A New Model: How NEMT Can Thrive Without The Broker System

Despite Non-Emergency Medical Transport (NEMT) being a crucial player in both the SOCIAL DETERMINANTS OF HEALTH and the success of a patient’s journey to wellness, our current NEMT model is unsustainable. Reliance on the broker model of transport leaves patients without the proper care they need, provides little transparency, and bloats costs in an already strained healthcare system.

If you haven’t already read our analysis of the NEMT brokerage model, YOU CAN FIND IT HERE.

How can the United States Healthcare system radically reinvent the NEMT model without sacrificing patient care?

The answer lies in a new category of healthcare logistics: PATIENT CARE LOGISTICS.

The current model of NEMT focuses on a fee-for-service model with a linear chain of communication. A hospital communicates with a broker, who then passes information along to the transport provider, who then performs the action with the patient. Parties are reimbursed per service provided, not by account of the quality of services rendered or how the trip impacted overall patient health.

Patient Care Logistics reimagines this telephone-game of passing information from healthcare provider → patient. What if all members of a patient’s care team (healthcare provider, doctors, family, transport providers, etc) could collaborate and communicate in realtime from one place? They could solve problems immediately, instantly send requests for services to one another, and leverage data and reporting to improve their processes on the fly.

Patient Care Logistics is the modern planning, scheduling, and execution around the delivery of: the patient, health-saving equipment, and credentialed caregivers to administer treatment. Ultimately, the deployment of anything the patient needs to get or stay healthy. PCL approaches NEMT differently because it:

• Puts collaboration at the forefront: Healthcare providers, brokers, transport providers, and patients no longer need to be caught in twisting wires of phone calls and faxes. Hospitals can instantly message transport providers rather than using the broker middle-man, and all members of the care team can communicate in one online space.
• Enables real-time data and visibility around all players: Transport providers and brokers can no longer hide behind a veil of secrecy. PCL enables healthcare providers to immediately view incidents as soon as they occur, track on-time percentage rates, and measure the quality of care provided in a tangible way. Transport dispatch teams can view where all of their vehicles are at-a-glance and view the realtime status of transports at any time. If there are any weak links in a care team, they will become apparent.
• Emphasizes value-based care: The data and transparency provided by PCL means that providers can now be reimbursed based on the quality and amount of services they provide, not a capitated amount annually with little or no relation to the actual transports.
• Creates more efficiencies and encourages codification of best practices: With modern technology and a PCL framework, requesting and fulfilling a service can be quick and painless. Rather than taking upwards of 45 minutes to order an oxygen tank for delivery to a patient’s home, a nurse can schedule the service in 1-3 minutes. PCL frees up time for care team members to focus on helping patients get better, rather than weighing themselves down with admin and logistics.

In a Patient Care Logistics Model, NEMT can leverage software to cut out the broker entirely. Below is an example of the typical NEMT process today:

A healthcare provider calls or faxes the broker with a request for transport, often waiting on hold with the broker for 45 minutes or more. After a broker successfully receives a request and writes all the relevant information down, they must find an available transportation provider. They search through their database of local providers, and find those who are local to the request pick-up and are up to date on their credentials. Next, the broker employee must call each transport provider until they find a company that is available to perform the request. The employee relays all the patient information about the request over the phone to the transport provider, hoping that they get all the details right. The transport provider fulfills the request, and submits their ride information back to the broker in order to get paid (crossing their fingers that they applied the right level of services to the patient, and can get accurately reimbursed for their services). All this for a single patient ride.

Let’s now observe a PCL model that removes the broker from the equation.

Through PCL, a provider can request a service and assign it to a service provider within seconds, no broker required. The entire exchange can be completed in just a few minutes, and includes no error-prone phone exchange of patient information.

But, practically, how is this PCL model achieved? Through modern Software as a Service (SaaS) built with PCL in mind. VectorCare’s collaborative Patient Care Logistics Platform is an example. With VectorCare, healthcare providers connect with local, credentialed service providers on a shared platform. Healthcare Providers fill out a configurable form requesting a service in 1-3 minutes, and instantly broadcast the request to their local provider network. Within 5-10 seconds (and yes, we do mean seconds), a transportation provider accepts the request and receives all relevant patient information. From there, the request is fulfilled and transportation crew members update the request status using a mobile app. Care team members can receive realtime data about the status of the request, and are able to securely message with the service provider or healthcare provider at any point in the process. In short: no lack of transparency, wasted time on the phone, or unnecessary middlemen. Keeping all request information in the platform (rather than exchanged via phone) means that there are no human errors in regards to important care information. Additionally, healthcare providers can pay transportation companies directly for the services they provide and eliminate unnecessary brokerage costs.

California’s largest not-for-profit insurance provider, which covers over 12 million members, recently put this model to the test. The Provider used VectorCare for all of their NEMT operations, and were able to increase their operations by over 40% at no additional cost. Rather than spending 30+ minutes on the phone to schedule patient transport, nurses scheduled patient transport in as little as 3 minutes on average. Their Regional Administrator remarks:

“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 gamechanger for us”.

“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 gamechanger for us”.

In order to tangibly improve the NEMT system, we need a departure from the error-ridden and inefficient brokerage system. Patient Care Logistics paves a way to a higher standard of NEMT care, while removing inefficiencies and reducing overall costs.

To learn more about the dangers of the NEMT broker system, check out our blog post on why it's time to "eliminate the middle man" in NEMT.