How to Re-imagine Your NEMT Operations

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NEMT Transportation: The Current Industry To successfully scale, medical transportation needs to embrace innovation and new technology.

A total of 7.1 million Americans annually rely on Non-Emergency Medical Transportation (NEMT) to provide them with access to the care they need. NEMT providers transport patients to and from doctor’s appointments, dialysis centers, and other lifesaving services. With global projected lifespans rising steadily and the growing popularity of home-health services, the industry is poised to rapidly expand in coming years: Global healthcare transportation services are expected to surge to a revenue of 101.88 billion by 20231

Healthcare innovation is currently shaping the future of NEMT: from ridesharing, to autonomous vehicles, and more. In order to provide the best level of care for their patients while still scaling and keeping up with rising demand, healthcare facilities and insurers need to leverage new technology to promote vendor management and transparency within their operations.

1 Industry ARC. Global Healthcare Transportation Services Market is expected to grow at a CAGR of 4.04% [Press Release}. Retrieved from http://www.digitaljournal.com/pr/3797590?utm_content=76751122&utm_medium=social&utm_source=twitter

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$765 Billion in Waste Pain points in the healthcare industry, and how to fix them. Despite the magnitude of the NEMT industry, inefficiencies and malpractice results in billions of lost revenue and misused funds. Up to 765$ billion dollars is wasted annually in healthcare. According to the Institute of Medicine, the breakdown is as follows2:

2 Source: Based on data in Best Care at Lower Cost (Institute of Medicine 2013),

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Fraud: In an industry where many rely on the phone and fax machine to track trips, fraud is commonplace in NEMT. Many vendors fraudulently increase mileage on trips, fudge medical necessity to invoice more expensive vehicle trips, bill rides for deceased patients, and more. During a 2015 audit, investigators revealed that one in 5 ambulance companies practice some form of fraudulent practices, totaling over $50 million in lost revenue from Medicare alone3. Some sources total ambulance fraud at up to $5 billion in losses annually4. Unnecessary services: Healthcare providers often foot the bill for NEMT rides which were not necessary for patient care. Both hospital staff and ambulance companies often fail to verify medical necessity for the levels of transport care they bill for– a dialysis patient may face hundreds of dollars in ambulance fees, when a $50 wheelchair van transport was all they required. Companies also increase their profits through a practice known as “upcoding”: charging for unnecessary medical devices and support(such as an Advanced Life Support(ALS), when only Basic Life Support(BLS) was needed5.

Inefficiently delivered care: Both provider and patient can be forced to pay far more money for services when a vendor is out-of-network. Poor organizational structures lead to an increased reliance on out-of-network vendors to fulfill requests. Missed Prevention Opportunities: 3.6 million patients miss routine appointments every year, leading to more ED visits and higher costs of care per patient. Lack of centralized NEMT 3 Goldstein, Amy. (2015). Fraudulent ambulance rides: Medicare paid more than $50 million, IG says. The Washington Post. https://www.washingtonpost.com/news/federal-eye/wp/2015/09/29/fraudulent-ambulance-rides-medicare-paid-more-than-50-million-ig-says/?utm_term=.fdff24ccdb35 4 Mahany, Brian. (2016). Ambulance Fraud Costs Medicare $5 Billion a Year. The Doctor Weighs In. https://thedoctorweighsin.com/ambulance-fraud-costs-medicare-5-billion-a-year/ 5 Ibid.

"People are just signing what the ambulance company puts in front of them and are unwittingly allowing them to defraud

Medicare, in which case the hospital can be charged, too…Hospital administrators need to make sure the people

who are signing these forms know what they're signing." –Brian Mahany, Healthcare Fraud Expert

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management and vendor accountability place lax expectations on drivers, and current facility-vendor contracts can mean a patient won’t be able to receive the care they need if the primary contracted vendor is busy.

Strategies for Success Tactics to better patient care and becoming a changemaker in the NEMT industry

1. Create a comprehensive Vendor Management System: Stop paying out of network vendors expensive market rates for the same service: reduce leakage by only sending requests to in-network vendors. Use a credentialing program which ensures that all your vendors are fully in compliance.

2. Use data as the bedrock of your billing practices, not merely a supplement. To create a fully transparent industry, it’s time to embrace bringing all your operations online. Web-enabled timestamps can keep track of pick-ups/drop-offs, online order requests make it crystal clear which patients require medical necessity, and performance reports enable you to make educated decisions about the partnerships in your vendor network.

3. Create an equal opportunity marketplace environment for your transportation requests. Rather than antiquated contracts which trap you into working with the same vendors regardless of performance, embrace the digital marketplace economy to assign trips based on quality of care and efficiency. 6 With hundreds of possible vendors at your disposal for any one trip, they should bid for fastest pick-up times and the highest standards of care.

Through these models, accountability and transparency are brought to the forefront of the industry. Patient care becomes the priority: better transportation means faster bed turnaround times, better care standards, and reduced costs for everyone.

The VectorCare Solution Take your operations to your web browser VectorCare’s online SaaS solution provides a way to easily manage transport requests. Accessible from any web browser, the HIPAA-secure software seamlessly connects healthcare 6 Durany, Enric. (2018). The Rise of the Digital Marketplace Economy. Hackernoon. Retrieved from https://hackernoon.com/the-rise-of-the-digital-marketplace-economy-6bd7607d537e

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providers with their transportation vendors and promotes open communication. Key features of the platform:

❏ All transport requests are broadcast online through the platform, rather than the phone or fax. Medical necessity for features are stated upfront, and no information can be “lost in transit”.

❏ Centralized vendor management: the platform’s built in network tools make sure that every transportation request is only broadcast to in-network providers. Vendor credentialing requires all vendors to maintain compliance by uploading their documents into a portal which checks them.

❏ Data at every step: the platform is designed to generate customized reports that analyze vendor performance, give timestamps for each pick-up/drop-off, enable real-time updates via secure messaging, and more. Every small aspect of the patient journey is recorded in detail, preventing fraud and saving hours of audition time.

❏ The VectorCare Marketplace: once a request has been broadcast through the system, vendors can bid on best times and accept/deny requests. Trip assignments are based on quality, not contract.

The VectorCare solution reduces fraud, creates clear billing workflows, and lowers costs overall. This enables providers to spend more time with patients, and less poring over audits and ensuring medical compliance.

Case Study: Kaiser Permanente How the national care consortium re-imagined their patient transport Kaiser Permanente, one of the nation’s largest care consortiums, decided to face this problem head on 2016 with the choice to upgrade their 20-year-old Lotus notes solution to a more sophisticated patient logistics platform. For the last couple decades, Kaiser had been operating

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using an in-house, spreadsheet-like application to manage NEMT for KP patients. Though this application had been state-of-the-art at the time of release(2001), it was past time for an upgrade that improved visibility between Kaiser and its vendors. Through VectorCare, Kaiser was able to dramatically improve and grow their NEMT operations without an increase in cost. With the bi-directional platform, Kaiser:

❏ Brought hundreds of credentialed vendors onto their platform

❏ Grew medical transport operations by 50% with no extra cost

❏ Identified poor-performing vendors and were better equipped to detect fraud

❏ Was able to scale their operations quickly during a crisis: during the Tubbs fire of October 2017, Kaiser used VectorCare to coordinate the transport of 130 patients to safety within 2 hours.

By upgrading to a SaaS system to manage their NEMT scheduling, Kaiser was able to focus on providing patients with the very best levels of care and encourage long-term health.

“We took this onerous, homemade process that we were limping along with...to

something that is sustainable and expandable into the future. It was a game-changer for us”

-Phyllis Stark, Kaiser’s Regional Continuum of Care Administrator

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The Future of NEMT By embracing bi-directional online management systems like VectorCare, healthcare facilities and providers can use innovation to vastly improve their business models. The current industry is overburdened with poor management and fraud, wasting billions of dollars a year, but hasn’t yet utilized the innovative tools available to it. The VectorCare solution is cost-effective, fully customizable, and can scale to meet your needs. As the NEMT market continues to rapidly expand, it’s time to innovate your business operations to follow suit.

Connect with Us: www.VectorCare.com Email: hello@vectorcare.com Twitter: @VectorCare

This paper represents the views of the author, not America’s Health Insurance Plans (AHIP). The publication, distribution or posting of this paper by AHIP does not constitute a guaranty of any product or service by AHIP.