The Impact of New Modes of Mobility on Non-Emergency Medical Transportation

March 17, 2021

Before answering “What are the impacts?”, you may be wondering “What is non-emergency medical transportation (NEMT)?”. NEMT can be defined as a transportation service for individuals traveling for medical services and are not in an emergency situation but might need more assistance than a regular ride service is able to provide. Service providers will be specially trained and may be equipped to transport riders in wheelchairs, stretchers, or with other special needs. NEMT rides can also be available as a Medicaid benefit that helps people with Medicaid insurance get to and from their health care appointments. Many states have different requirements and ways on how this benefit is delivered. An individual would need to be pre-approved and eligible to use the benefit. Another way the term NEMT is used in this space is a way to fill other transportation gaps that various demographic groups have. An area of growing focus is to provide rides for social determinants of health (SDOH) such as trips to the grocery store or to a senior center. In addition to Medicaid, Medicare Advantage Plans can provide NEMT benefits to their insured population and other funding comes through local/federal grant funds, or even by hospitals earmarking money for transportation.

Without the innovation of health care mobility, many patients would succumb to poor health and an unsatisfactory health care experience. We will be exploring who needs this type of service, why it is important, challenges the health care industry and patients are facing, the path of where the Strategic Innovation team thinks the future of this service will lead to, and how our partnership with Feonix Mobility Rising is providing solutions to fill the current gap in the market.

Who benefits and why is Non-Emergency Medical Transportation (NEMT) important?

The group of people with the most to gain from the use of health care mobility are the elderly, disabled, and underserved communities. These communities are already the most at-risk and unfortunately often-times they do not have the resources to acquire a reliable form of transportation. This is how health care mobility plays a crucial role in assisting these specific demographic populations to receive the best medical care possible.

Missed Medical Appointments

NEMT paves a way for seniors, people with special needs, and those in underprivileged populations to get to their medical appointments. A good number of these patients end up as “no-show” appointments because they do not have their own car, are unable to drive, lack viable public transportation options and they cannot afford taxi or car-share services. The problem is compounded when the rider has frequent doctor visits, so having a dependable way to get to and from these appointments is imperative. With the shortage of the right types of transportation options within these communities, regular medical care is lacking. Chronic care patients are the most affected community due to the consistent nature of medical appointments that are required for the upkeep of their health.

Social Determinants of Health

The need for transportation does not only exist for medical appointments but also for SDOH like the following:

  • travel to the pharmacy
  • grocery store
  • educational institution
  • place of employment

All these determinants are critical to allow seniors to age in their own homes and be independent with the right services in place.


Disabled Community

Another group deeply impacted with a shortage of the right types of transportation options are individuals with disabilities. Current options require reservations 48-72 hours in advance. Standard ride hailing services allow a customer to book a vehicle and have it at their doorstep within 5-10 minutes. People with disabilities require specialized transport coming and going to their appointments. Of this subset of patients, numerous people use wheelchairs, canes, and walkers that are needed for them to be mobile themselves. It is their top priority to have a vehicle that fits their needs or have a service that offers handicap accessible cars for them to ride in. Many of the people that health care mobility would benefit fall into more than one of these demographic categories. Some who are disabled may be part of the underserved community, just as some who are elderly may also be disabled.

NEMT Industry Challenges

Not only are many demographic groups affected, but the NEMT industry itself faces a few concerns. One being that the system is fractured, inefficient, and disjointed. Currently there is not one full-service solution available that provides all of the following:

  • a paid trip coming from the source (insurer, hospital, etc.)
  • trained drivers
  • technology to book and manage the rides
  • flexible fleet management with the right vehicles for different patient needs (wheelchair, cane, walker)
  • call center for customer support and operations team

Another problem is the layers of companies it takes to provide enhanced care transportation. Medicaid works with brokers, who then work with third party companies to provide transportation to patients. These companies are only incentivized to manage the relationship up stream, which in turn, causes customer experience to suffer due to cost/margin pressures. The industry is now starting to react by incentivizing the right behavior. They are changing from a fee for service (FFS) model, which did not prioritize customer experience, to a value/outcome-based model. This in turn can help provide an overall healthy population.

With the needs of patients changing, so is regulation. Regulations from state to state vary, which make it hard to scale national programs. Also, not having an on-demand NEMT service is a big issue to solve since there are eligibility checks by insurers and Medicaid to be able to reconcile and pay for trips correctly. In some cases, customers must call in 48-72 hours in advance, which results in a poor customer experience due to time constraints and no opportunity of scheduling their ride same day.

Working Together to Provide Solutions

With the many challenges present, hospital systems, Medicare, Medicaid, insurance providers, and mobility companies are coming together to address these issues to ensure patients get to their medical appointments on a consistent basis. Now many patients can find assistance with non-emergency medical transport through their insurance plans and Medicaid to cover the costs associated with their travel to their doctor’s office or local clinic.

Today, there are a few ride share companies who are partnering with insurers and health plans to provide these types of services that were previously not available. By the passing of Texas House Bill, HB1576, in 2019, insurance providers and patients are finding this type of service beneficial. It is helping to reduce costs and create better patient outcomes regarding their health. The bill was lobbied by ride share companies looking to provide a solution. Looking toward the future, NEMT could change both the health care and mobility industries as the demand for these services will most likely grow.

Vision for the Future of Mobility in the Health Care Sector

The US population is aging rapidly and the need for health care mobility will rise in years to come. Based on a study, in 2019, 16% of the US population is above 65 years of age and by the year 2034, 20% of the US population will be above 65 years of age. The Strategic Innovation team is looking to solve this challenge in 4 different ways in the future. The first step would be to expand patient mobility, which could improve access to care. As ridesharing and carsharing become more prevalent, vulnerable populations such as the elderly, disabled, or those without cars, can obtain accessible health care. The second step would be for mobility companies to actively collaborate with health plans and providers to offer specialized transportation and improve point-to-point and last-mile shared solutions to allow those living in transportation deserts (where transportation is not easily accessible) to access crucial services more effortlessly. The third step would be to investigate how technology can be used to bring in efficiency of operations. Finally, finding a way to grow a large segment of riders and drivers, could optimize the supply chain, as opposed to having smaller segments of customers and trying to establish operations to cater to a smaller group.

To gather some insight on the subject we sat down with our industry experts here in the SI Lab and understand their viewpoint on what they believe we will see with the upcoming years for health care mobility.

“The demographics of United States and Japan will change dramatically in the next decade with people above the age of 65+ making a quarter of the respective country’s population. With both these countries being key markets to Toyota, it was important for us to start looking at different services (adjacent to our core business) to serve this population. As people grow older, they often become less willing or able to drive, making it necessary to depend on alternative methods of transportation.

Though lack of transportation impacts many facets of an aged person’s life, access to much needed medical care, quality food, and medicines were of primary importance. As we started looking at the current infrastructure supporting the above use cases, we came across non-emergency medical transportation market, which we felt was very poorly served from a customer standpoint.

We feel that Toyota has a unique opportunity to come in and create a vertically integrated ecosystem and remove some of the inefficiencies.”

-Ajey Devaraj, Consultant, Strategic Innovation

Feonix Wellness Program

Our Strategic Innovation team is constantly striving to meet the needs of our customers and learn how we can bridge the gap within mobility and fintech services. After a call for partnership with small businesses and startups in mobility, we found a great opportunity to partner with a grant funded non-profit organization, called Feonix Mobility Rising. During our initial meeting, we learned about their organization, their expansive vision to develop mobility solutions for solving transportation problems, and their goal of having a healthy community. We knew we wanted to move forward with them as a partner because of their expertise in the mobility space.

As a partnership we were able to leverage:

  • Toyota’s knowledge and journey to be a mobility company
  • Toyota’s Customer First approach
  • Quality Toyota vehicles for the NEMT fleets
  • Kaizen, one of the Toyota Way beliefs for continuous improvement
  • Toyota Business Practice (8 step process to solve a problem effectively) and other business processes in place to filter out inefficiencies
  • Toyota brand name and trust

It was a mutually beneficial partnership to complement Feonix with their capabilities to develop and deploy volunteer and paid drivers, create strong relationships at the grass roots level to understand local priorities and social needs, provide state of the art technology solutions, and place an operations team on-site. With these resources in place, we worked with them to test out the feasibility of Toyota in the NEMT sector. During our collaboration, Feonix Mobility Rising created the Feonix Wellness Program with the support of a grant fund provided by Toyota. It provides NEMT and SDOH travel to places like medical appointments, dental appointments, food deliveries, and the pickup of prescriptions for patients.

Bridging the Gap

Together the SI team and Feonix have identified gaps due to the nature of the business that need to be filled.

  • The dangers of a missed appointment creating a financial burden and lost efficiency
  • Lack or inaccessibility of transportation causing less heath care utilization or medical care

After identifying these gaps, the Strategic Innovation team’s learning objective for this pilot was, “Can we do all of the above and still develop a sustainable business model which has a path to profitability?” The team continues to work through this challenge with Feonix to this day to provide better health care for all.

Learn More about our Partnership with Feonix Mobility Rising

Want to read more about the Feonix Wellness program, our partnership with Feonix Mobility Rising, and how it was to work with the SI Lab team? We will be featuring a follow up story giving an in-depth insight to the program and how we grew our partnership to bring health care mobility solutions to those in the elderly, disabled, and underserved communities with a future social media post. Follow us on Facebook or Instagram by clicking on our icons below to learn more.

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“We feel that Toyota has a unique opportunity to come in and create a vertically integrated ecosystem and remove some of the inefficiencies.”

-Ajey Devaraj, Consultant, Strategic Innovation