What is a Medicaid NEMT Broker?

March 31, 2017

What is a Medicaid NEMT Broker?

Medicaid NEMT or Non Emergency Medical Transportation is a phrase typically used to describe a transportation benefit for Medicaid members that ensures eligible patients can get to and from their medical appointments, the pharmacy, urgent care, or the hospital. NEMT is an important part of the healthcare continuum, especially for those with chronic conditions such as diabetes, heart disease, cancer, COPD, or asthma. A Medicaid NEMT broker contracts with a health plan or State Medicaid Agency to manage patient transportation in a designated area.

How are Medicaid NEMT benefits managed?

It starts with the state agency that is responsible for overseeing the management of the Medicaid health care benefit. State Medicaid agencies can manage the authorization of NEMT coverage, or they can contract with another entity – a transportation broker or a managed care organization – to manage NEMT coverage.

Overall NEMT Broker Process - Veyo

If a state decides to work with a transportation broker, they will choose a broker based on a variety of qualifications which may include cost, experience, and knowledge of their region. The chosen broker’s main responsibility is ensuring that members are transported by licensed and credentialed transportation providers. Additional responsibilities include, but are not limited to, provider management, eligibility verification, trip reporting, and grievance management.

The Basics of the Traditional NEMT Broker Model

Let’s take a look at how a trip gets booked in the traditional NEMT broker model. The process starts when a member calls a call center to schedule a trip to their healthcare appointment. Call centers are often managed by the broker. This means that the broker is responsible for verifying the eligibility of the member (based on records they receive from the state or health plan), maintaining up-to-date contact information for the member, and coordinating transportation for the member. The member may be looking to book one single trip, or a series of trips, often called recurring or blanket trips. Once the trip request has been recorded by the broker, they must pass that information to a transportation provider that they’ve contracted with, who will then complete the trip and get the member to their appointment.

Traditional Broker Process - Booking a Trip

Traditional Broker Model – Booking a Trip 

Trips are conducted by the transportation providers, and it’s up to them to complete each trip and report back to the broker with details of each trip. Brokers must ensure that transportation providers (and their drivers) are properly licensed and credentialed, and must record trip and member data to report back to the state agency or health plan.

The Problems Facing the Traditional NEMT Broker Model : Trip Delays

What happens if the transportation provider is late to a pickup? Or the member finishes their appointment early and needs to be picked up before their scheduled time? What if a blizzard comes to town? Let’s look at the example of a driver being late. If a transportation provider is late, a member may call in to the call center to check on their ride. Because the call center is owned by the broker and the trips are managed by the transportation provider, the call center won’t have up-to-date information on why the transportation provider hasn’t arrived. The call center will have to put the member on hold, call the transportation provider, and have them contact their driver.

Traditional Broker Process - Checking in on a Trip

Traditional Broker Model: Process for Getting a Trip ETA

Once they determine the status and ETA of the driver, they’ll pass this information back to the call center, who can then pass it on to the member. If the delay is too long, the member may have to reschedule both their transportation and their appointment. This is particularly impactful for certain members like dialysis patients, whose risk of hospitalization increases 300% when they miss an appointment.

The Problems Facing the Traditional NEMT Broker Model : Throwing Trips “Over the Fence”

In creating Veyo, we set out to use technology, a vertically integrated approach, and an innovative and cost-effective delivery system to solve a variety of issues that exist within the traditional NEMT model. One of those issues relates to the information barrier that exists between the NEMT broker and the transportation provider. As we see below, trips are thrown “over the fence” to the transportation providers, leaving the broker with little visibility into what happens as the day progresses. Trips may be delayed, or missed completely, and the broker won’t know that an issue has occurred until the member or healthcare provider calls in looking for information on the trip (and if the member never calls in, the broker may be unaware of the issue).    

Traditional NEMT Broker Model - Throwing Trips Over the Fence

The Traditional NEMT Broker Model: Throwing Trips “Over the Fence”

Another issue with throwing trips “over the fence” is the lack of ability to control supply levels (i.e. the number of vehicles on the road). When you’re working with a fixed fleet of vehicles, they’re often overloaded during peak times – leading to delays and long trips for members, and underutilized during quiet times. Traditional brokers have no ability to add additional vehicles when needed or remove vehicles when they’re not needed. And for those vehicles that are on the road, there is little automation or oversight, leaving brokers with a lack of access to real-time information or trip-related data such as on-time performance or trip routes. Drivers may be taking inefficient routes or dropping members off at unapproved locations and the broker will never know. Traditional brokers must rely on self-reported trip data from the transportation providers, and assume that those transportation providers will report accurate data, even if they were late for a trip or didn’t pick up a member. This can be tricky, especially when you consider that every transportation provider may use a different system or process for dispatching and reporting.

A New Approach to the NEMT Broker Model

Veyo has taken a new approach to the NEMT broker model. Our proprietary technology allows us to integrate every step of the NEMT process into one vertically integrated platform. Everything from our call center to our Driver App is connected by Veyo’s proprietary technology. A single trip can be tracked from beginning to end without any loss of information. There’s no more throwing a trip over the fence and hoping it gets completed. And, by removing the fence, Veyo gains greater insight into the performance of our transportation providers and greater control over our supply system.

A New Approach to the NEMT Broker Model: Veyo’s Vertically Integrated Platform

In addition to removing the information barrier between the broker and the transportation provider, Veyo has optimized the supply model through the use of our Virtual Fleet. Veyo’s Virtual Fleet augments the traditional network of commercial transportation providers with highly-qualified and NEMT-specialized Independent Driver-Providers (IDPs). They meet strict healthcare standards and participate in ADA, CPR, HIPAA, Sensitivity, and Medical Needs training. They undergo drug testing and multi-level background checks to ensure safety and the highest level of quality. The addition of these IDP fleets allows us to serve eligible members with reliability, efficiency, and cost-effectiveness.

Unlike a fixed fleet, the Veyo flexible fleet models allow capacity to be rapidly scaled up and down in minutes to meet demand changes. Our dynamic supply system constantly manages and optimizes the right supply levels for different modes across geographies (both urban and rural), ensuring that every member gets picked up on time.

With the Veyo model, every part of the NEMT process can be viewed and tracked. Our Driver-Provider apps allow us to track trips in real time, our Provider Portal allows for full transparency in dispatching and routing to transportation providers, and the Veyo Platform tracks everything from eligibility to credentialing to call center records, ensuring full and complete data for each trip. In addition to gaining transparency into our provider operations, we have greater control over our supply, better quality controls, and the following benefits:

  • Transparency and automation around driver training, credentialing, and fleet maintenance
  • Real-time data for each trip
  • Fewer calls per trip (no need to call a driver when you can see where they are on the trip)
  • The ability to route transportation providers in real time and control supply as needed
  • Faster on-demand dispatch capabilities
  • Detailed and accurate encounter data
  • Greater transparency for Health Plan and State Medicaid Departments
  • Simplified reporting and payments for transportation providers
  • The ability to better monitor for fraud, waste, and abuse

Additional Reading and References:

  1. More information on Medicaid NEMT Brokers and transportation providers can be found in the Medicaid Non-Emergency Medical Transportation Booklet for Providers
  2. Adherence Barriers to Chronic Dialysis in the United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214530/
  3. Learn more about the basics of NEMT here.
  4. Learn how Veyo stands apart from Transportation Network Companies here.