Analysis to Determine Return on Investment (ROI) Using Non-Emergency Medical Transportation

In the United States, people with low income are prone to lack reliable transportation. Not having reliable transportation can lead to missed medical appointments and therefore poor health outcomes. To address this challenge, Non-Emergency Medical Transportation (NEMT) is free or low-cost transport to medical appointments for beneficiaries who need it. The Medical Transportation Access Coalition commissioned consulting groups and doctors to conduct a study examining NEMTs return on investment. The findings suggest that NEMT more than compensates for financial benefits as part of care management for patients with chronic diseases, resulting in a total positive return on investment of over $40 million per month ($480 million annually) per 30,000 Medicaid beneficiaries.

The financial benefit of NEMT is best shown in the costs avoided due to increased utilization of lower cost medical services as compared to the more expensive services without NEMT. Missed medical appointments lead to deviations from clinical guidelines which, in turn, lead to complications and increased expensive medical services, such as hospitalizations. A 2013 study in the Journal of Health Economics and Outcomes Research examined the high costs of ambulance transportation and suggested that greater use of public transportation and NEMT might save as much as $1 billion a year.

This NEMT ROI study used a survey to determine treatment attendance with and without NEMT. The survey asked participants the following questions: what disease treatment he or she uses NEMT to attend; whether he or she has access to public or private transportation; what type of NEMT he or she uses; how many treatments he or she attends per month and uses NEMT to attend; how many treatments he or she would attend per month absent the availability of NEMT; how his or her health has been affected by NEMT; and what would happen if NEMT were not provided. Nearly all survey respondents reported that they used NEMT to attend all of their treatments. Overall, 58% of respondents reported that they would make none of their treatments if NEMT was not provided, 22% reported that they would make all of their treatments if NEMT was not provided, and 20% reported that they would make less than all but more than none of their treatments if NEMT was not provided. Importantly, in open-ended responses to the question what would happen if you did not have the transportation services you currently receive, 10% reported that they would die or probably die. There were limited variations found in the survey data by different demographics. No significant variations were found between members in different states, different genders, different marital statuses, different ethnicities, different living environments (urban/rural/suburban), or different age ranges. The only significant variations were found between members that responded yes or no to the question do you have access to public or private transportation. Yes respondents were approximately two times higher on average than no respondents in projecting the number of expected treatments per month without NEMT.

Survey respondents reported attending 12 dialysis treatments per month on average with NEMT and would expect to attend 4.1 treatments per month without NEMT. For example, the Medicaid cost analysis shows that dialysis patients who attend 3 to 6 dialysis treatments per month incur on average $4,140 more per month in total medical costs than dialysis patients who attend 11+ dialysis treatments per month. The cost of the average round trip of NEMT for dialysis patients (based on private broker data) is $60.24, so the average cost of NEMT per survey respondent per month for dialysis is 11.98 x $60.24 = $717.25. Therefore, the Medicaid cost avoided due to NEMT per survey respondent per month is $4,140 $717.25 = $3,423. Assuming that the survey represents at least 10,000 like Medicaid members, the ROI of NEMT for treating kidney disease with dialysis per 10,000 members per month is $34,229,448. In another example, for diabetic wound care, survey respondents reported attending 5.5 wound care treatments per month on average with NEMT and would expect to attend 1.3 treatments per month without NEMT. The Medicaid cost analysis shows that wound care patients who attend 0.5 to 3 wound care treatments per month incur on average $1,084 more monthly medical costs than wound care patients who attend 3+ wound care treatments per month. The cost of the average round trip of NEMT for wound care patients (based on private broker data) is $53.25, so the average cost of NEMT per survey respondent per month for wound care is 5.5 x $53.25 = $291.96. Therefore, the Medicaid cost avoided due to NEMT per survey respondent per month is $1,084 $291.96 = $792. Assuming that the survey represents at least 10,000 like Medicaid members, the ROI of NEMT for attending diabetic wound care treatments per 10,000 members per month is $7,920,635. In summary, the ROI for only two chronic illnesses, kidney care and diabetic wound care, totals over $40 million.

The significant ROI associated with dialysis and wound care transportation services demonstrate that, at least for these conditions and presumably others (such as asthma and heart disease), utilizing NEMT is a very economical solution for patients that miss healthcare treatments because of transportation issues. The data presented above offers a strong indication that NEMT more than pays for itself as part of a care management strategy for people with chronic diseases within and outside of Medicaid.