The Solve.Care platform aims to improve health outcomes through effective care coordination while empowering the consumer to better manage their healthcare decisions. Being able to attend healthcare appointments plays a key role in this.

Solve.Care has executed a partnership agreement with a significant transportation service in the United States. This will now allow participating clients of the platform to offer ride services to their members. Full details of the partnership are expected to be announced in the coming weeks.

This article provides a brief overview of non-emergency medical transportation (“NEMT”) in the United States, how it operates, who it serves and how Solve.Care can participate to make a difference.

What is NEMT?

NEMT provides free or subsidised specialised transportation services to assist individuals to attend healthcare appointments. It is a required benefit for those who are entitled to participate in Medicaid but is also provided on a discretionary basis by other healthcare entities. For those on low incomes it is an especially important service and in 2015 alone this group used 59 million rides. According to the Transit Cooperative Research Program, the market for NEMT is worth more than $3 billion annually.

Why is NEMT important?

Missed healthcare appointments are estimated to cost the US healthcare system $150 billion annually. Every year more than 3.6 million Americans are estimated to miss their healthcare appointments due to lack of availability of reliable or suitable transportation. One study showed that increasing attendance at medical appointments helped improve patients’ overall health, resulting in cost savings to Medicaid. Improving access to transportation could therefore result in not only improved health outcomes but also in considerable cost savings.

Who operates NEMT?

There are two primary methods employed in providing for transportation services:

NEMT brokers (e.g. Veyo) and Managed Care Organisations (“MCO”) Ride providers such as local taxi services or Uber and Lyft

To date, brokers and MCOs have been the preferred model. They receive a capped sum of money and it is then their responsibility to manage those funds in providing the required services. Ride providers typically operate on a fee for service basis.

Both Uber and Lyft have identified medical transportation as an attractive growth area for their businesses. Uber has created “Uber Health” and Lyft has created “Lyft Mobility Services”. Their business models differ but this is outside of the scope of this article.

What is the outlook for NEMT?

There is presently much discussion around recent changes introduced by the Trump administration that allow states to limit NEMT or to adopt waivers to exclude it as a benefit. This appears to be in stark contrast to the practices being adopted by private sector insurance companies. Indeed, in 2017 Blue Cross Blue Shield Association announced a partnership with Lyft to provide services nationwide to its members. In its press release the company explained a key driver for entering this partnership: “We are committed to addressing issues like transportation that are inextricably linked to health outcomes yet can’t be tackled through health care resources alone.” It is clearly in the interest of health insurers to reduce the net cost of care provision and effective transportation services are evidently seen as a way to achieve this.

What are the concerns over NEMT?

As with other benefit programmes, there is some concern over the risk of fraud and abuse both from bad actors and poor administrative oversight (ref: 2016 study by Government Accountability Office). In addition to this, there is the discussion referred to earlier around the extent to which the service’s provision is necessary. This latter point, however, fails to take properly into account the potential cost savings that arise from its provision. This itself presents a challenge given that service tracking is inconsistent from state to state, making it problematic to identify clear links between the provision of NEMT and health care outcomes.

How might Solve.Care help?

By entering into a partnership with an engaged and significant ride providing company, Solve.Care will be providing ride access via its convenient wallet application — Care.Wallet. Any organisation establishing a Care Network on the Solve.Care platform will be able to immediately tap into this partnership to offer ride benefits to its members. One would assume that the benefits of scale would allow for favourable commercial terms to be shared by all platform participants.

Perhaps more significantly, there may be the opportunity for Solve.Care, together with its partner, to better track who uses the service and to identify how this improves access to healthcare and improves downstream outcomes. More granular and reliable statistical and cost benefit analysis may present a very compelling case for broader adoption of subsidised medical transportation services. Importantly, the Solve.Care platform’s use of blockchain gives rise to an immutable and auditable record of each and every transaction in an event sequence. This offers greater scope for analysis of the effectiveness of an individual’s aggregate care. It also helps to minimise the opportunity for fraud, duplication and waste.

Interestingly, Solve.Care already has an existing partnership with American Research and Policy Institute (ARPI) in Washington. ARPI describes its activities as having “a specific emphasis on the application of health care technology aimed at improving quality of care, access and market mechanisms to deliver health care services”. Together with ARPI, Solve.Care may even be in a position to inform public policy, for the betterment of everyone associated with healthcare.

Conclusion

This is a significant partnership arrangement for both parties. The market opportunity is substantial and there is increasing interest from the private sector in providing transportation services to their healthcare plan members. It is seen as good risk mitigation strategy as well as having significant social merit. By adding a versatile transportation service to its offer Solve.Care continues to add utility to its platform as it continues its drive to disrupt healthcare globally.