Medical Transportation

Providing a new model for the delivery of non-emergency medical transportation in Texas.

Challenge:

A national leader in the non-emergency medical transportation field wanted to work with the state to implement a new model for the delivery for Texas Medicaid recipients. In Texas, the cost of non-emergency medical transportation for Medicaid patients had risen exponentially since 2000. The state has traditionally contracted with providers on a fee for service model, which can result in high costs for the state and subpar services for patients.

Our client offers a non-emergency transportation program brokerage model that would increase the state’s savings and run a reliable and effective service to patients through a capitated brokerage model.

Strategy:

Working with the Health and Human Services Commission and state legislative leaders we designed an approach to better understand the past cost drivers and determine future cost savings through the brokerage model. Through the capitated brokerage model, the real financial value is realized over time as utilization management, provider discipline, facility outreach, and fraud reduction procedures all become established and start to positively impact the NEMT. Our analysis made a compelling case with HHSC and Legislative leaders. Based on our analysis the state was able to project budget savings and implement a more effective and efficient system of delivery.

Result:

As a result of Legislation passed in 2007 and budget directives in 2009, the state of Texas is now in the process of implementing a brokerage model in two major metropolitan areas of the state. The state will continue to roll out the brokerage model to the remainder of the state over time.