Quantifying the Value of Medicaid Non-Emergency Medical Transportation (NEMT)

Transcription

1 Quantifying the Value of Medicaid Non-Emergency Medical Transportation (NEMT) 2018 NCSL Capitol Forum December 6, 2018 Tricia Beckmann, JD, Advisor to MTAC Faegre Baker Daniels Consulting

2 Background on NEMT Users NEMT is most frequently used for trips to access behavioral health services, preventative care, and treatment for chronic conditions. Adult Medicaid beneficiaries most commonly use NEMT for dialysis and mental health / substance use disorder (SUD) treatment, while expansion adults and children use NEMT more for preventative care. NEMT is only used by a small percentage of often the sickest Medicaid beneficiaries. NEMT is increasingly becoming offered to enrollees with Medicare or commercial insurance.

3 Why We Chose to Study NEMT s Return on Investment Many studies have reinforced transportation as a social determinant of health and revealed the prevalence of transportation barriers nationwide. It is often cited that about 3.6 million Americans do not obtain medical care because of a lack of transportation in a given year. But few studies exist that demonstrate NEMT s cost savings A 2006 cost-benefit analysis of NEMT by the Transit Cooperative Research Program examined 12 medical conditions and found that investing in transportation leads to a decrease in total costs when both transportation and healthcare are examined. Florida State University s 2007 study concluded that if only 1% of trips funded resulted in reduced ER visits, the payback to the state would be 1108%. A 2013 study in the Journal of Health Economics and Outcomes Research suggested that greater use of NEMT might save as much as $1 billion per year. No study has used Medicaid claims data and surveyed actual NEMT users to determine a positive ROI. MTAC moved forward with commissioning our own ROI analysis to address these gaps so that we could effectively advocate for the NEMT benefit to remain mandatory.

4 Return on Investment Scope & Overview The goal of the analysis was to review medical claims to determine the cost impact associated with lack of adherence to proper treatment protocols / regimens for three specific treatment types: Dialysis Wound Care Substance Abuse We compared the cost of lack of adherence to the cost of providing NEMT services to and from appointments based on proper treatment protocols. To supplement this analysis, we conducted NEMT user surveys in three geographically diverse markets (LA, MI, NJ).

5 Return on Investment Analysis Results NEMT more than pays for itself. NEMT saves state program dollars by averting more intensive and more costly healthcare procedures. Total ROI for all three conditions per 30,000 members (10,000 per condition) per month is $40,040,304. The ROI to attend regular dialysis treatments for treating kidney disease per 10,000 members per month is $34,229,448. The ROI to attend diabetic wound care treatments per 10,000 members per month is $7,920,635. The parameters of the study failed to demonstrate positive ROI for SUD; different study parameters (such as a longer claims review period or consideration of broader social and govt l costs) might have led to a positive ROI.

6 Return on Investment Analysis Survey Findings 58% of nearly 1,000 beneficiaries surveyed reported that they would not be able to make any medical appointments without NEMT.

7 Return on Investment Analysis Survey Findings Those with access to public or private transportation were twice as likely to report that they d make their expected treatments per month than those without these options. Survey showed slightly larger impacts in out-of-pocket costs and missed appointments among rural residents, but results were overall consistent across demographic categories.