Population-Tailored Rideshare Non-Emergency Medical Transportation

Rideshare companies, like Uber and Lyft, are good additions to the non-emergency medical transportation (NEMT) ecosystem, researchers from the RAND Corporation wrote in a recent report, and are particularly good for patients who need to request rides or need a ride on-demand.

The report, which builds on the argument that NEMT is good for overcoming transportation barriers to care, outlines particularly for which patients rideshare options are a good fit and how to scale rideshare to meet population needs.

But per the RAND Corporation assessment, traditional NEMT providers, referred to as transportation network companies or TNCs, also see some gaps in efficiency. For example, although many Medicare and Medicaid plans cover NEMT for members, that coverage can be spotty and vary across states.

TNCs themselves have room to improve in efficiency and customer support, while the entire traditional NEMT industry can often be riddled by fraud, the researchers said.

Currently, Uber and Lyft dominate the medical rideshare market, using their significant market share in other sectors to permeate medical needs. Since the mid-2010s, payer and provider organizations across the country have teamed up with one of the two rideshare giants to enable better patient access to NEMT.

“We found that [rideshare-based]-NEMT can help reduce system strain and satisfy the unmet or poorly met need for on-demand cost-effective solutions within the NEMT ecosystem,” the researchers wrote in a summary of the report.

Rideshare as NEMT is not going to be a great fit for every patient, the researchers conceded. Healthcare payers or providers considering rideshare for members or patients should consider how ambulatory the patient is on her own, or how much assistance she needs to get places. A patient with bulky medical equipment, for example, may not be a good candidate for rideshare NEMT.

Conversely, the researchers said patients who need to request rides—like a patient whose discharge time is unknown—or who otherwise need a ride on-demand are better candidates for rideshare NEMT.

“Current RB-NEMT capabilities are most appropriate for individuals with medical conditions that result in the need to request rides and those who use Door2Door, Curb2Curb, or Area2Area (e.g., bus stop–to–bus stop) services,” the researchers wrote.

“RB-NEMT is also most appropriate for inpatient and outpatient discharges, on-demand rides, requests for rides in which the scheduled mode failed to arrive, and rides requiring minimal assistance or monitoring,” the team continued.

Moving forward, the healthcare industry needs to do more research into the best approach for rideshare NEMT, the researchers said. Particularly, research into the outcomes for rideshare NEMT and how efficient programs are in focusing on high-yield populations will be key.

Additionally, the researchers recommended a closer look at the actual need for rideshare NEMT services, particularly among older adults, individuals with disabilities, and those living in rural areas.

On a policy level, the team said officials need to acknowledge the role that transportation access plays in overall patient access to care, as well as the role that all kinds of NEMT can play in filling transportation gaps.

“Rideshare is a generally unique, economical, efficient, and otherwise unoccupied niche of the NEMT ecosystem, although the specific pathways to incorporating rideshare into NEMT will vary by state,” the researchers added.

“As rideshare services expand in popularity—and as the populations accessing NEMT through Medicaid and Medicare Advantage increases—it becomes more pressing to explore gaps and insufficiencies in current NEMT service paradigms, the role RB-NEMT can optimally play, and the benefit of RB-NEMT playing that role in the health care access ecosystem,” the researchers concluded. “Rideshare is a new technology in the NEMT space, and its role is still evolving.”