Health & Economic Benefits

Non-emergency medical transportation (NEMT) – particularly when delivered by brokers tasked with efficiently managing the benefit -is cost-effective. That’s why a number of state agencies, health plans, and other organizations have turned to the brokerage model as an alternative to directly contracting with transportation providers on a fee-for-service basis.

By contracting with a broker, these organizations are able to maintain budget predictability, reduce costs, and minimize fraud while ensuring transportation access throughout their entire service area. Following are some key data points on the economic value of NEMT services.

Medicaid Claims Analysis

A first-of-its-kind study published in July 2018 looking at the return on investment (ROI) of NEMT among three Medicaid beneficiary categories – persons receiving dialysis treatments, wound care visits to care for wounds caused by diabetes and substance abuse disorder (SUD) sessions – found that providing NEMT saves state Medicaid program dollars by averting more intensive and more costly healthcare procedures.

Click here to read the methodology used to conduct the study.

Click here to review the claims codes used to identify beneficiaries for the study.

Arkansas

An October 2015 report to the Arkansas Health Reform Task Force prepared by the Stephen Group found that the state currently has “a very effective brokerage model for non-emergency medical transportation (NEMT) with a capitated benefit structure that manages the program in a cost effective manner.”[1] As a result, the Stephen Group recommended retaining the benefit, noting that “the system is running efficiently with the best model possible and the value of the services has been validated through national studies.”[2]

Florida

In 2008, the Florida State University College of Business undertook a comprehensive study of the state’s transportation programs for its disadvantaged residents. The University found that for every $1.00 in state spending on medical transportation, the state received back $11.08, a return of investment of 1,108 percent.[3] The University used what it called “an extremely conservative estimate” that one of every 100 trips prevents a one-day hospital stay to determine this ROI.

Georgia and Kentucky

In the years 1996 to 1999, which corresponds to the period of a natural experiment during which Georgia and Kentucky implemented transportation brokerage services, for both study populations (asthmatic children and diabetic adults), researchers estimated a 13 percent decrease in total health care expenditures for children with asthma and 4 percent decrease for adults with diabetes.[4]

Oklahoma

A 2014 article in Social Work in Public Health studied NEMT use in Oklahoma. This review found that Medicaid beneficiaries with access to NEMT services were more likely to not miss a medical appointment than beneficiaries who did not have access to such services. It also found that “it is important to make transportation services available to the poor and undeserved among the chronically ill if they are expected to access available medical care and services.”[5]

Nationally

In 2006, the Deficit Reduction Act was enacted into law, containing a provision to allow states to use brokers to manage their NEMT benefits. The Congressional Budget Office (CBO) estimated that this provision would save the federal government $235 million over 10 years.[6]

Additionally, the Department of Health and Human Service’s Office of Inspector General (OIG) has identified NEMT brokers, identified as “prime vendor contracts in the report, as being a “proactive safeguard” that reduce the price of products and services.[7]

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[1] See http://www.arkleg.state.ar.us/assembly/2015/Meeting%20Attachments/836/I14099/TSG%20Volume%20II%20Recommendations.pdf, pages 21-22.

[2] ibid

[3] Florida Transportation Disadvantaged Programs Return on Investment Study, March 2008.

[4] Jinkung Kim, Edward C. Norton, and Sally C. Stearns, Transportation Brokerage Services and Medicaid Beneficiaries’ Access to Care, Health Services Research, 2009 Feb; 44(1): 145–161.

[5] Leela V. Thomas & Kenneth R. Wedel (2014) Nonemergency Medical Transportation and Health care Visits Among Chronically Ill Urban and Rural Medicaid Beneficiaries, Social Work in Public Health, 29:6, 629-639.

[6] See: https://www.cbo.gov/sites/default/files/109th-congress-2005-2006/costestimate/s1932conf0.pdf

[7] Medicaid Proactive Safeguards. OEI-05-99-00070. Washington, D.C.: July, 2000.