Back to the future: Why self-driving cars are an opportunity for NEMT

By Walt Meffert

Some say the dream of an autonomous vehicle began more than 600 years ago with a spring-driven cart designed by Leonardo da Vinci. Others may cite the 1939 World’s Fair, GM used electromagnetic fields and magnetized spikes embedded in the road to guide a vehicle. Still more might jump to the 1970s and then to the 1990s and the researchers who used onboard cameras to send data to computers, and neural networks and image processing, respectively, to guide a vehicle down the road.

While these vehicles embody the spirit of today’s autonomous vehicles, they often don’t look much like today’s sophisticated and complex designs. The Stanford Cart, as seen in its late 1970s configuration, is a cross between WALL-E and a child’s wagon, yet embodies the spirit of today’s complex and possibly-soon-to-be realized autonomous vehicles (AVs).

“(C)ity governments and private organizations will benefit from exploring new opportunities for designing an innovative health transportation system that harnesses this new technology—while also reducing costs and improving community health,” explains a master’s thesis titled Autonomous Healthcare Transportation: A Human to Delivering Care. “These benefits may include the ability to deliver healthcare at times and locations most convenient to patients, to facilitate transport for those with limited mobility, cognition, and vision; and to test new ways of delivering preventative care and health-related items, such as medical equipment, groceries, and medication.”

One definition of AVs, posited by the Milken Institute Review, brings together technologies with the practical concerns of daily driving:

“An autonomous vehicle drives itself by using a combination of onboard technologies to measure the distance of the car from various objects, including pedestrians, bicyclists and other cars. GPS, supplemented with highly detailed up-to-date digital maps, locates vehicles and indicates which has the right of way. Communications among AVs, as well as between AVs and roadway infrastructure, determine the location and intention of other vehicles, the condition of the roadway, and the status of traffic signals.”

The dream of a fully autonomous vehicle has been around for many years, and today, thanks to artificial intelligence, expanding computing power, hypersensitive sensors and high-resolution cameras, it’s closer than ever.

AVs in healthcare, NEMT

The future is nearly here when it comes to AVs and healthcare services. One recent example of AVs used in healthcare services occurred during the COVID-19 pandemic. During the height of the pandemic, the Mayo Clinic in Florida used AVs to deliver nasal test kits from a test facility to a lab to process the samples.

If we use the Mayo Clinic as a test case, it’s easy to see how AVs can positively impact healthcare generally and NEMT specifically.

AVs create the opportunity to transform NEMT providers and the way individuals receive the services. Most NEMT rides are ambulatory, recurring rides for mental health or substance abuse treatments, and dialysis treatments. The use of AVs allows NEMT providers to standardize these types of rides. Specific underserved populations are especially susceptible to needing reliable transportation to healthcare appointments; AVs can be part of the solution for this group and others. “For millions of Medicaid beneficiaries, lack of access to reliable and affordable transportation presents a serious barrier to receiving medical treatment and maintaining their health status,” according to a 2017 Center for Health Care Strategies report. “Missed or delayed medical appointments can lead to poorer health outcomes and increased emergency department (ED) use”

But no matter how the technology advances, we must focus on the individual’s experience first whether they come from a commercial health plan, Medicaid or Medicare. Any ride, but especially those taking place in an AV, must show a deep understanding of the ride lifecycle to ensure each part of the journey is safe, comfortable, on time and meets the needs of the member.

Where did the drivers go?

During the COVID pandemic and even today, while it’s seemingly waning, drivers of all types are in high demand. Whether an organization is looking to add more non-emergency medical transportation providers to its ranks or simply needs someone to deliver a pizza, there’s real concern that finding the appropriate person will be time-consuming, difficult and, in some instances, nearly impossible.

During a Domino's Pizza earnings call in late 2021, this is what the company’s CEO said about the driver shortage: “…I think labor continues to be a significant challenge and you look at the number of open job positions across the U.S. right now. It's a pretty staggering number and a lot of those are certainly related to our industry. But drivers, in particular, have been challenging as we look over the last third quarter.”

The scarcity of drivers, in fact, caused Domino’s sales to drop.

AVs supplement NEMT operations

The use of AVs has the potential to help NEMT providers who were hard hit during the pandemic and could face similar disruptions in the future, including today’s sky-high fuel prices. While AV acquisition costs are higher than traditional vehicles, some would be negated because there would be no need for a driver. Instead of transportation providers managing many drivers, they could manage fleets of AVs. This, in turn, would provide different career opportunities—IT-related virtual infrastructure, artificial intelligence, predictive analytics and other software jobs—for those who decide to enter the world of NEMT.

AVs will need software for maps, routing and real-time adjustments in rides due to accidents, inclement weather or other unforeseen issues. Live video of members entering and leaving vehicles, facial recognition and biometrics to identify members all will be important aspects of making AVs successful in NEMT.

Clifford Winston and Joan Winston often write about AV technology and the effect it may have in the future. In a Barron’s article, they discuss the potential impact of AVs on public transportation, such as buses, which are often used by NEMT providers. They say that rather than taking away from public transportation, AVs can supplement it by providing opportunities for underserved populations to receive better service, while creating new jobs.

“Other naysayers may lament the demise of public transit, which won’t be able to compete effectively against AVs, yet overlook that AVs will greatly improve mobility, especially for low-income households, the elderly, and people with disabilities,” they write. “Others may lament the job loss of drivers in the seat, yet overlook that AVs are likely to increase employment by creating new types of jobs and expanding economic activity.”

Rather than eliminating NEMT as we see it today, AVs would augment the TP workforce in a world where human drivers will continue to be needed to deliver service. While AVs could offer partial coverage when drivers are hard to find, the technology likely won’t be a full-on replacement for people.

Now, we don’t know what the future holds in terms of the availability of drivers—for pizza delivery or NEMT—but it appears the paucity will continue for the time being and, perhaps, last even longer.

If the current labor shortage continues, and even if it doesn’t, this may be the time to go back to the future and embrace AVs as the next step in the evolution of NEMT.

Walt Meffert is Chief Information Officer at Modivcare. He ensures Modivcare’s NEMT technology focuses on improving the member experience.