Don't start a NEMT business before financially projecting profits! | NEMT Experts Podcast Episode 43

Bambi CEO Nirav Chheda talks with Adam Hoeksema, the creator of ProjectionHub, which helps business owners, including NEMT entrepreneurs, to create SBA ready financial projections for their business.

See the full interview on YouTube. 

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Get ProjectionHub’s  full NEMT financial projections model here.

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Podcast Show Notes:

Nirav Chheda interviews Adam Hoeksema, co-founder and CEO of Projection Hub, about a financial model specifically designed for NEMT businesses. The model helps entrepreneurs project revenues, costs, and profitability, crucial for securing loans and running a successful business. Adam's experience as an SBA lender inspired him to create user-friendly financial models.

The model covers various aspects like vehicle costs (purchase/lease), revenue per mile, driver pay, fixed and variable costs. It emphasizes the importance of factoring in delays in payment collection (accounts receivable) and adjusting assumptions based on the specific business situation (e.g., location, vehicle type). The model demonstrates potential profitability even with conservative assumptions.

Key Takeaways:

• Financial projections are crucial for securing loans and understanding profitability.
• The model helps entrepreneurs project revenues, costs, and profitability.
• Adjust assumptions (revenue per mile, costs) based on your specific business situation.
• Factor in delays in payment collection to avoid cash flow problems.
• Even with conservative assumptions, NEMT businesses can be profitable.
• Run Bambi Run can help optimize capacity utilization.

Interesting Quotes:

• "We should be able to find a better way to help these loan applicants create a better set of financial projections." - Adam Hoeksema
• "You might earn revenue today, but you're not going to get paid on that for maybe 30 days. And so, yeah, sometimes even longer in the NEMT industry, sometimes longer." - Adam Hoeksema
• "The key thing here, I think, is that you can set these expenses to be either a fixed dollar amount, a per vehicle amount, or a percentage of revenue. And so it kind of scales automatically, like as you add more vehicles." - Adam Hoeksema
• "You do all this work, you think you're making all this money, but when do you actually get the money? And that's what really hits people a lot harder than they would expect." - Nirav Chheda

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What is the role of NEMT Brokers? 

Non-Emergency Medical Transportation (NEMT) brokers play a vital role in connecting patients with transportation services for medical appointments, therapies, and other healthcare needs. However, the landscape of NEMT coverage can be complex, with variations in eligibility and funding sources from state to state.

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This article aims to shed light on the role of NEMT brokers and provide a general overview of NEMT coverage across different states.

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What is an NEMT Broker?

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An NEMT broker acts as an intermediary between patients and transportation providers. They coordinate transportation arrangements, ensuring patients receive timely and reliable transportation to their healthcare appointments. They integrate with leading NEMT software (like Bambi) to streamline trip requests and scheduling with NEMT providers. Brokers work with various funding sources, including Medicaid, private insurance, and managed care organizations, to secure coverage for eligible patients.

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NEMT Coverage by State:

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NEMT coverage varies significantly across states. While Medicaid is a primary source of funding for NEMT services, eligibility criteria and covered services can differ. Some states offer comprehensive coverage, including transportation to and from medical appointments, pharmacies, and adult day care centers. Others may have more limited coverage, focusing primarily on essential medical appointments.

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Key Factors Affecting Coverage:

Several factors influence NEMT coverage, including:

• State Medicaid Policies: Each state determines its own Medicaid eligibility criteria and covered NEMT services.
• Individual Eligibility: Patients must meet specific criteria, such as income level and medical necessity, to qualify for Medicaid NEMT coverage.
• Funding Sources: Besides Medicaid, other potential funding sources include private insurance, managed care organizations, and charitable organizations.

The Importance of NEMT Brokers:

NEMT brokers simplify the process of accessing transportation services for patients. They along with NEMT scheduling software help navigate the complexities of coverage, coordinate transportation arrangements, and ensure patients reach their appointments safely and on time. Their expertise is invaluable in helping patients overcome transportation barriers and access essential healthcare services.

What NEMT Brokers are available in my state?

Bambi has put together a comprehensive list and deep dive into each NEMT broker to help NEMT providers expand their business opportunities and connect with local brokers.

Conclusion:

Understanding the role of NEMT brokers and the variations in NEMT coverage across states is essential for patients and healthcare providers alike. By working with a qualified NEMT broker and staying informed about available coverage options, patients can ensure they have reliable transportation to their healthcare appointments, promoting better health outcomes and overall well-being.

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NEMT Brokers: Frequently Asked Questions (FAQs)

Non-emergency medical transportation (NEMT) brokers play a crucial role in connecting patients with transportation providers, ensuring individuals can access essential healthcare services. But what exactly are NEMT brokers, and how do they work? Let's dive into the details.

What is an NEMT Broker?

NEMT brokers are independent contractors who act as intermediaries between healthcare providers, patients, and transportation providers. They manage the logistics of scheduling and coordinating non-emergency medical transportation services, ensuring patients can get to and from appointments, treatments, and other healthcare facilities. They operate within specific regions and can offer coverage locally, statewide, or even nationally.

What Does an NEMT Broker do?

NEMT brokers handle the administrative tasks involved in authorizing patients for transport services. They work with insurance providers, Medicaid, and other billing sources to ensure patients are eligible and trips are appropriately reimbursed. They also manage trip scheduling and dispatching, considering patient needs, vehicle types, and billing sources.

NEMT brokers excel at navigating the healthcare system, collaborating with patients, healthcare providers, and insurance agencies. They ensure they partner with licensed and credentialed NEMT providers and only work with eligible patients with the necessary insurance coverage.

Many brokers utilize NEMT scheduling software with broker integration to streamline their operations. This allows them to understand patient needs, assign suitable vehicles for specialized trips, and provide necessary equipment like wheelchairs or gurneys.

How to Choose the Right NEMT Broker

Selecting the right NEMT broker is vital for NEMT providers. Consider these key factors:

1. Industry Knowledge: Look for a broker with expertise in both healthcare and transportation industries.
2. Local Presence and Specialization: Choose a broker familiar with your local area and any specialized services you offer.
3. Technology Adoption: Opt for a broker who leverages technology for efficient operations.
4. Communication Skills: Ensure the broker communicates effectively with partners and clients.
5. Reputation and Reliability: Choose a trustworthy broker with a positive track record.
6. Adaptability: Seek a broker who can adapt to industry changes and problem-solve effectively.
7. Professionalism: Prioritize a broker who demonstrates professionalism and courtesy in all interactions.
8. Fair Rates: Ensure the broker offers reasonable rates and transparent payment terms.
9. Contract Clarity: Thoroughly review and understand all contract details before partnering.

Can I work Without NEMT Brokers?

While working with brokers can offer benefits like additional revenue streams and streamlined administrative tasks, there are also potential downsides such as limited control over rates and dependence on the broker for business volume. Weigh the pros and cons carefully to determine the best approach for your business.

What NEMT Brokers are available in my area?

Bambi has put together a comprehensive list and deep dive into each NEMT broker to help NEMT providers expand their business opportunities and connect with local brokers.

Final Thoughts

NEMT brokers are essential in the healthcare transportation landscape, connecting patients with the services they need. Choosing the right broker involves careful consideration of factors like industry knowledge, local presence, technology adoption, and communication skills. By partnering with the right broker and leveraging tools like the best NEMT software, NEMT providers can enhance their operations and deliver quality care to their patients.

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The NEMT Providers Perspective | Challenges with NEMT Brokers

Non-Emergency Medical Transportation (NEMT) plays a crucial role in ensuring millions of people can access necessary healthcare services. However, the industry faces numerous challenges, particularly when it comes to the relationship between NEMT providers and brokers.

We recently were able to get a group of NEMT providers and brokers together virtually to shed light on the current state of NEMT, highlighting key insights and concerns on the industry.

NEMT Broker Profit Models and the Impact on NEMT Providers

One of the core issues raised revolves around how each NEMT brokers generates revenue. Primarily, brokers earn money through two mechanisms:

1. On-demand payments: Brokers receive payment each time a member uses the NEMT service, along with an administrative fee.
2. Per-month-per-user payments: Insurance companies pay a fixed rate per member, regardless of whether they use the service, plus an admin fee. This model can incentivize brokers to prioritize maximizing the number of covered members rather than ensuring efficient service utilization.

One NEMT owner notes that a significant portion of broker profit often stems from healthcare providers in the broker network who are unaware they have NEMT coverage and never utilize the service. One participant said "I would estimate that about 45% of the people (healthcare facilities) I reached out to did not have any clue that the service was a thing." This disconnect between healthcare facilities and the benefits available to them raises concerns about the effectiveness of the current system.

Challenges for NEMT Providers

NEMT providers working with brokers face several obstacles, including:

• Dependence on Brokers: Providers are reliant on brokers for trip assignments, and negative feedback or blacklisting can lead to a sudden loss of business. One participant noted: "You are beholden to them and the trips that they give you." 
• Outdated Systems and Poor Training: Brokers may not invest in adequate technology or training, leading to miscommunication and missed trips.
• Lack of Support: NEMT providers may feel their concerns are not taken seriously by brokers, even when they experience significant issues impacting their ability to serve members.
• Dispatch Agent Errors: Underpaid and overworked agents may make mistakes that negatively affect providers' operations and income.
• Potential for In-House Competition: Brokers may develop their own NEMT provider services, potentially displacing existing providers in the future. "Most brokers are creating in-house providers in an attempt to replace their contracts." according to one participant. 

Conclusion

NEMT is a vital service, but the current landscape presents significant challenges for providers. Addressing issues such as communication breakdowns, inadequate technology, and power imbalances between NEMT brokers and providers is crucial for ensuring the sustainability and effectiveness of NEMT services.

Furthermore, efforts to improve member awareness and access to NEMT benefits are essential for maximizing the impact of these services and ensuring that individuals can receive the care they need.

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NEMT Broker: Transdev

Who is Transdev?

Update: July 2023 Transdev acquires First Transit.

In the United States, Transdev is the largest private-sector operator of multiple modes of transit. They have a significant presence in North America, providing essential transportation services to communities across the continent.   

Transdev acts as a broker and coordinator of non-emergency medical transportation services. They connect transportation providers with clients who need rides to medical appointments, therapies, and other healthcare-related destinations.  

Here's a breakdown of what Transdev offers NEMT providers:

• Access to Clients: Transdev manages contracts with various healthcare organizations, providing a steady stream of potential clients and trip assignments for providers in their network.  
• Technology and Support: They offer technology solutions like scheduling software and trip management tools to streamline operations for providers. They also provide training and support to help providers meet their service standards.  
• Operational Expertise: With years of experience in the transportation industry, Transdev can assist providers in optimizing their operations, improving efficiency, and ensuring compliance with regulations.
• Billing and Administrative Support: Transdev handles much of the administrative burden, including billing and claims processing, freeing providers to focus on delivering quality transportation services.

In summary, Transdev serves as a valuable partner for NEMT providers by connecting them with clients, providing technology and support, and streamlining their operations. They help providers grow their business and deliver essential transportation services to those in need

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What areas does Transdev cover?

Transdev's NEMT services in the USA cover a wide range of states and areas, though not nationwide. Based on available information, their current coverage includes:

• Colorado: They are the state-contracted broker for Health First Colorado, managing NEMT services for the entire state.

https://transdevhealthsolutions.com/colorado 

• Oregon: They manage NEMT services for the Oregon Health Authority.

https://transdevhealthsolutions.com/oregon/

• Hawaii: They provide NEMT services for specific health plans within the state, including Aloha Care and Ohana Health Plan.
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https://transdevhealthsolutions.com/alohacare

https://transdevhealthsolutions.com/ohp

• Illinois: They have operations in Cook County, managing transportation services for CountyCare.  

https://transdevhealthsolutions.com/netspap

https://transdevhealthsolutions.com/cookcounty/

• California: They operate paratransit services in San Bernardino County, which could include NEMT trips.  

Additionally, Transdev mentions having "transportation coordination centers located from coast to coast," implying a broader reach, but the specific locations are not explicitly listed.  

How can Transportation Providers or NEMT Providers Join Transdev's NEMT Network?

Each program managed by Transdev has a slightly different process, but essentially each requires the following.

1. Complete: Credentialing Request Form and License Agreement.
2. Train: Participate in credentialing software training.
3. Submit: Driver and vehicle information.
4. Vehicle inspection: Schedule a vehicle inspection.

Apply to the Transdev Networks

• https://transdevhealthsolutions.com/ohp/transportation-providers/ “Apply to OHP (HI) Network”
• https://transdevhealthsolutions.com/colorado/transportation-providers/ “Apply to HealthFirst Colorado (CO)”
• https://transdevhealthsolutions.com/netspap/providers/ “Apply to NETSPAP (IL)”
• https://transdevhealthsolutions.com/alohacare/transportation-providers/ “Apply to AlohaCare (HI)”
• https://transdevhealthsolutions.com/cookcounty/join-the-network/ “Apply to County Care (IL)”
• https://transdevhealthsolutions.com/oregon/join-the-network/ “Apply to Oregon health Authority (OR)”

Why NEMT Providers Should Consider Transdev?

By joining the Transdev NEMT Broker network, providers can expand their reach, streamline their operations, and benefit from the support and expertise of a leading transportation company.

• Access to a Wider Client Base: Transdev works with various healthcare organizations, increasing the potential for more trips and revenue for providers.
• Streamlined Operations: Transdev handles many administrative tasks such as eligibility verification, billing, and customer service, allowing providers to focus on delivering quality transportation services.
• Technology Support: Transdev provides software solutions to help providers with scheduling and optimizing their operations, leading to increased efficiency.
• Focus on Safety and Compliance: Transdev prioritizes safety and compliance, ensuring providers adhere to necessary regulations and standards.
• Commitment to Quality: Transdev has a long history in the transportation industry and is dedicated to providing reliable and high-quality NEMT services.

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NEMT Broker: Ride Health

Who is Ride Health?

Ride Health is a technology company revolutionizing patient transportation by connecting healthcare organizations, transportation providers, and patients through an integrated network. Their platform streamlines ride scheduling and communication, reducing the burden on providers and improving the patient experience. They aim to eliminate transportation barriers to healthcare by providing real-time access to a wide range of transportation modes, ensuring that patients can get to their appointments and access essential care.

What states does Ride Health cover?

Ride Health operates in the Northeast and Mid-Atlantic (New York, New Jersey, Pennsylvania)

How can Transportation Providers or NEMT Providers Join Ride Health's NEMT Network?

Apply to the Ride Health Network: https://www.ridehealth.com/tp/application “Apply to Join the Ride Health NEMT Network”

Why NEMT Providers Should Consider Ride Health?

Ride Health provides NEMT providers with a technology solution designed to streamline their processes, increase their business opportunities, and support the broader goal of enhancing access to healthcare.

• High-quality trip offers: Access to trips from local healthcare organizations, ensuring a steady stream of business.
• Integration with existing systems: No need to learn a new platform, reducing 'portal fatigue' and streamlining operations.
• Simplicity and transparency: One-click trip acceptance and direct trip information into your dispatch system.

Reduced no-shows: Ride Health handles passenger communications, including reminders, easing the burden on drivers and improving efficiency.

NEMT Broker: Alivi

Who is Alivi?

Alivi Health is a company that manages card, transportation, and specialty benefits. They offer an integrated benefits solution that is easy and efficient. Their platform allows members to access their card, transportation, and specialty benefits on a single platform.

What states does Alivi cover?

Alivi Health covers 13 states including New York, New Jersey, Pennsylvania, Massachusetts, and Alabama.

How can Transportation Providers or NEMT Providers Join Alivi's NEMT Network?

To join Alivi Health's network as a transportation provider, you can follow these steps:

1. Visit the Alivi Health website and navigate to the "Join Our Network" page.
2. Fill out the online form with your company information, contact details, and insurance coverage details.
3. Submit the form and wait for a representative from Alivi Health to contact you.
4. Once you are contacted, you will be asked to complete a more detailed application and provide additional documentation.
5. If your application is approved, you will be required to attend a training session and sign a contract with Alivi Health.

Apply to the Alivi Network: https://alivi.com/become-a-transportation-provider/ “Apply to Join the Alivi NEMT Network”

Why NEMT Providers Should Consider Alivi?

Here are some of the benefits of joining Alivi Health's network:

• Steady stream of trips: Alivi Health has a large network of members who require non-emergency medical transportation services. This means that you will have a consistent flow of trips to keep your business running smoothly.
• Improved revenue: Alivi Health offers competitive rates for transportation services. This means that you can earn a good income by providing transportation services to Alivi Health members.
• Simplified trips: Alivi Health's technology platform makes it easy to schedule and manage trips. This means that you can spend less time on paperwork and more time on providing quality care to your patients.  

Potential facility sole source opportunities: Alivi Health may offer sole source contracts to transportation providers who meet their high standards of quality and service. This means that you could have the exclusive opportunity to provide transportation services to a particular facility.

NEMT Broker: Modivcare

Who is Modivcare?

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Modivcare is the nation's leading provider of Non-Emergency Medical Transportation (NEMT), dedicated to ensuring patients reach their care destinations. They employ technology to simplify the transportation process, matching individuals with the right ride options, including specialized transportation, ride-share, and public transit, to optimize both cost and experience. Their advanced Mobility Access Platform offers real-time insights into every ride, fostering a tech-enabled and relationship-driven approach to patient care.

Modivcare goes beyond just transportation, providing a suite of supportive care services designed to address diverse clinical, technical, and individual needs. They leverage data and member insights to identify care gaps proactively and ensure members receive the right care at the right time. Their commitment extends to making NEMT easily accessible, allowing members to book and track rides 24/7 through various channels, including apps, the web, phone, and fax.

In essence, Modivcare is more than a transportation provider; they're a partner in navigating complex care needs, leveraging technology, and building relationships to deliver exceptional service and support to patients.

Update: Jan. 2021 LogistiCare changes name to Modivcare 

Update: May 2020 LogistiCare acquires National MedTrans

What States does Modivcare serve?
Modivcare’s network for NEMT covers 35 states nationwide:

• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Florida
• Georgia
• Hawaii
• Illinois
• Indiana
• Iowa
• Kansas
• Louisiana
• Maine
• Massachusetts
• Michigan

• Mississippi
• Missouri
• Nevada
• New Jersey
• New Mexico
• New York
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• Tennessee
• Texas
• Utah
• Virginia
• West Virginia
• Wisconsin

How can Transportation Providers or NEMT Providers Join Modivcare's NEMT Network?
Joining the Modivcare network can benefit NEMT providers by offering them access to a large and consistent volume of trips, advanced technology solutions, and a collaborative approach focused on improving the patient experience and driving positive health outcomes.

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Apply to Modivcare: https://www.modivcare.com/transportation-providers-contact-us/ [Button “Apply to Join Modivcare”]

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Why NEMT Providers Should Consider Modivcare?

• Steady Stream of Trips: As the nation's leading NEMT provider, Modivcare manages a high volume of trip requests, offering providers a reliable source of business and revenue stability.
• Technology-Driven Efficiency: Modivcare's advanced Mobility Access Platform streamlines operations, automating tasks and providing real-time insights for better trip management and optimization.
• Focus on Member Experience: Modivcare prioritizes matching members with the right transportation options, ensuring a positive experience for both patients and providers.
• Data-Driven Approach: Modivcare uses data and analytics to identify care gaps, improve service delivery, and ultimately achieve better health outcomes for members.
• Commitment to Quality: Modivcare emphasizes high service standards, fostering a network known for reliability, safety, and professionalism.

Growth Potential: Partnering with a national leader like Modivcare can open doors to new business opportunities and facilitate network expansion for providers.

NEMT Broker: Verida

Who is Verida?

Verida, formerly Southeastrans, is a minority-owned NEMT management company specializing in Medicaid and managed care organizations. With over 20 years of experience, they offer comprehensive NEMT administrative services in several states. The rebranding reflects their commitment to expand beyond transportation and connect people with much-needed care, embracing change and striving for continuous improvement. The name Verida combines "Veritas" (truth) and "ride," symbolizing their core business and dedication to honesty and progress.

Verida partners with over 900 NEMT providers to manage transportation services for more than 3 million people. They have a thorough process for recruiting, credentialing, and training providers. Their negotiations are based on fairness and honesty, earning them a reputation as a "NEMT provider-friendly" broker.

What states or areas does Verida cover?

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ARKANSAS

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WASHINGTON, DC

Transportation
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Georgia

Transportation
Providers

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Indiana

Transportation
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Louisiana

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Mississippi

Transportation
Providers & Volunteers

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Tennessee

Transportation
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How can Transportation Providers or NEMT Providers Join Verida's NEMT Network?

Verida has a thorough training and credentialing process for transportation providers and their drivers. It includes training on customer service, safety, first aid, and specific NEMT requirements. The 4-step credentialing process involves submitting an application and documents, passing vehicle inspections and driver training, and attending an orientation session. This ensures that all providers meet Verida's high standards for quality and safety.

1. Submission of Request for Qualifications Application, Including Driver and Vehicle Lists
2. Submission of Required Documents
3. Vehicle Inspections and Driver Training
4. NEMT Provider Orientation & Contracting

Apply to the Verida Network: https://verida.com/provider-request-for-qualifications-form/ “Apply to Join the Verida NEMT Network”

Why NEMT Providers Should Consider Verida?

Overall, partnering with Verida offers NEMT providers the opportunity to grow their business, improve their operations, and contribute to a network dedicated to providing quality care to those in need

• Access to a large client base: Verida manages transportation for over 3 million covered lives, meaning providers will have access to a large pool of potential clients.  
• Fair and honest negotiations: Verida is known for its "NEMT provider-friendly" approach, ensuring fair compensation and transparent communication.  
• Comprehensive training and credentialing: Providers receive extensive training and support, ensuring they meet high standards of quality and safety.  
• Streamlined operations: Verida handles many administrative tasks, allowing providers to focus on delivering quality transportation services.  

Reputation and experience: Verida has over 20 years of experience and a strong reputation in the industry, providing credibility and stability for its partners.