Medicare Provider Software

Trends in Elective Healthcare

Over the past decade, the interest in consumer-directed healthcare—often referred to as elective healthcare—has significantly increased. Another critical movement in healthcare, value-based care, has also influenced the way people interact with healthcare, including elective options.

This is where the discussion about non-emergency medical transportation (NEMT) comes into play; as we will learn, there will be a need for a healthcare delivery system to focus more on the quality of service provided versus focusing on cost.

What Is Elective Healthcare?

The idea of elective healthcare is empowering individuals to make decisions about healthcare utilization and expenditures based on their preferences for quality of life. Any service or procedure that the individual plans ahead of time and isn’t emergent care can be considered part of elective healthcare. This type of healthcare can be provided either in an inpatient setting (e.g., surgery) or outpatient setting (e.g., colonoscopy).

What Is NEMT?

With elective healthcare, consumers are empowered to choose the method of transportation to access their services. NEMT is available to those who cannot transport themselves. This section of the healthcare industry often has good transparency into quality and pricing, allowing the consumer to select the transport service to meet their needs best. If someone cannot get to the healthcare they need, the result is more emergency healthcare needs.

Elective Healthcare and NEMT

Transportation is a critical component of healthcare delivery. The increased number of NEMT providers offering different types of services at different prices raises the question of the varying levels of quality and how to choose the best service. Selecting a cost-efficient transportation provider that provides the most appropriate service is challenging.

Value-based care—a system in which care providers of all kinds are compensated based on patient outcomes and not just on services rendered—improves the quality of service and provides the best results for patients. The goal is to make changes and enhance the elective healthcare patients receive.

While it is true that medical providers are incentivized to provide care cost-effectively, there are limited economic incentives for patients to choose services based on their preferences or financial resources when they have insurance or government assistance.

As a result, it may be the case that patients choose the NEMT service offering that is most convenient or accessible. Although, this sometimes may not reflect patients’ preferences or constitute an effective use of health system resources.

In other words, it’s possible to have a situation in which a patient uses a high-price provider who is accessible as opposed to a lower-price provider who is not accessible. This poses competition for transportation providers and challenges to the healthcare system. Maximizing patient satisfaction may mean absorbing higher costs. At the same time, under a value-based care delivery method, the transportation provider may receive a greater payment for maximizing patient satisfaction.

Influence on Policy

Given these factors, policymakers recognize that value-based care necessitates a change in the way reimbursements are provided due to these unique differences in dynamic for the relationship between the patient and the NEMT provider.

While most other service providers in different industries have direct economic incentives to provide good customer service, NEMT providers are paid directly by the healthcare system. This is where value-based care comes into play. When pay is directly related to health outcomes, the economic incentive becomes direct.

What Does This Mean for the Patient?

With all these choices and differing opinions on the best option, how does the patient truly know what they want and need? There is a certain degree of trial and error involved. This can be cut down by asking for recommendations from others, especially medical professionals. Open communication between individuals, medical professionals, and providers is vital to building a successful relationship.

Ultimately, those seeking additional services will need extra support to access the services they feel are required. NEMT plays a significant role in this process.

Kris Lyon

Kris, VP, Business Development, specializes in adapting the operational needs of customers to Momentm's NEMT software platforms. With a strong 30+ year history working in the Health and Human Services field, Kris provides insight into the health care industry and its relation to medical transportation.

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