How rich is your NEMT Medicaid Broker? Are they making you money?


Medicaid and brokers are critical components associated with the various changes affecting the medical industry.  And needless to say, they are two key components that have huge influence on the NEMT and home care industries.

The following article was published this past week and was brought to my attention by a transportation provider in the great state of Florida.  As you read, ask yourself where your business and our industry will be next year, three years, five years and more.

MTM Ramps up Florida Operations

All eyes are on Florida’s Medicaid transformation since the federal government approved a plan this month that lumps certain Medicaid recipients into managed care programs in an effort to curb rising costs, Kaiser Health News reports.

The move to managed care is causing Medical Transportation Management Inc. to ramp up its efforts to expand its core business in Florida.

Health plans will now be reimbursed a set amount for each Medicaid recipient in this new deal which only includes elderly and disabled in long-term care for now.  This payment model removes the fee for service reimbursement model.  Since health plans will be reimbursed on an individual basis, the assumption is they’ll have to create a network of providers to help these Medicaid recipients receive better care that’s easier to navigate, although critics think it will lead to worse care.

MTM is hoping to land a subcontract from the health plans that eventually win the contracts to provide managed care.  If MTM is a subcontractor for a health plan, they’ll provide non-emergency medical transportation – their core business, to these Medicaid recipients.

In the first year, the state will set aside nearly $417 million to pay for care of the 36,795 qualified Medicaid recipients, Kaiser Health News reports.  Currently, MTM operates as a transportation provider in two Florida counties.  But this federal approval could open the door to subcontracts throughout the entire state.

Michele Lucas, a spokeswoman for MTM, said it’s too early to tell just how much added revenue that could mean.  But Alaina Macia, MTM’s chief executive, said “This is a huge deal!”

MTM reported revenue of $135 million in 2012, up from $132 million in 2011.

Questions…

1. MTM generated $135 million last year and they are less than a third of the size of Logisticare.  Hmm, how much money did Logisticare generate in 2012?  Realizing how much money Logisticare, MTM, and other brokers can generate, how’d they treat you this past year?

2. Opportunities are continuing to grow and expand for Medicaid brokers, how does that affect your business long-term?

3. Some predict that these healthcare changes will afford recipients “better care that’s easier to navigate” while “critics think it will lead to worse care.”  So, who is right and who is wrong?  But more importantly, how is any of this, right or wrong, going to affect your business?  How can you even predict the fallout and the ramifications on your business when there is so much uncertainty?

4. MTM’s chief executive obviously thinks that the coming changes “Is a huge deal.”  But, do you share the same excitment and enthusiasm?  How will your business benefit as a result of MTM’s, or any of the broker’s expansion and empowerment?

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