Nonemergency Medical Transportation Research Articles

The evaluation and cost-benefit analysis of a nonemergency private transportation program for low-income adults in a rural setting

BackgroundAccess to transportation can improve the health of communities. Since 2015, Project TRIP (Transporting Residents with Innovative Practices) has offered free nonemergency privately operated individualized transportation for low-income residents in rural eastern North Carolina. We sought to evaluate the impact of Project TRIP on health outcome and healthcare utilization measures and to conduct an economic evaluation of its cost benefit. MethodsKey health outcome and healthcare utilization variables were compared across 101 Project TRIP users before and after TRIP participation via data obtained from electronic health records from 2017 to 2021. The cost-benefit analysis included a comparison of the costs of operating Project TRIP as compared to the savings of fewer hospital and emergency department admissions. Pre and post TRIP comparisons were analyzed on the following: A1C scores, no show/missed appointments, body weight, body mass index, and number of emergency room and hospital admissions. ResultsOver half (58%) of Project TRIP users were female with a mean age of 54. Most riders were Black (69%), either received Medicaid (32%) or Medicare (17%) or were uninsured (22%). All variables showed a decrease (improvement) post TRIP utilization. The average A1C level decreased by 0.52 post TRIP utilization (statistically significant at 10% level). The number of hospital admissions also decreased (statistically significant at 1% level) for TRIP users. Other key measures also improved for TRIP users but not at statistically significant levels. The estimated net savings of Project TRIP in hospital and emergency room visits alone after deducting operating costs in the past 5 years was $720,544. ConclusionsThis study found that access to a non-emergency medical transportation program was cost-effective in reducing emergency room and hospital expenditures. Project TRIP users demonstrated an improvement in health outcomes post TRIP utilization. Expanding model rural transit programs and policies are needed.

Impacts of North Carolina’s medicaid transformation on community transit systems: A qualitative analysis with policy implications

North Carolina began its Medicaid Transformation implementation process in July of 2021. The Transformation shifted responsibility for arranging non-emergency medical transportation (NEMT) for transportation-disadvantaged Medicaid beneficiaries from county Departments of Social Services (DSS) to private transportation brokers. Brokers also decide NEMT eligibility and select transportation service providers that best meet beneficiaries' transportation needs. Before this transition, county DSS offices relied on community transit organizations (CTOs) to coordinate NEMT and other human transportation services. This is a significant shift from North Carolina's coordinated transportation model, which emphasized coordinating medical and other trips using local transit providers. This paper examines how the Medicaid Transformation in the state has altered CTOs' ability to continue coordinating individual human service transportation programs. Findings from interviews and policy content analyses indicate that the Medicaid Transformation has negatively affected CTOs' ability to coordinate between individual human service transportation programs. Control of several mechanisms CTOs historically used to coordinate transportation programs has shifted to brokers, who are neither prepared nor intended to take on the coordination role. Since these programs serve various transportation-disadvantaged residents in the state, including those enrolled in Medicaid, obstacles that CTOs encounter while coordinating transportation affect these communities disproportionately. Several factors explain CTOs' diminished ability to coordinate transportation, including goals and policy misalignment between health and transportation state authorities, regional location disadvantages, and logistical constraints that emerged with the Transformation.

Essential not Supplemental: Medicare Advantage Members’ Use of Non-Emergency Medical Transportation (NEMT)

BackgroundOver five million people in the USA miss or delay medical care because of a lack of transportation. Transportation barriers are especially relevant to Medicare Advantage (MA) health plan enrollees, who are more likely to live with multiple chronic conditions and experience mobility challenges. Non-Emergency Medical Transportation (NEMT) helps to address transportation gaps by providing rides to and from routine medical care (for example, medical appointments, laboratory tests, and pharmacy visits) and has been added as a supplemental benefit to some MA health plans.ObjectiveWe aimed to characterize MA enrollees’ experiences with supplemental NEMT benefits.DesignQualitative interviews focused on participants’ experiences with existing NEMT benefits, transportation, and mobility.ParticipantsTwenty-one MA enrollees who used their MA NEMT benefit in 2019 and who remained eligible for ongoing transportation benefits through 2021.ApproachUsing purposive sampling from a list of eligible participants, we recruited individuals who used their MA NEMT benefit in 2019 and who remained eligible for benefit-covered transportation services through 2021.Key ResultsParticipants considered NEMT an essential service, particularly because these services helped them decrease social isolation, reduce financial insecurity, and manage their own medical needs. Navigating logistical challenges associated with arranging NEMT services required participants to commit considerable time and energy and limited the effectiveness and reliability of NEMT.ConclusionParticipants described NEMT as a valued service essential to their ability to access health care. They suggested ways to increase service flexibility and reliability that could inform future NEMT policy and practice. As health systems and payers learn how to best address social risks, particularly as the US population ages, our findings underscore the importance of NEMT services and highlight opportunities to advance comprehensive transportation solutions for MA participants.

Estimated Costs of Intervening in Health-Related Social Needs Detected in Primary Care

Health-related social needs are increasingly being screened for in primary care practices, but it remains unclear how much additional financing is required to address those needs to improve health outcomes. To estimate the cost of implementing evidence-based interventions to address social needs identified in primary care practices. A decision analytical microsimulation of patients seen in primary care practices, using data on social needs from the National Center for Health Statistics from 2015 through 2018 (N = 19 225) was conducted. Primary care practices were categorized as federally qualified health centers (FQHCs), non-FQHC urban practices in high-poverty areas, non-FQHC rural practices in high-poverty areas, and practices in lower-poverty areas. Data analysis was performed from March 3 to December 16, 2022. Simulated evidence-based interventions of primary care-based screening and referral protocols, food assistance, housing programs, nonemergency medical transportation, and community-based care coordination. The primary outcome was per-person per-month cost of interventions. Intervention costs that have existing federally funded financing mechanisms (eg, the Supplemental Nutrition Assistance Program) and costs without such an existing mechanism were tabulated. Of the population included in the analysis, the mean (SD) age was 34.4 (25.9) years, and 54.3% were female. Among people with food and housing needs, most were program eligible for federally funded programs, but had low enrollment (eg, due to inadequate program capacity), with 78.0% of people with housing needs being program eligible vs 24.0% enrolled, and 95.6% of people with food needs being program eligible vs 70.2% enrolled. Among those with transportation insecurity and care coordination needs, eligibility criteria limited enrollment (26.3% of those in need being program eligible for transportation programs, and 5.7% of those in need being program eligible for care coordination programs). The cost of providing evidence-based interventions for these 4 domains averaged $60 (95% CI, $55-$65) per member per month (including approximately $5 for screening and referral management in clinics), of which $27 (95% CI, $24-$31) (45.8%) was federally funded. While disproportionate funding was available to populations seen at FQHCs, populations seen at non-FQHC practices in high-poverty areas had larger funding gaps (intervention costs not borne by existing federal funding mechanisms). In this decision analytical microsimulation study, food and housing interventions were limited by low enrollment among eligible people, whereas transportation and care coordination interventions were more limited by narrow eligibility criteria. Screening and referral management in primary care was a small expenditure relative to the cost of interventions to address social needs, and just under half of the costs of interventions were covered by existing federal funding mechanisms. These findings suggest that many resources are necessary to address social needs that fall largely outside of existing federal financing mechanisms.

Non-emergency medical transportation practice in Shanghai

Background: To describe the current landscape of non-emergency medical transportation (NEMT) services in China’s mainland, and analyze information obtained from a private NEMT company in Shanghai. Methods: With regards to the NEMT environment in China’s mainland, we collected relevant NEMT policies from the websites of local Health Commissions, and collected business operating data from a Chinese enterprise information query tool, Qichacha. With regards to NEMT service in Shanghai, we analyzed operating data from 3426 trips by a professional NEMT company. Descriptive statistics were used to explain the characteristics of NEMT trips, and log-linear analyses were performed to compare the trips inside Shanghai with trips to/from other areas. Results: Of the 3426 trips in this study, there were 2962 trips inside Shanghai (86.5%) and 464 trips to/from other areas (13.5%), and the number of trips to/from each province was related to the distance to Shanghai. When comparing transportation types between trips inside Shanghai and to/from other areas, there was a significant difference (χ2=144.87, p<0.001), with a significantly larger proportion of trips for discharge to/from other areas, and a significantly larger proportion of referrals in trips inside Shanghai. Over 50% of trips were to orthopedics-featured class A tertiary hospitals. Discussion and Conclusion: To lower the NEMT service costs and bring benefit to patients with a broader spectrum of diseases, medical insurance could completely or partially cover NEMT services, and companies could initiate rideshare services. Shanghai is an attractive place for patients, with the highest level of healthcare resources. Transportation combining high-speed trains and NEMT vehicles ensures patients who live further away can access health care in Shanghai.

Non-emergency medical transportation practice in Shanghai

Background: To describe the current landscape of non-emergency medical transportation (NEMT) services in China’s mainland, and analyze information obtained from a private NEMT company in Shanghai. Methods: With regards to the NEMT environment in China’s mainland, we collected relevant NEMT policies from the websites of local Health Commissions, and collected business operating data from a Chinese enterprise information query tool, Qichacha. With regards to NEMT service in Shanghai, we analyzed operating data from 3426 trips by a professional NEMT company. Descriptive statistics were used to explain the characteristics of NEMT trips, and log-linear analyses were performed to compare the trips inside Shanghai with trips to/from other areas. Results: Of the 3426 trips in this study, there were 2962 trips inside Shanghai (86.5%) and 464 trips to/from other areas (13.5%), and the number of trips to/from each province was related to the distance to Shanghai. When comparing transportation types between trips inside Shanghai and to/from other areas, there was a significant difference (χ2=144.87, p<0.001), with a significantly larger proportion of trips for discharge to/from other areas, and a significantly larger proportion of referrals in trips inside Shanghai. Over 50% of trips were to orthopedics-featured class A tertiary hospitals. Discussion and Conclusion: To lower the NEMT service costs and bring benefit to patients with a broader spectrum of diseases, medical insurance could completely or partially cover NEMT services, and companies could initiate rideshare services. Shanghai is an attractive place for patients, with the highest level of healthcare resources. Transportation combining high-speed trains and NEMT vehicles ensures patients who live further away can access health care in Shanghai.

Evaluating A Nonemergency Medical Transportation Benefit For Accountable Care Organization Members.

Nonemergency medical transportation benefits, often using smartphone application-based ridesharing services, are increasingly being offered as part of population health management programs. However, the impact of these programs on health care use and costs remains understudied. We conducted a mixed-methods evaluation of a nonemergency medical transportation benefit offered to members of a Medicare accountable care organization (ACO) within a large academic health system, the UNC Health Alliance ACO. Participation in the transportation program was associated with a greater number of per person per year outpatient visits (9.2) and higher outpatient spending ($4,420) than in a comparison group. However, there was no difference in inpatient admissions or emergency department visits, and the program was not cost saving. Qualitative analyses revealed that participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health. These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances.

Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations.

Transportation is a common barrier to colonoscopy completion for colorectal cancer (CRC) screening. The study aims to identify the barriers, facilitators, and process recommendations to implement a rideshare non-emergency medical transportation (NEMT) intervention following colonoscopy completion within a safety-net healthcare setting. We used informal stakeholder engagement, story boards - a novel user-centered design technique, listening sessions and the nominal group technique to identify the barriers, facilitators, and process to implementing a rideshare NEMT program following colonoscopy completion in a large safety-net healthcare system. Barriers to implementing a rideshare NEMT intervention for colonoscopy completion included: inability to expand an existing NEMT program beyond Medicaid patients and lack of patient chaperones with rideshare NEMT programs. Facilitators included: commercially available rideshare NEMT platforms that were lower cost and had shorter wait times than the alternative of taxis. Operationalizing and implementing a rideshare NEMT intervention in our healthcare system required the following steps: 1) identifying key stakeholders, 2) engaging stakeholder groups in discussion to identify barriers and solutions, 3) obtaining institutional sign-off, 4) developing a process for reviewing and selecting a rideshare NEMT program, 5) executing contracts, 6) developing a standard operating procedure and 7) training clinic staff to use the rideshare platform. Rideshare NEMT after procedural sedation is administered may improve colonoscopy completion rates and provide one solution to inadequate CRC screening. If successful, our rideshare model could be broadly applicable to other safety-net health systems, populations with high social needs, and settings where procedural sedation is administered.

Medicaid Enrollees’ Experiences with Non-Emergency Medical Transportation

Medicaid Enrollees’ Experiences with Non-Emergency Medical Transportation

Integrated Vehicle Routing and Service Scheduling Under Time and Cancellation Uncertainties with Application in Nonemergency Medical Transportation

In this paper, we consider an integrated vehicle routing and service scheduling problem for serving customers in distributed locations who need pick-up, drop-off, or delivery services. We take into account the random trip time, nonnegligible service time, and possible customer cancellations, under which an ill-designed schedule may lead to undesirable vehicle idleness and customer waiting. We build a stochastic mixed-integer program to minimize the operational cost plus expected penalty cost of customers’ waiting time, vehicles’ idleness, and overtime. Furthermore, to handle real-time arrived service requests, we develop K-means clustering-based algorithms to dynamically update planned routes and schedules. The algorithms assign customers to vehicles based on similarities and then plan schedules on each vehicle separately. We conduct numerical experiments based on diverse instances generated from census data and data from the Ford Motor Company’s GoRide service, to evaluate result sensitivity and to compare the in-sample and out-of-sample performance of different approaches. Managerial insights are provided using numerical results based on different parameter choices and uncertainty settings.

Industry-informed perspectives on the benefits of rideshare-based medical transportation.

Previous research on rideshare-based nonemergency medical transportation has limited generalizability due to the specific model studied, and the lack of trip-level data raises concerns of ecological fallacy.

An Evaluation of the Non-Emergency Medical Transportation System of Rural Southern Illinois

The purpose of the study was to determine if disparities existed in the non-emergency medical transportation (NEMT) system in the lower 34 counties of southern Illinois. NEMT is described as the transfer of individuals from a pre-hospital care setting to care facilities, and ongoing care transfer of individuals from pre-hospital care settings. Several research themes developed during the study. These themes included an underserved rural population by non-emergency medical transportation, negative health consequences, and an ineffective use of medical staff’s time. Two types of data collection were used in the collection of information about the non-urgent medical transportation system. Qualitative research consisted of three focus groups, made-up of various stakeholders within the medical community. The quantitative research consisted of the collection of 250 surveys from various participating healthcare professionals. The results of the data collected indicated that the rural population of southern Illinois is inadequately served by the NEMT system. It also indicated that due to insufficient non-urgent medical transportation, patients and medical staff alike had undue burdens placed on them because of missed appointments, lack of timely healthcare services, reduced effectiveness of patient care, and medical staff distress.

Staying Out of the Way: Perceptions of Digital Non-Emergency Medical Transportation Services, Barriers, and Access to Care Among Young Black Male Survivors of Firearm Violence.

With a reduction in primary barriers to healthcare access as a result of the Affordable Care Act, there is an increased need to address secondary barriers faced by low-income young Black male survivors of violent injury. While transportation is often characterized as a barrier for individuals with chronic disease and disability, it also acts as a significant barrier in accessing cognitive behavioral therapy and mentoring services through hospital-based violence intervention programs (HVIPs). These services address the traumatic stress associated with surviving gun violence. Although there are many challenges associated with the current practices of non-emergency medical transportation, participants in HVIPs face additional risk factors. We highlight the application of a digital transportation intervention to increase the use of psychosocial services among low-income young Black male survivors of violent injury participating in an HVIP. Digital non-emergency medical transportation services (DNEMT) address issues concerning financial barriers, personal safety, program credibility, and program participation. We conducted qualitative interviews and a focus group with this population to assess the impact of Uber Health, a DNEMT service, on their participation in an HVIP located in a suburban Maryland hospital immediately outside of Washington, D.C. Survivors identified the use of Uber Health as essential to addressing the multifaceted and interconnected barriers to treatment. These barriers included reluctance to use alternative forms of transportation services (i.e., bus or subway) due to potential encounters with rivals, increased risk of repeat violent victimization, the need to carry a weapon for protection, stigmatization, and symptoms associated with traumatic stress. We found that integrating digital transportation services into the standard practices of HVIPs, as a part of a patient-centered outcomes framework, contributes to a reduction in violent injury and re-traumatization by addressing the multi-layered risks experienced by survivors of gun violence.

Rideshare transportation to health care: evidence from a Medicaid implementation.

Some managed care companies are testing rideshare services as an approach to providing transportation to health care for Medicaid enrollees. The objective of this study was to assess whether more rideshare transportation to health care was associated with improved self-reported ride experiences and fewer late/failed passenger pickups for Medicaid enrollees. We surveyed a random sample of Medicaid enrollees in a northwestern US state on their experiences with nonemergency medical transportation (NEMT) in the past year. We linked survey responses to administrative data on NEMT utilization from the state's transportation broker to obtain an objective measure of rideshare utilization. We used bivariate tests and multivariable logistic regressions to examine associations between enrollee perspectives on the quality of and access to health care and rideshare use, defined as none, some, or many NEMT trips through rideshare services. More than 35% of respondents received NEMT from rideshare services at least once. Perceptions of the ride experience, driver, and vehicle did not differ based on the proportion of rideshare trips received. Having more rideshare trips was associated with reporting late and failed pickups. In multivariable regression, the statistical significance held for failed pickups. Sensitivity analyses showed similar results. This study suggests that rideshare to health care programs can meet similar goals of quality compared with traditional NEMT services but may have implications for health care access for Medicaid enrollees. Future evaluations need to include the perspectives of enrollees and explore potential differences among different Medicaid subpopulations.

Ensuring access to health care by FQHCs as states reopen amid COVID-19.

One in 5 Americans utilizes federally qualified health center (FQHC) services for their primary care, preventive, and community health needs. Medicaid and FQHC programs have been partners at the forefront of addressing population health needs for more than 50 years. Although testing and contact tracing during the coronavirus disease 2019 (COVID-19) crisis are helping rural FQHC patients, there are other vital Medicaid services that are both available right now and ripe for enhancement to ensure the accessibility of services during and after the COVID-19 emergency. A primary example is nonemergency medical transportation (NEMT). Community health centers must focus on NEMT use to ensure access to care for rural patients as states reopen. This commentary defines NEMT and ways that FQHCs can enhance it as a Medicaid benefit as states reopen amid COVID-19.

Re-designing the service experience in the value co-creation process: an exploratory study of a healthcare network

PurposeThe study aims to provide an exploratory investigation of the magnitude of the customer-centric approach in the specific area of healthcare as a contribution to the scarce and preliminary literature on this topic. In particular, it explores the role of sharing economy-based (SE-based) platforms as an experiential touchpoint to co-create value within different levels. Specifically, the purpose of the study is threefold. First, it aims to address the service experience innovation in healthcare with a customer-centric approach. Second, it seeks to define the role of the SE-based platform as a touchpoint to redefine business processes, and third, it measures the co-created value within the network when redesigning the service experience.Design/methodology/approachTo address the research question, the authors proposed an analysis of service innovation and customer centricity in healthcare networks by using the case study of Saluber, an SE-based platform that offers logistics services for non-emergency medical transportation in the Campania region (south of Italy). By using a qualitative approach, the authors analysed primary and secondary data from multiple sources of evidence.FindingsThe results show that a customer-centric approach based on the SE-based platform can improve the customer experience and help to redesign and expand the business processes of healthcare organisations. A multilevel model demonstrates the possible service innovations that use SE principles that can co-create value for the customer (micro level), for the healthcare network (meso level) and for the community (macro-level).Research limitations/implicationsThis study provides managerial implications for the players who intend to take advantage of the possibilities offered by service innovations developed by the health and social organisations in the network. The SE-based platform helps redefine business processes to improve clinical and financial outcomes and improves the overall customer experience within this network.Originality/valueThis study allows new and important reflections from ethical, social and managerial points of view and underlines how digital platforms act as a support for healthcare services, not as a substitute.

Impact of Transportation Interventions on Health Care Outcomes: A Systematic Review.

Lack of reliable transportation can be a barrier to keeping appointments or accessing other health care services. Increasingly, insurers and health care delivery systems subsidize transportation services for patients. This systematic review synthesizes existing research on nonemergency medical transportation interventions. We searched 3 databases (Embase, PubMed, Google) for studies of health care sector-sponsored programs that provided patients assistance with nonemergency transportation and directly assessed the impact of transportation assistance on health and health care utilization outcomes. Studies meeting inclusion criteria were graded for quality using standard grading criteria. Eight studies met all inclusion criteria. Most were rated as low quality. All studies included examined process or health care utilization outcomes, such as uptake of transportation services, return for follow-up, or missed appointment rates; only 1 included health outcomes, such as illness severity and blood pressure. Results were mixed. More rigorous studies showed low patient uptake of transportation services and inconsistent impacts on health and utilization outcomes. Despite considerable interest in subsidizing transportation services to improve health for patients facing transportation barriers, little rigorously conducted research has demonstrated the impact of transportation services on health or health care utilization. Some extant literature suggests that transportation assistance is more likely to be effective when offered with other interventions to reduce social and economic barriers to health.

Barriers to Transportation: A Study on Patients with End-Stage Renal Disease Receiving in-Center Hemodialysis

Without kidney transplant, treatment for end-stage renal disease is considered lifelong. Non-emergency medical transportation through Medicaid and the complementary paratransit services under the Americans with Disabilities Act 1990, were identified as the two major sources of transportation services for end-stage renal disease patients. The purpose of the study was to explore barriers to transportation experienced by dialysis patients using transportation services for in-center dialysis and transplant related medical appointments. The study used a non-experimental quantitative research design to explore the barriers and used web-based survey to collect the data. The link to the web-based survey was disseminated on National Kidney Foundation’s Facebook and online forum and the survey collected 231 responses. The results of the study indicated prevalence of barriers to transportation for patients with end-stage renal disease. The barriers pose a risk for shortening or missing dialysis appointments affecting dialysis patient’s health, leading to an increase in hospitalization and mortality rates. The findings of the study provided foundations for interventions and policy implications to diminish barriers to transportation for patients with end-stage renal disease. Future studies may address barriers to transportation based on end-stage disease patients’ physical limitations and at different geographic settings.

Not Everyone Has Somebody: How Health Care Organizations Are Assisting Patients With Nonemergency Medical Transportation

Varicose veins are enlarged, tortuous veins that are commonly found in the lower extremities, affecting people over a wide age range with increasing prevalence with age. This pathology is typically a benign process with complications that can decrease a person's quality of life and lead to potentially life-threatening complications. There are surgical, endovascular, and chemical treatments which improve quality of life and decrease secondary complications of varicose veins. This review article will discuss the technical aspects of these procedures, potential and rare complications, preprocedural and postprocedural considerations, and overall comparison of technique efficacy.

Economic Benefit of "Modern" Nonemergency Medical Transportation That Utilizes Digital Transportation Networks.

To determine the economic benefit of "modern" nonemergency medical transportation (NEMT) that utilizes digital transportation networks compared with traditional NEMT in the United States. We used the National Academies' NEMT cost-effectiveness model to perform a baseline cost savings analysis for provision of NEMT for transportation-disadvantaged Medicaid beneficiaries. On the basis of a review of the literature, commercial information, and structured expert interviews, we performed a sensitivity analysis to determine the incremental economic benefit of using modern NEMT. We estimated confidence intervals (CIs) by using Monte Carlo simulation. Total annual net savings for traditional NEMT in Medicaid was approximately $4 billion. For modern NEMT, estimated savings on ride costs varied from 30% to 70%. In comparison with traditional, modern NEMT was estimated to save $268 per expected user (95% CI = $248, $288 per member per year) and $537 million annually (95% CI = $496 million, $577 million) when scaled nationally. Modern NEMT has the potential to yield greater cost savings than traditional NEMT while also improving patient experience. Public Health Implications: Barriers to NEMT are a health risk affecting high-need, economically disadvantaged patients. Economic arguments supporting modern NEMT are important given decreased support for human services spending.