"Is the Fixation on ROI Hindering Healthcare Outcomes and Access-to-Care?"

The highest level of accreditation, credentialing and certifications an NEMT provider can achieve

What was originally an opportunity for better health outcomes and increased access-to-care has evolved in to nothing more than a profit grab by Broker Coordinated Transportation Programs. Broker Coordinated Transportation Programs are initiatives that facilitate non-emergency medical transportation (NEMT) services for individuals covered by Medicaid - a vital benefit that ensures eligible individuals can access medical care by providing rides.

Steve Newman, President of 360 Quality Care + Transportation Services in St. Louis says that the current system is counterproductive and fails to acknowledge that the most "at-risk" patients within the system are also the ones who require the most care. While the brokerage models provide cost savings and reduce administrative burdens for the states, they fail to understand that this is not a one size fits all problem.

“This has become a missed opportunity for a very significant group of patients making up between 5 and 10% of all NEMT rides. These patients are experiencing critical, chronic and catastrophic health issues and need a higher level of care during transport. These patients do not align with the bottom dollar approach found in todays broker exchanges and it has to change, says Newman".

Newman has taken the lead in advocating for change in how coordinated transportation programs recognize the most vulnerable. He calls it Priority Medical Transport (PMT), the highest level of NEMT accreditation, credentialing and certifications an NEMT provider can attain. PMT is designed to drive down healthcare expenses and improve health outcomes.

NEMT Service Comparison - PMT provides better outcomes and is often cost neutral.

A growing number of "quality providers" are becoming critical of how today’s system works against better outcomes - especially given the fact that these programs are subsidized by Federal Funds. "In its current state there are far too many missed rides and missed appointments that have a direct impact on health outcomes and downstream expenses from lack of intervention. Priority Medical Transport distinguishes itself in cost, service, satisfaction and outcomes" says Newman.

"It's time for a call-to-action, encouraging patients, healthcare providers, supportive care providers and healthcare workers to speak out against a system that is basically contributing to a lower standard of care" says Newman.  Transportation is a fundamental determinant of healthcare accessibility. According to the American Hospitals Association, approximately 3.6 million Americans miss or delay medical appointments due to transportation-related issues. For both Medicaid and Medicare beneficiaries, this barrier can significantly impact their health outcomes. 

Medicare Advantage plans are also at odds, now grappling with performance limitations that impact their customer star ratings. "It's always the the usual things like timeliness, reliability, safety and liability", says Newman. "While Medicare Advantage plans have made strides in enhancing healthcare access, one critical area remains under scrutiny: transportation". 

 As the healthcare landscape evolves, addressing transportation limitations is essential for improving health outcomes and lowing healthcare expenses. Seniors deserve seamless access to care, unencumbered by transportation barriers. By prioritizing innovative solutions like PMT, we can elevate the care for all beneficiaries.