries out for applied advanced technologies and interoperability among the various stakeholders to boost the efficiency and effectiveness of NEMT services, while waylaying fraud and abuse — such as overbilling.
We can implement industry-wide strategies to boost the efficiency and effectiveness of NEMT services with the following actions:
Adopt integrated digital platforms – Utilizing digital platforms that connect all the stakeholders within the area to a network of transport providers for scheduling and dispatching rides can significantly reduce errors, improve communication between providers and patients, and reduce the time necessary to book a ride from three days to two hours. These platforms can offer real-time updates, ensuring patients are informed about their ride status and reducing the likelihood of missed appointments.
Automate billing processes – Implementing fully interoperable technology for billing and claims processing can ensure accuracy, eliminate the need for third-party billing services, and speed up the payment process, improving providers’ cash flow.
Enhance data analytics – Integrating NEMT services with electronic health records (EHRs) allows for comprehensive tracking of patient healthcare outcomes. This data can be used to make informed decisions about program design and to measure the long-term impact of NEMT services on patient health.
Increase provider support – It is vital to provide small NEMT providers with resources and tools to improve their operational efficiency. This includes providing training on new technologies and offering financial incentives to encourage adoption.
The impact on health equity
Effective NEMT services are not just about transportation; they are a critical component of health equity. For many low-income individuals, lack of access to reliable transportation is a significant barrier to receiving timely medical care. By improving NEMT services, we can ensure that all patients, regardless of socioeconomic status, have equal access to essential healthcare services. Not everyone owns a car, lives near or can use public transportation, or has a credit card for a ride-sharing service. But we must ensure they have the same patient experience as those who do. Every patient should have a streamlined, integrated experience.
While the federal government understands the need for reform, NEMT services are mandated through the states. A 2018 federal government report on “Cost Allocation Technology for Non Emergency Medical Transportation” recognizes the need for coordination between governmentally funded public and human service transportation programs, recommending that Medicaid programs consider increasing investments in their NEMT information technology infrastructure to strengthen existing programs’ efficiency and oversight.
The technology exists to get us there. Digitally integrated, interoperable platforms allow for seamless delivery of NEMT services, providing full visibility into the life cycle of each trip for health plans and their members while allowing transportation providers to get paid on time.
When we consider the value of NEMT services, it’s critical to start with how these services impact the individual. A person diagnosed with cancer, for example, is now dealing with life-threatening complications. They must be able to get to their treatment — and not have to worry whether their driver is delayed by a scheduling snafu or doesn’t show because of a strike. It’s incumbent on us to make this experience as easy and peaceful as possible, for this individual and the tens of millions of people who desperately need NEMT services to receive what may be life-saving treatment.
Photo: nullplus, Getty Images
Sufian Chowdhury graduated summa cum laude from Berkeley College (BS, Finance), beginning his career in corporate finance for Health Systems and Physician Organizations like New York Presbyterian and Weill Cornell Medical College (WCMC). While there, he worked on M&A efforts where dozens of physician organizations were acquired by WCMC.
After two years, Sufian joined pre-IPO ad-tech company, Collective Media, as a business development manager, and before launching Kinetik, co-founded LetsApply, an online platform that simplified the college application process, and Inlingoo, a Norway-based language learning platform.
Currently, Sufian is the co-founder and CEO of Kinetik, a SaaS healthcare startup based in New York City. Kinetik is developing innovative API & Platform solutions that connect key stakeholders in the non-emergency medical transportation (NEMT) industry. He envisions a future in which the coordination and delivery of medical transportation will be so seamless that any patient, anywhere, can request a healthcare ride in real-time.
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