By Erin Mayor
It was in 1966, in the “Handbook of Public Assistance” (Supplement D), that the first form of non-emergency medical transportation (NEMT), though not mentioned plainly, entered the list of potential benefits for underserved populations in the U.S. This was well before computers became a household item much less the ubiquitous business machines they are today.
In 2022, however, NEMT continues as an option for many Medicaid and Medicare Advantage members as well as those in conventional health plans. Nevertheless, numerous NEMT providers continue to rely on paper and a frenzy of phone calls to implement NEMT rides for those who receive the services.
The concept of “Modern” NEMT has existed for several years and some providers are quickly moving toward this method of ensuring rides are on time or can be recovered because of unexpected issues. Modern NEMT uses digital transportation networks and the general digitization of workflows and operations to create efficiencies for providers and to improve the experience for individuals.
Digitizing NEMT will have a positive impact by helping to make it easier for individuals to use the service reliably while it benefits the service providers, as well. Oftentimes, there are unforeseen challenges—inclement weather, an accident, a road closure—that cause NEMT providers to run behind schedule. Without reliable NEMT services that can make changes at moment’s notice, individuals may suffer from an exacerbated medical condition or, at the very least, a missed appointment that must be rescheduled.
“Health practitioners see transportation access as one of the most significant social determinants of health,” according to THE ROLE OF TRANSPORTATION IN IMPROVING AMERICA'S HEALTH, produced by the Eno Center for Transportation. “Access to other SDOH such as healthcare, food, and social connections may be improved or inhibited depending on an individual’s ability to travel to them. Lack of access to healthcare can be particularly damaging because it can exacerbate health conditions and cause more serious issues over time.”
The healthcare industry recognizes, and has for some time, that social determinants of health (SDoH) have a real and frequently negative impact on an individual’s health. Lack of or unreliable transportation can be a significant contributor to poor health and wellness. Not only because it impacts an individual’s ability to get to work or the store, but to important health appointments, including medical and dental visits. “Barriers to NEMT are a health risk affecting high-need, economically disadvantaged patients,” according to the American Journal of Public Health. “Economic arguments supporting modern NEMT are important given decreased support for human services spending.”
Modern NEMT organizations are working toward a full, digital transformation using a variety of hardware and software platforms to modernize the NEMT infrastructure. This benefits NEMT providers, of course, who can optimize operations using technology, as well as those who are entitled to the services and those who pay for them, like the federal government or health plans. While NEMT expenditures are a small fraction of government healthcare spending, the dollars are not insignificant. In 2018, for example, the Department of Health and Human Services alone spent $3 billion on NEMT; other agencies that offer NEMT spent hundreds of millions more. By improving the NEMT infrastructure using digital technologies, it’s possible to help ensure that these dollars are spent efficiently.
Researchers used the National Academies’ NEMT cost-effectiveness model to understand the impact of Modern NEMT on the U.S. Medicaid population of more than 67 million people, at the time of the study. The researchers found Modern NEMT could potentially save $537 million every year if every transportation provider in the U.S. digitized operations.
For many NEMT providers rider data and other types of information exist, but in a paper form, the minds of schedulers or computers not connected to technologies that could help them make decisions. All of which are massively inefficient and prone to causing mistakes that impact both the rider and the transportation provider. To make a full digital transformation, NEMT as an industry must support the movement. We need to understand and predict how drivers will get from point a to b to c, instead of dropping the ride because of an unforeseen challenge.
“(M)odern NEMT brokers have on-demand scheduling, an electronic record for transparent monitoring, direct routes, and greater reliability with higher customer satisfaction rates,” according to American Journal of Public Health. “Modern NEMT may be quickly scalable because it builds on existent software and infrastructure.”
With predictive analytics, an NEMT provider can intervene proactively or in real-time by reassigning a leg of a journey to another driver or transportation provider in the network.
My colleague Walt Meffert, CIO at Modivcare, explored how NEMT can incorporate predictive analytics to improve performance: “We can use predictive analytics to help improve performance by reacting to business challenges in the same way other digital businesses react to theirs via predictive models and insights.”
Whether NEMT providers use predictive analytics or other methods to digitize their business, there are many advantages to making the change.
NEMT providers who digitize operations can benefit from the:
One piece of the digitization process, however, may cause discomfort to some drivers: GPS. While GPS tracking is a critical component of digitization, understandably, some drivers are less than enthusiastic about its implementation. To create trust, NEMT organizations must create a transparent program that reassures drivers that they are not being monitored with the intent to spy, but, rather, to make their work more efficient, cost-effective and profitable. In addition, NEMT companies should use GPS only to monitor trip exceptions, not every trip.
In today’s digital world, Modern NEMT is a change that needs to be made to create efficiencies and scale the ability to increase ridership. Today’s technology has made digitization easy and cost-effective for NEMT providers.
In many ways, individuals expect this change. They already use other smartphone-based services that are convenient, customer-focused and centered on making transactions extremely easy and fast with individuals receiving real-time updates, as well. The American Journal of Public Health researchers say it well: “Modern NEMT has the potential to yield greater cost savings than traditional NEMT while also improving patient experience.”
Erin Mayor is Senior Director, Digitization at Modivcare.