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Lack of transportation leaves millions in need of substance abuse treatment on the sidelines

About the author: Melissa Jankowski is the executive director of The Non-Emergency Medical Transportation Accreditation Commission (NEMTAC), a non-profit organization dedicated to ensuring safe medical transportation. NEMTAC partners with medical transport brokers and associations to develop best practices and has a role in the establishment of American National Standards that affect the industry.

For many years, there has been a widening gap in the number of people needing substance abuse treatment and those who receive care. There are many reasons for this disparity, one of which includes lack of access to transportation.

According to National Institute on Drug Abuse (NIDA) statistics compiled over a 12-month period, 21.6 million Americans aged 12 or older needed treatment for drug and/or alcohol abuse but, alarmingly, only 2.3 million received care. The simple lack of rides to the doctors’ offices, ambulatory care centers or other places for treatment has created a barrier for millions in need of lifesaving care.

Substance abuse treatment is a viable long-term solution according to NIDA. Depending on the needs of the individual, a minimum three months of treatment is needed to significantly reduce or stop substance use. The longer a person is in treatment, the better the outcome and the lower the chance of recurrence.

For example, NIDA reports that the minimum treatment period for methadone maintenance is 12 months but, depending on the individual, it could take years for an effective treatment plan. The most effective regimens focus on integrated delivery that includes mental health evaluations and therapy, medical care, education, counseling and other clinical interventions. However, proper treatment can’t be provided for those who can’t access regular appointments and interventions.

Advancements in NEMT technology enhance capacity to address substance use disorder

Reducing barriers to healthcare transportation for service providers and improving access for people in need via technology-enabled solutions that provide enhanced functionality and high overall system efficiency is essential.

Digitally integrated transportation networks have set the stage for advancements in non-emergency medical transportation (NEMT). Emerging technology will enable automated administration of transportation benefits, simple ride scheduling and trip assignments by call centers, healthcare facilities, case managers, care givers and patients.

Take a second to consider the way the system has worked traditionally. Now flip that on its head. Instead of a patient care coordinator or healthcare provider calling a cab company or transportation provider to determine when a patient will arrive, they will now have this information at their fingertips via a dashboard that provides the estimated time.

Every ride will be digitized and include GPS tracking. Facilities and care coordinators will have a dashboard showing when a member is picked up or dropped off, and what happens throughout the trip. This real-time, actionable data is invaluable in helping care coordinators effectively navigate the many facets of their patients’ NEMT and provide the appropriate regimens of treatment.

Patients will have access to apps featuring technology similar to those utilized by Uber and Lyft. Users will be able to simply request a ride by swiping and selecting, rather than calling. What is perhaps most anticipated by patients is the ability to know the exact time they will be picked up for appointments. Additionally, patients will be able to rate their interactions and overall trip experiences using one to five stars to denote levels of satisfaction.

The role of non-emergency medical transportation

The nation’s NEMT networks are vast, more technologically advanced and effective than ever before, and provide a solution for a vital piece of the substance use treatment puzzle. First, let’s look at how NEMT can help solve an economic riddle of treatment cost versus societal and financial benefits of three primary medication-assisted treatment programs for opioid addiction: Methadone, Buprenorphine, and Naltrexone.

  • Methadone is a very restricted treatment program and must be dispensed under the supervision of a physician in an Opioid Treatment Program (OTP) clinic, certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). Methadone is typically administered on a daily basis and is part of a comprehensive treatment program including integrated services of medical and psychosocial support. The average cost of the medication alone is $6,552 annually according to NIDA.

  • Buprenorphine can be administered in a physician’s office and is for more stable patients, but SAMHSA indicates it must still be part of a comprehensive, integrated program. Buprenorphine is administered twice weekly at office visits at an average annual cost for medication of $5,980.

  • Naltrexone is also administered in a physician’s office. NIDA statistics show the once-a-month injectable has an annual cost for medication of $14,112.

Clearly, the cost of medication alone in opioid treatment programs is expensive regardless of the regimen. Adding in other associated expenses such as physician and staff time would push costs even higher. However, NIDA reports the cost to society is far greater without treatments. Consider that substance abuse costs American taxpayers over $600 billion annually, a large portion of which is attributable to incarceration of tens of thousands arrested and charged with substance use offenses and/or related illicit activities.

Effective substance use disorder treatment is less costly than incarceration

A comparative analysis conducted by NIDA shows a stark contrast in the government-funded cost of incarcerating substance-use offenders versus providing treatment. The study shows the average annual cost of incarceration for one year is $24,000 per inmate versus the highest cost for the noted medication, Naltrexone, at $14,112 per year.

Simple math (cost of incarceration minus cost of medication) shows providing medication to one patient in year one versus incarceration saves taxpayers almost $10,000.

Considering the average time sentenced for substance abuse related offenses is roughly 4.75 years, the expense of incarceration balloons to a per person average of $114,000 or $94,295 more than the cost of the most expensive one-year treatment regimen (Naltrexone). The savings are even greater when less expensive Methadone and Buprenorphine options are prescribed.

According to Federal Bureau of Prisons statistics, as of June 2019, about 76,000 inmates in the federal system are incarcerated because of drug offenses. That represents 45.3 percent of all inmates in federal prisons. The Prison Policy Initiative reports that across local, state and federal systems, an average of 451,000 are locked up for non-violent drug offenses on any given day.

Industry research validates NEMT as a part of the solution

Aside from the overriding aspect of human compassion, in terms of financial rationale, it is increasingly the public that benefits from positive outcomes made possible by decisions about how to respond to the substance abuse epidemic.

It points back to transportation as a key solution that enables better access to treatment for substance use disorders. The value NEMT brings to the populace is made clear in a recent Medical Transportation Access Coalition (MTAC) study of patients needing kidney dialysis, diabetic wound care or treatment for substance abuse disorder. According to the study, 58% of Medicaid-eligible users say they would not be able to make any medical appointments if they didn’t have access to NEMT services. A more somber note was struck by 10% of survey participants who said they would die, or probably die if their NEMT services were halted.

The study shows that the NEMT system improves the likelihood of successful substance use disorder treatments. Survey respondents reported attending 16.4 treatments per month on average with NEMT and would expect to attend only 4.3 treatments per month without it. The cost analysis shows that those who attend three to six treatments per month incur, on average, $123 more per month in total medical costs than those who attend 15-plus treatments per month. The cost of the average round trip of NEMT for substance use disorder patients (based on private broker data) is $20.47, so the average cost of NEMT per survey respondent per month is 16.3 x $20.47 = $333.71.

Therefore, the taxpayer funded costs avoided attributable to NEMT, per respondent, per month equates to $333.71 - $123.00 = $210.71. The return on investment per 10,000 members per month totals more than $2.1 million. This does not include secondary cost savings associated with lower incidences of relapse or quantification of social costs such as increased employment and productivity, less law enforcement and judicial system costs, less strain on child services agencies and foster care systems and more.

From a humanitarian viewpoint, NEMT is critically important and must grow to meet the certainty of increased future demand. There is a clear indication the NEMT sector is uniquely positioned to help address this crisis by continuing to provide a keystone service for the medical and social services ecosystem that is engaged in comprehensive treatment for the afflicted population.

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