NEMT is a crucial part of the healthcare system, but it faces considerable challenges this year
Non-Emergency Medical Transport (NEMT) is a critical lifeline for people who need to get to medical appointments or from the hospital. But NEMT isn’t just about making sure someone gets to their cancer treatment or dialysis on time as our population ages, services like PACE (Program of All-inclusive Care for the Elderly) and Medicare Advantage (MA) are increasingly important for the health and well-being of our senior population.
This is the first post in a series on NEMT with a look at the entire non-emergency transportation space, its challenges, solutions, and what the future looks like as more and more people need NEMT.
What NEMT is, and isn’t
NEMT is an on-demand service that helps people get to and from their medical appointments, to-from hospitals, connect them with wellness providers, and stay active in their community overall. NEMT is like paratransit in that it’s an on-demand service, but the key difference is NEMT is designed to get anyone to and from medical treatments, while paratransit is more focused on general transportation within a transit system. NEMT is adjacent to paratransit, but not run by public transit agencies.
NEMT providers connect with PACE programs where someone has a disability, but NEMT providers don’t have to check for ADA eligibility but do have to check for Medicaid/Medicare Advantage eligibility. Both paratransit and NEMT are essential, and have different, but often overlapping, people they help and serve. NEMT is paid for by Medicare Advantage or Medicaid as part of someone’s overall health and wellness. It’s important to remember the medical part of NEMT. NEMT is very much focused on the medical side of transportation, where other transportation solutions are more generalized.
NEMT is a lynchpin in the healthcare system for transporting people when emergency transportation by ambulance isn’t needed. NEMT goes far beyond paratransit. Paratransit is locally-focused transportation, but NEMT can cover planes and trains, meals, lodging, and mileage. NEMT is more akin to a holistic transportation solution than simply a first-mile/last-mile solution for people.
How NEMT helps people and communities
The most crucial need is getting people to their medical appointments when they don’t have another way to get there. Maybe they don’t have someone to drive them or maybe they need special care enroute and just driving there isn’t an option. NEMT is more akin to a health-focused taxi than public transit.
What’s essential here are the connections to healthcare NEMT provides. While things like access to dialysis and cancer treatments are a big part of what NEMT providers do, they also play a crucial role in keeping people healthy and out of the hospital in general. When people can’t get to basic care, eventually they will get sicker. And urgently sick people need ambulances and ER visits and ambulances and hospitals are tremendously expensive. NEMT can make sure people can get to doctor’s appointments before something is urgent. NEMT can connect people with mental health resource or (like with PACE) just a way to be with other people for a while.
We often focus on the critical parts of healthcare, the emergencies, but emergencies can be avoided if people can just get the basic care they need when they need it.
NEMT is that transportation connection for better health.
NEMT at a crossroads: Current challenges facing providers and clients
Our aging population is straining healthcare systems everywhere. Increased demands are felt from homes to hospitals and NEMT is no different. Here are just a few of the challenges NEMT brokers and providers are facing:
- Compliance and regulation
- Customer service and satisfaction
- System responsiveness and efficiency
- Fraud and abuse
- Rising costs
Some of these challenges aren’t just from demand, they stem from outdated systems and processes that haven’t kept up with the times. Brokers answering all the phones themselves, planning routes on paper, and filling out forms manually are drowning under the increased workload.
It’s getting more and more expensive to run NEMT solutions. Inflation has driven up the cost of fuel and vehicles. Like the rest of the transportation industry, NEMT providers are struggling to find and hire enough drivers.
All these issues can push NEMT providers out of business, threatening the health and wellness of huge swaths of the community. And this isn’t a situation where just pouring money and people into the problem will solve it. There are some more fundamental changes that need to be made around how NEMT is managed and delivered.
And many of those changes can be made with better technology to let people do people things and computers to do complicated things.
Solutions in brief: taking the burden off people and onto software
NEMT providers care about people. They want to help people and make a difference in someone’s life. Doesn’t matter if that’s getting people to dialysis or to the senior center, it’s the getting there and connection that’s important.
But figuring out how to dispatch and plan your NEMT fleet day to day is a huge challenge. You have people who have pre-booked, you have last minute calls, and there are always no shows and cancelations. Anyone who thinks the pickups they have planned at the start of the day will be the same by lunch time, is fooling themselves. The only way to deal with this constant state of flux is software to handle the heavy lifting. Software can route and re-route drivers. It can make sure the right kind of vehicle shows up for patients with special requirements. Most of all it can make sure your schedule is as efficient as possible so you don’t waste time, resources, or fuel.
Then there’s also the administrative side of NEMT. Like everything that deals with insurance companies or government-funded programs, there is paperwork to be done. Most providers rely on reimbursement from one source or another to pay for the business. As anyone who has filled out an insurance claim form or applied for government benefits can attest, small errors can delay payments or even deny claims. Software can manage a lot of the heavy lifting here. Software can take a client’s record and fill in all the correct information on a multitude of forms in moments then invoice payors through Electronic Data Exchange (EDI). No cutting and pasting from one place to another. No retyping a person’s information on form after form. No more manual filing for reimbursement from payors. Software handles the tedious things that take time away from helping people—and also the source of many administrative errors that have to be fixed and managed later.
Software can take some of the burden of running, managing, and administering an NEMT business off people. Let people help people. Let your call center be a bright moment in someone’s day, not hours on hold. Use apps and automation to make the hard (and annoying) stuff easy. And you can get back to getting people where they need to be.
What’s coming next
In our next post we’re going to dive into the challenges facing NEMT in more depth. Healthcare is complex and NEMT is no different. The challenges we face now didn’t even exist a few years ago, and the new constraints on budgets and regulations aren’t changing anytime soon.
About Momentm
Momentm is a dedicated Health & Human Services Transportation brand, emerging with 30+ years of prior experience from TripSpark and Trapeze. We are committed to addressing a key social determinant of health (SDOH), namely non-emergency medical transportation (NEMT), for many market segments including Managed Care Organizations, brokers, transportation providers, PACE, IDD and health groups. Contact us to understand how technology can support NEMT operations at your organization.
