- Non-emergency medical transportation yields a considerable return on investment (ROI) as it helps with patient care access in chronic disease management, according to new data from the Medical Transportation Access Coalition (MTAC).
On the whole, non-emergency medical transportation (NEMT) saves Medicaid about $40 million per month for every 30,000 patients receiving treatment for one of three high-cost chronic conditions including end-stage renal disease, diabetic wound care, and treatment for substance abuse disorders.
NEMT has long be an essential Medicaid benefit. Medicaid, which is the safety-net payer option for low-income or otherwise vulnerable populations, brokers with various transport services to help patients get rides to their care appointments. Rides can be as simple as an Uber or Lyft ride to the doctor or as complex as a non-emergency ambulance ride.
This covered benefit not only fulfills moral or ethical obligations, but also yields a substantial ROI for the public payer. ROI is a rare feat for such a public service, according to Mike Adelberg, a principal with Faegre Baker Daniels Consulting and co-author of the study
“As we surveyed nearly 1,000 vulnerable users of NEMT, we heard again and again about the importance of this benefit,” Adelberg said in a statement. “Now that we've crunched the numbers, we see that for the conditions we examined, NEMT is also a benefit to Medicaid's coffers. Win-win scenarios are uncommon in public programs—this appears to be one.”
The researchers investigated and surveyed Medicaid claims data for 1,000 Medicaid beneficiaries, taking a careful look at patient care usage and benefits realized.
The survey showed that NEMT was essential for patients, with 58 percent saying they would not be able to keep their medical appointments if they did not have access to NEMT. For 10 percent of patients, NEMT access was a matter of life or death because of the importance of their regular chronic care management.
The researchers analyzed the cost for care for patients who used NEMT and adhered to recommended treatment protocol compared to patients who did not adhere to treatment protocol. The team specifically looked at patients who used NEMT for only their prescribed medical needs – for example, for a set frequency of liver dialysis.
The team did not include patients who used NEMT for purposes outside of their recommended treatment protocol. This is an important distinction because it excludes patients who may be over-utilizing healthcare. Avenues that have made healthcare simpler and cheaper to access, such as NEMT, have in some cases led to patients accessing care they may not have needed resulting in higher overall costs.
This research indicates that when NEMT is used as it is intended, it drives return on investment.
Overall, patients who used NEMT to adhere to recommended protocols ended up seeing better health outcomes and lower long-term healthcare costs. Monthly cost savings per Medicaid beneficiary reached $1,300.
When looking at specific conditions, the researchers saw pronounced results. For example, patients using NEMT to access dialysis treatment saved Medicaid $3,423 per patient per month by driving treatment adherence. Yearly cost savings reached over $40,000 per patient.
On average, patients are recommended about 12 dialysis sessions monthly, but without access to NEMT patients report they would only be able to attend about 4 of those treatments. Non-adherence to treatment often results in worse health outcomes and higher long-term costs, but with access to NEMT to patients are able to prevent those costs and achieve wellness.
Similar results were seen in patients with diabetes-related wounds. These wounds require regular attendance, but when patients do not have access to transportation they can only receive treatment about once a month.
With access to NEMT, patients attend five or six maintenance appointments, resulting in nearly $800 in monthly cost savings per patient, or just over $9,000 in yearly cost savings per patient.
Just like in the dialysis patients, these cost savings occur because patients are able to avoid more expensive interventions stemming from lack of health management.
“These results remind us of the importance of access to care. It is scary to think of end-stage renal disease patients getting fewer than six treatments per month,” said Jackson Williams, director of regulatory affairs for Dialysis Patient Citizens, a Washington-based, nonprofit advocacy organization and an MTAC affiliate.
“Optimal dialysis care and improving the quality of life for all patients starts with getting them to dialysis centers,” Williams continued. “Well-managed Medicaid NEMT, especially for our patient population, means better health, fewer complications and lower costs.”
These results should inform further healthcare policymaking, especially at the state Medicaid level, according to Jeff Felton, CEO of NEMT broker provider LogistiCare.
“We are pleased with the findings and hope governors, legislators, members of Congress and the administration will continue supporting policies that provide NEMT services for Medicaid beneficiaries,” Felton said. “Many lack access to reliable transportation and those that rely on the benefit do not have the means or personal resources to keep their medical appointments without it. NEMT is an essential component in a healthcare system for those in greatest need.”