Our conversation with Miguel was not just about the logistics of transportation, but about a critical, often-overlooked challenge in healthcare that costs billions and impacts millions of lives.

Transportation: The Unseen Barrier to Healthcare

Miguel began our discussion with a powerful statistic: one in five Americans without access to a vehicle or public transportation skipped needed medical care in the past year. The impact of this is staggering. Missed appointments cost the U.S. healthcare system an estimated $150 billion annually in lost revenue, operational inefficiencies, and, most importantly, worsened patient outcomes.

This is the core problem that non-emergency medical transportation (NEMT), and organizations like CTS, are working to solve. For Miguel, the need for NEMT is a passion that goes back to his time as a student at Yale, where he founded a non-profit clinic to serve an underserved community.

Miguel emphasized that transportation is not just a convenience; it's a key factor in ensuring access to care for vulnerable populations, including:

• Older adults
• Individuals with disabilities or chronic illnesses
• Low-income families
• Those in rural or poor transit areas

By ensuring patients can get to their appointments, NEMT not only improves healthcare outcomes and helps manage chronic diseases but also supports the independence and well-being of individuals, allowing them to access care with dignity.

The State of the Industry: A Growing Market with a Mission

The non-emergency medical transportation market is poised for significant growth, projected to reach approximately $13.3 billion by 2031. This growth is primarily fueled by the increasing number of seniors, especially those over 85, who require consistent transportation to medical appointments.

What sets Coordinated Transportation Solutions apart in this growing market is its non-profit status. Unlike for-profit competitors, CTS is driven by a mission to provide access to care for anyone in need, regardless of their socioeconomic status. As a broker, CTS works with health plans and transportation providers to coordinate and manage transportation services, ensuring that every dollar is reinvested back into the mission.

Why Governments Struggle and B2B Opportunities Abound

I asked Miguel why governments haven't been able to establish a comprehensive infrastructure for this critical need. He pointed to a lack of investment in public transportation, which creates significant gaps in service, particularly in areas with aging populations.

This gap, however, presents a massive opportunity for businesses. With the growing demand for NEMT services, there is a substantial market for new entrants to help meet this need. Miguel highlighted that as healthcare systems seek to better manage costs, they are increasingly recognizing the value of NEMT in providing preventive care and avoiding more expensive downstream costs.

The Pandemic's Lasting Impact on Healthcare

The COVID-19 pandemic has fundamentally changed how people access healthcare, accelerating the use of technology and telehealth. However, Miguel noted that it has also highlighted the persistent need for physical transportation for services that cannot be delivered remotely, such as physicals, dialysis, and other in-person treatments. The pandemic showed us just how many people are truly disconnected from consistent healthcare, a problem that NEMT is uniquely positioned to address.

The CTS Process: Patient-Centered and Technology-Driven

Miguel walked us through the service delivery mechanism of CTS, explaining how a customer accesses their services. For those with Medicaid, it's an entitled benefit, while many Medicare Advantage plans offer transportation as a supplemental benefit.

Once a patient is identified, they can schedule a ride through a variety of channels, including a call center, website, or mobile app. An assessment is then made to determine the appropriate transportation, which could range from a standard shared ride to a wheelchair-accessible van, a stretcher service, or even a non-emergency ambulance for monitored transport. The entire process is patient-centered, focused on providing the right level of care for the individual's specific needs.

As a broker, CTS contracts with a network of transportation providers. Miguel outlined the rigorous criteria for these providers, including:

• State and federal licensing and certification
• National Provider Identifier for Medicaid billing
• Proper vehicle inspections and ADA compliance
• Adequate insurance and liability coverage
• Thorough driver training, background checks, and emotional intelligence skills

The Future of NEMT: Compliance, Technology, and Private Pay

Miguel concluded with key insights for anyone in the NEMT business:

• Compliance is Paramount: The industry is highly regulated, and staying current on state and federal requirements is crucial.
• Operational Efficiency is Key: NEMT is a commoditized business, so utilizing technology for dispatch, billing, and scheduling is essential for remaining competitive.
• Quality is Non-Negotiable: A reputation for trust, on-time arrivals, and safe, accessible transportation is vital for securing long-term contracts.
• Private Pay is a Growing Market: Beyond insurance-covered services, there is a growing market for private pay customers, leading to new opportunities like subscription models.

For Miguel, the decision to run a non-profit organization was a conscious continuation of his predecessor’s mission. While grounded in the principle that "no margin, no mission," CTS is committed to reinvesting its resources to improve technology, enhance the customer experience, and support its employees, all with the goal of expanding access to care.

A Guiding Principle: Capital Markets for Social Problems

When asked for the best advice he's ever received, Miguel shared a powerful principle he learned early in his career: "using capital market principles to solve social problems." He believes that government can't solve everything, and that the private sector has a role to play in creating social change and improving lives. This philosophy has guided his entire career and is the driving force behind the mission of Coordinated Transportation Solutions.