“Technology-based on-demand non-emergency medical transportation is the way out for driving disadvantaged patients.”
The thought of visiting a hospital can be stressful enough. But when the question of ‘how do we go to hospital’ pops up, it further stresses out millions of Americans who cannot drive themselves for various reasons. Whether they are ill, aged, differently abled or just non-drivers, many Americans rely on friends or family for the hospital trip.
Almost everyone needs to visit a hospital or health care center at some point of time in life and transport (or the lack thereof) to the medical facility turns out to be a big hurdle for them. Even cabs or public transportation like buses, metros, and trains may not be the best choice sometimes. Did you know over 3.6 million Americans miss or delay their healthcare appointments every year? Invariably, such delays or default on medical appointments tend to cost money.
This segment of people including healthcare seekers and accompanying individuals make for a potential business opportunity for the transport industry. There are multiple transport providers in the market, both large and small, that cater to the NEMT segment.
NEMT services are usually covered under Medicaid or by health insurance and are categorized under preventive care. The transport itself could include a multitude of modes such as wheelchairs, taxicabs, sedans, SUV, stretcher cars and even air travel if one is required. The NEMT transport arrangement is brokered by some people between the transporters, patients and the healthcare centers.
However, there are critical challenges confronted by the various players in this segment:
- Tedious Process:
The transport is often originated and coordinated from the hospital premises by care managers. They call the NEMT transport service providers manually and also organize for suitable handling equipment such as wheelchairs. In case repeated calls have to be made due to non-availability or for time reasons, it just gets more tedious.
- Identifying Transport Providers:
Identifying the transport providers out of a few dozen operators in a given region is another daunting task. The NEMT market is fragmented and does not provide regular business. So it is an ‘also ran’ business for most of them. In such cases choosing the availability and suitability can be another challenge.
- Comparison between Providers:
It is not easy to strike comparisons for better quality, price and any other parameter among any selected transport providers. Availability becomes the prime factor which may override other advantageous factors in the absence of comparisons. Unsuitability of the features in a particular vehicle can be frustrating for the transporter as well as the patient.
Government investigators in 2016 had warned that there is “a high risk for fraud and abuse” in the NEMT program. Over the past few years, the Centers for Medicare & Medicaid Services (CMS) reported that a Massachusetts NEMT provider was jailed and fined almost $475,000 for billing for rides attributed to dead people.
Additionally, two ambulance programs in Connecticut had to pay about $600,000 to settle claims that they had provided transportation for dialysis patients who did not have medical needs for ambulance transportation. Numerous NEMT rides initiated by the hospitals arrived out of their time limits but still claimed for the services. Some of the NEMT services paid off the patients for NEMT claims although the patients drove by themselves.
The success of NEMT transportation lies in overcoming these challenges effectively. The above difficulties point to the necessity of a technology solution for the transportation of NEMT patients which could help meet all of the above challenges.
Tech giants such as Uber and Lyft coming forward to collaborate with healthcare providers is a glowing testimony to the immensely increasing role of technology in improving NEMT services.
The sheer size of this target segment and the opportunity to make NEMT services better make it an instant case for technology intervention. It needs transport dispatch management features to act as a virtual broker between the three parties — the transporter, patient and the reimbursing agency — when the hospitals endorse the trip.
In general, the following improvements must happen shortly concerning healthcare transportation. The role of technology is imperative in each case and makes a particular impact:
- Technology Advancements Similar to Taxi Solutions:
The technology advancements that enable traveling patients to visualize the whole process of taxi booking to payments while getting updates at every step can be extended to NEMT transport solutions. This makes NEMT transport services to be more reliable, cost-effective and transparent.
- Application of Analytics to NEMT Services:
As the NEMT solutions gather momentum, it is good to understand the various aspects of the services provided. Especially for the paying agencies such as Medicaid or Insurance, these are essential to understanding how their budgets have been consumed and what more is needed.
- Fraud Prevention:
Nearly $3 billion is spent by government on NEMT to provide roughly 103 million trips. A vast majority of low-income Americans rely on Medicaid to avail the benefits of NEMT. However, NEMT benefits prove a convenient target for elimination — especially when it comes to the potential for fraud and abuse. But when the technology is used to make the booking and avail of the service, each aspect can be tracked. Technology not only helps in fraud prevention but also improves safer transportation with better transparency.
- Reducing Communication Gaps:
The scenario of millions of patients missing their healthcare due to the ineffective availability of NEMT services is primarily due to communication gaps. Since healthcare providers initiate most of the NEMT transport, brokered by agencies, operated by transporters, availed by patients and paid for by Medicaid agencies, communication gaps can be galore. By ensuring that the technology solutions provide seamless communication between various parties concerned, NEMT services can be made far more effective.
In addition to the above, the new Medicaid regulations and the necessity of brokers (public, private or mixed)of any selected type require sharing of info on cost-efficiencies, quality and compliance. This is possible only if NEMT services are well backed-up by technology solutions that provide features for each one of these requirements.