Summary
Lack of transportation is one of the most commonly cited barriers to healthcare, especially for patients with Medicaid. Non-Emergent Medical Transport, or NEMT, is an important and obvious solution to this problem, but the system has struggled with cost containment and program integrity challenges for payers, and service inadequacy complaints from beneficiaries.
I had the chance to chat with Buck Poropatich, VP of Lyft Healthcare, to discuss what the NEMT business looks like operationally, what they’re hearing from states and payers about needs, and where NEMT is headed in the coming years.
Check out the conversation below!
What we covered:
0:00 Introductions
00:31 Understanding NEMT: use cases and importance
04:42 How the NEMT business has evolved for Lyft
06:58 How it works for drivers
13:44 State contracting
23:36 Waste, Fraud and Abuse in NEMT
26:06 What’s next for Lyft Healthcare and NEMT
Interview
Analysis
There’s a long history of starts and, inevitably, stops for large companies outside of healthcare trying to enter, and Lyft’s entry into NEMT is as of yet a fascinating exception to the rule. In particular, I found Buck’s telling of the origin story where NEMT brokers were using burner phones to order rides for their patients which tripped the Lyft fraud alert systems particularly fascinating.
In Buck’s telling, it’s a great business school case study in product-market fit hitting the company directly in the forehead rather than a top-down corporate strategy project from a team of ex-MBB consultants.
But I also think it’s fitting that it was an opportunity discovered by Lyft’s fraud detection since the NEMT market has long been a source of waste, fraud, and abuse for Medicare and Medicaid, with Professor Jetson Leder-Luis memorably referring to NEMT fraud for dialysis patients as the “canonical Medicare fraud” where “we build in a little thing for the few people who need it, and that turns into a loophole through which bad actors drive a truck” on an episode of Bloomberg’s OddLots podcast.
Although Lyft’s liquid driver network is clearly valuable for the insurers or value-based care providers who pay for its services, it strikes me as just as important in an era of increasingly stretched state budgets and increased program integrity scrutiny that Lyft is making the ride from start to stop much more legible and transparent through the digital breadcrumbs that Buck describes in the interview.
While preparing for the discussion Jeremy Friese a few weeks back about the WISeR program from CMS, it was interesting to learn that NEMT was one of the first examples of a prior authorization requirement in traditional Medicare. Balancing fraud and administrative burdens for program participants is a delicate task, and although it’s still too early with too few data points to say anything conclusive, there’s a case to be made that, relative to old model, where there was lots of fraud, Lyft (and its ride share platform competitors) are, in their small corner of healthcare, improving access, quality, and cost.