Why Direct NEMT Partnerships Outperform Brokered Models

Health plans have traditionally relied on transportation brokers to manage NEMT benefits. But as quality expectations rise and cost transparency becomes a priority, more plans are discovering that direct partnerships with credentialed NEMT providers deliver better member outcomes, lower costs, and stronger operational control. This guide compares the two models and outlines how to make the transition.

Published: Feb 19, 2025Updated: Feb 19, 202512 min read

How NEMT Brokerage Works

In the traditional brokered NEMT model, a health plan contracts with an intermediary company — the broker — to manage non-emergency medical transportation for its members. The broker does not own vehicles or employ drivers. Instead, it operates as a dispatch and administrative layer between the health plan and a network of local transportation providers.

When a member needs a ride to a medical appointment, the request flows from the health plan (or the member directly) to the broker. The broker then assigns the trip to one of its subcontracted transportation providers based on availability, geography, and vehicle type. The subcontractor dispatches a driver and vehicle to complete the trip. The broker takes a margin on each trip — typically 15% to 30% of the per-trip cost — for managing the network, handling dispatch logistics, and processing claims.

This model was originally designed for scale. A health plan operating across an entire state or multi-state region would need to credential, contract, and manage dozens or even hundreds of local providers. The broker consolidates that complexity into a single contract, promising the plan geographic coverage without the administrative burden of managing individual provider relationships.

How the Money Flows

In a brokered model, the health plan pays the broker a per-trip rate or a per-member-per-month (PMPM) fee. The broker retains its margin and pays a reduced rate to the subcontracted transportation provider who actually performs the trip. The plan rarely sees what the actual transportation cost is versus the broker's administrative overhead.

Limitations of the Brokered Model

While the brokered model offers administrative convenience, it introduces structural limitations that directly impact transportation quality, member experience, and the health plan's ability to manage its NEMT benefit effectively.

Quality Inconsistency

Because the broker assigns trips to whichever subcontractor is available, members experience different drivers, different vehicles, and different service standards on every trip. A member going to dialysis three times per week may see three different drivers in three different vehicles with three different levels of professionalism. This inconsistency erodes member trust and satisfaction.

Longer Complaint Resolution

When a member reports a problem — a late pickup, a rude driver, a vehicle safety concern — the complaint travels from the member to the health plan, from the plan to the broker, and from the broker to the subcontracted provider. Each layer adds time and reduces accountability. Resolution that should take 24 to 48 hours can stretch into days or weeks.

Limited Data Visibility

The broker controls trip data, performance metrics, and reporting. Health plans often receive aggregated reports that obscure individual provider performance, making it difficult to identify which subcontractors are underperforming. Without granular data, the plan cannot make informed decisions about transportation quality or hold specific providers accountable.

Cost Opacity

The broker's margin is embedded in the per-trip rate, making it difficult for the plan to determine how much of each dollar goes to actual transportation versus administrative overhead. Plans paying a broker $85 per wheelchair trip may not realize that the subcontractor performing the trip receives only $60 to $70, with the remainder covering the broker's margin.

Member Dissatisfaction

Members — particularly elderly and disabled individuals who rely on NEMT for critical medical appointments — value consistency and familiarity. The brokered model, by design, does not provide this. A member who never sees the same driver twice, who cannot predict what vehicle will arrive, and who has no direct relationship with the transportation provider is inherently less satisfied with their experience.

No-Show Accountability Gaps

When a driver fails to show up for a scheduled pickup, the broker and the subcontractor often point fingers at each other. The broker claims it dispatched the trip correctly; the subcontractor claims it never received the assignment or that the pickup details were wrong. The member, meanwhile, missed their medical appointment. This accountability gap is a structural feature of the multi-layered brokered model.

Advantages of Direct Provider Partnerships

A direct partnership means the health plan contracts directly with the NEMT provider that owns the vehicles, employs the drivers, and performs every trip. There is no intermediary layer. The plan knows exactly who is transporting its members and has a direct line to the organization accountable for service quality.

Single Point of Accountability

When the health plan contracts directly with the provider, there is one organization responsible for every aspect of the member's transportation experience. If a trip is late, a driver is unprofessional, or a vehicle has an issue, the plan contacts the provider directly. No middleman, no finger-pointing, no multi-layer escalation. One call resolves the issue.

In-House Fleet Means Consistent Quality

Direct providers who operate their own fleets control every variable that affects service quality: vehicle maintenance schedules, driver hiring and training standards, GPS tracking and dispatch technology, and service protocols. The plan's members experience the same standard of service on every trip because one organization controls the entire operation.

Direct Data Access and Real-Time Reporting

With a direct partnership, the health plan receives granular trip data directly from the provider: on-time rates by driver and route, no-show rates, member feedback, trip completion documentation, and cost breakdowns by vehicle type and geography. This data is not filtered or aggregated by a broker — the plan sees exactly what is happening with its NEMT benefit.

Transparent Pricing Without Broker Margin

Every dollar the plan pays goes to the organization performing the transportation. There is no hidden broker margin inflating per-trip costs. The plan can negotiate volume-based pricing, contract rates, or hybrid payment models directly with the provider and know exactly what transportation costs versus what administrative overhead costs.

Faster Issue Resolution

Complaints, schedule changes, and escalations go directly from the plan to the provider and are typically resolved within 24 to 48 hours. In the brokered model, the same issue passes through multiple organizations and can take days or weeks to resolve. Direct communication eliminates the telephone game that plagues brokered transportation.

Stronger Member Relationships

Direct providers can assign consistent drivers to recurring members, building familiarity and trust that is especially important for elderly, disabled, and cognitively impaired members who rely on NEMT for critical medical appointments. A member who recognizes their driver and knows what vehicle to expect experiences significantly less anxiety and higher satisfaction.

Quality Control: Direct vs. Brokered

Quality control is where the structural differences between direct and brokered models become most apparent. The health plan's ability to enforce service standards, monitor performance, and protect its members depends entirely on the model it chooses.

Driver Standards

In a direct partnership, the provider enforces its own driver standards across every trip because it employs every driver. The health plan can review and approve the provider's hiring criteria, training curriculum, and ongoing performance requirements. In the brokered model, driver standards vary across every subcontractor in the broker's network. The broker may set minimum requirements, but enforcement depends on each subcontractor's self-reporting — and the plan has no direct visibility into whether those standards are actually met.

Vehicle Condition

A direct provider maintains its own fleet under a single maintenance schedule with documented inspection records. Every vehicle meets the same cleanliness, safety, and equipment standards. In the brokered model, vehicle condition varies across the broker's subcontractor network. A member may ride in a well-maintained van on Monday and a vehicle with worn upholstery and outdated equipment on Wednesday. The broker has limited ability to inspect or enforce vehicle standards across dozens of independent operators.

Training Consistency

Direct providers train all drivers to a single standard that can be aligned to the health plan's specific requirements: PASS wheelchair securement certification, CPR and First Aid, HIPAA compliance, sensitivity training for elderly and cognitively impaired passengers, and plan-specific protocols. In the brokered model, each subcontractor has its own training program (or lack thereof), and the broker cannot guarantee that every driver completing a trip for the plan has received the same level of training.

Performance Monitoring

A direct partner provides the health plan with real-time GPS tracking on every vehicle and driver, automated trip status notifications, and detailed performance dashboards covering on-time rates, trip completion rates, and member satisfaction scores. The plan can audit any trip at any time. In the brokered model, the plan receives the broker's aggregated reports, which may not reflect the performance of individual subcontractors. The broker controls what data the plan sees and how it is presented.

Key Difference

In a direct partnership, the health plan has one provider to hold accountable and full visibility into performance. In a brokered model, the plan has visibility only into what the broker chooses to share, and accountability is diluted across multiple layers of subcontracted organizations.

See the Direct Partnership Difference

Compare your current broker's performance against Dream Care Rides' direct model. Transparent pricing, in-house fleet, real-time data, and single-point accountability.

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Cost Transparency and Efficiency

Cost is one of the most compelling reasons health plans are moving from brokered to direct NEMT models. The financial structure of each model produces fundamentally different outcomes for the plan's transportation spend.

The Brokered Cost Structure

In the brokered model, the health plan pays the broker a per-trip rate that includes the broker's administrative margin — typically 15% to 30% of the total cost. This margin covers the broker's dispatch operations, network management, technology platform, and profit. Because the margin is embedded in the per-trip rate, the plan cannot easily determine how much of each dollar goes to actual transportation versus broker overhead. A plan paying $90 per wheelchair trip may be unaware that the subcontracted provider performing the ride receives only $63 to $77.

The Direct Partnership Cost Structure

In a direct model, the plan negotiates pricing directly with the provider that performs the transportation. There is no intermediary margin. The plan sees exactly what each trip costs and can structure payments in the format that works best for its operations: per-trip rates for on-demand or low-volume usage, monthly contract pricing for predictable high-volume corridors, or hybrid models that combine a base retainer with per-trip charges for overflow volume.

No Hidden Broker Margin: Every dollar the plan pays goes to the organization operating the vehicles and employing the drivers. The plan can audit costs at any time and knows exactly what transportation costs.
Volume Efficiencies Passed to the Plan: When a direct provider achieves routing efficiencies, consolidates trips, or optimizes fleet utilization, those savings are reflected in the plan's pricing — not absorbed by a broker as additional margin.
Custom Pricing Structures: Direct providers work with the plan to design pricing that aligns with utilization patterns, member geography, and vehicle type mix. This flexibility is difficult to achieve through a broker that applies standardized rate cards across its entire provider network.
Predictable Budgeting: Contract-based pricing with a direct provider gives the plan cost predictability that per-trip broker pricing cannot match, especially for members with recurring transportation needs like dialysis and therapy.

Impact on Member Experience

Member experience is where the difference between brokered and direct NEMT is felt most acutely. The members who depend on NEMT are among the most vulnerable populations in a health plan's membership: elderly individuals, people with disabilities, dialysis patients, and members recovering from surgery or hospitalization. Their transportation experience directly affects their health outcomes and their perception of the health plan.

Consistent Drivers Build Trust

Direct providers can assign the same driver to a member's recurring trips. For elderly members and those with cognitive impairments, seeing a familiar face reduces anxiety and builds the trust needed to maintain appointment adherence. In the brokered model, a different stranger arrives for every trip.

On-Time Reliability Improves Adherence

Members who trust that their ride will arrive on time are more likely to schedule and keep medical appointments. Direct providers with in-house fleets and real-time dispatch have stronger on-time performance than brokered services that depend on subcontractor availability. Consistent reliability translates directly into better appointment adherence rates.

CAHPS Scores Reflect Transportation Quality

Member satisfaction surveys — including CAHPS — capture the overall care experience, and transportation is a significant component for members who use NEMT. Plans that provide consistent, professional, on-time transportation through a direct partner see measurably higher satisfaction scores than plans relying on brokered services with variable quality.

Door-Through-Door Service With Trained Attendants

Direct providers train every driver to assist members from their door to the vehicle and from the vehicle to the appointment entrance. This door-through-door service is especially important for members with mobility limitations, post-surgical restrictions, or cognitive impairments who cannot navigate parking lots and building lobbies independently.

Star Rating Impact

For Medicare Advantage plans, member experience drives CMS Star Ratings, which directly affect plan rebate revenue and enrollment competitiveness. Improving the NEMT experience through a direct partnership is one of the most actionable ways to boost member satisfaction scores and protect Star Rating performance.

How to Transition to Direct Partnerships

Transitioning from a brokered to a direct NEMT model does not need to happen overnight. Most health plans implement the change through a structured pilot program that validates the direct model before scaling.

Evaluate Current Broker Performance

Pull your current broker's performance data: on-time pickup rates, no-show rates, member complaint volume, complaint resolution time, and cost per trip by vehicle type. Identify the specific areas where the brokered model is underperforming. This baseline becomes the benchmark against which you measure the direct model.

Identify Service Area Needs and Volume

Map your member distribution and trip volume by geography. Identify the corridors and regions with the highest NEMT utilization. These high-volume areas are the best candidates for a direct partnership pilot because they offer enough trip volume to evaluate the provider's performance across a statistically meaningful sample.

Credential Direct Providers

Identify NEMT providers in your target corridors who operate their own in-house fleets. Verify NPI registration, commercial auto liability insurance ($1.5 million minimum), general liability and workers' compensation coverage, HIPAA compliance documentation, willingness to execute a BAA, and documented driver qualification files including background checks, drug testing, and certifications.

Launch a Pilot Program

Start with a defined geographic area or member segment. Route a portion of trips to the direct provider while maintaining broker coverage for the remainder. Run the pilot for 60 to 90 days to collect enough data for meaningful comparison. Track on-time rates, no-show rates, member complaints, resolution times, and cost per trip.

Measure and Compare Metrics

At the end of the pilot, compare the direct provider's performance against the broker baseline across all key metrics. The comparison should include both quantitative data (on-time rates, no-show rates, cost per trip) and qualitative feedback (member satisfaction, staff experience, ease of communication).

Scale Based on Results

If the pilot demonstrates improved performance, expand the direct partnership to additional corridors and member segments. Many plans phase the transition over 6 to 12 months, gradually shifting volume from the broker to the direct provider while maintaining service continuity for members throughout the transition.

Why Dream Care Rides as Your Direct Partner

Dream Care Rides is a direct NEMT provider serving health plans, managed care organizations, hospitals, and skilled nursing facilities across Illinois and Indiana. We operate our own in-house fleet — we do not subcontract trips to third-party drivers. When your plan partners with Dream Care Rides, you know exactly who is transporting your members.

In-House Fleet Across IL & IN

Our entire fleet is owned and operated by Dream Care Rides. No subcontracting, no third-party drivers, no variable quality. Every vehicle is maintained to the same standard, every driver is trained to the same protocols, and every trip is tracked through our centralized dispatch system.

NPI Registered, HIPAA Compliant, FIFCA Documented

We maintain full credentialing documentation including NPI registration, HIPAA compliance with BAA execution, FIFCA documentation confirming proper employee classification, commercial auto liability insurance, and general liability and workers' compensation coverage. Our credentialing packet is available within 24 hours of request.

AMB, WCH, STR, BRT Coverage

Ambulatory sedans, wheelchair-accessible vans with hydraulic lifts, stretcher and gurney vehicles, and bariatric configurations — all dispatched from a single account. Your plan's members receive the correct vehicle matched to their mobility assessment on every trip.

Real-Time GPS Tracking

Every vehicle in our fleet is GPS-tracked in real time. Health plan coordinators and facility staff receive automated status notifications when a driver is dispatched, arrives for pickup, and completes the drop-off. Full trip documentation is available for audit and care coordination.

80+ Cities Served

Coverage across the Chicago metropolitan area and surrounding communities in Illinois and Indiana. Contact our provider relations team to confirm coverage for your plan's service area and discuss corridor-specific volume.

Proactive Communication

Our dispatch team proactively communicates schedule changes, delays, and trip status updates. Plan coordinators and members are not left wondering where their ride is. We contact the plan and the member if any trip is running behind schedule.

Credentialing Packet Available Within 24 Hours: Our credentialing documentation is organized and ready to submit. NPI, insurance certificates, HIPAA policies, BAA template, driver qualification summaries, and fleet documentation are available within 24 hours of your request.
Direct Provider Relations Team: Our dedicated provider relations team works directly with health plan credentialing departments, network managers, and transportation coordinators. One team, one point of contact, one organization accountable for your members' transportation.

Start a Direct Partnership

Contact our provider relations team at (866) 507-5724 or visit dreamcarerides.com/mcos
We provide our complete credentialing packet and discuss your plan's service area, volume, and vehicle type requirements
Receive a custom partnership proposal with transparent pricing, service level commitments, and dedicated account management
Launch a pilot program or go live with full fleet coverage within 30 days

Frequently Asked Questions About Direct NEMT Partnerships vs. Brokered Models

An NEMT broker is an intermediary company that contracts with health plans, Medicaid agencies, or managed care organizations to manage non-emergency medical transportation benefits on their behalf. The broker does not typically operate its own vehicles. Instead, it receives trip requests from the health plan or its members, then subcontracts those trips to local transportation providers in the area. The broker takes a margin on each trip for managing the dispatch, provider network, and administrative functions. Brokers were originally designed to give health plans a single point of contact for transportation across large geographic areas without needing to credential and manage dozens of individual providers.

Health plans historically used NEMT brokers for operational convenience and geographic scale. Managing transportation across multiple counties or states requires coordinating with many local providers, each with different vehicle types, coverage areas, and billing processes. A broker consolidates this complexity into a single contract, handling provider recruitment, credentialing, dispatch, and claims processing on the plan's behalf. For plans that lacked the internal resources or expertise to manage transportation directly, the brokered model offered a turnkey solution. However, as plans have gained more sophistication in managing supplemental benefits and as direct provider partnerships have demonstrated superior quality and cost outcomes, many plans are reevaluating the brokered approach.

The primary risks of brokered NEMT include quality inconsistency because the broker assigns different subcontracted providers and drivers to each trip, accountability gaps where complaints must travel through multiple layers before reaching the actual provider, limited data visibility because the broker controls trip data and may not share granular performance metrics with the plan, cost opacity where the broker's margin is embedded in the per-trip rate making it difficult to determine the actual cost of transportation versus administrative overhead, member dissatisfaction from inconsistent vehicles and unfamiliar drivers, and no-show accountability gaps where the broker and subcontractor each deflect responsibility for missed pickups.

Yes, and it is becoming increasingly common. Health plans can credential and contract directly with NEMT providers who operate their own fleets in the plan's service area. This approach gives the plan direct control over quality standards, pricing transparency, performance metrics, and member experience. Plans that serve defined geographic areas — particularly in metropolitan regions where a single provider can cover the majority of trip volume — often find that a direct partnership with one or two quality providers delivers better outcomes than routing all trips through a broker. The credentialing process for a direct NEMT provider follows the same framework as other healthcare vendor credentialing: NPI verification, insurance documentation, HIPAA compliance, and a Business Associate Agreement.

Direct NEMT partnerships positively impact HEDIS scores by improving member appointment adherence for measures that depend on follow-up visit completion. When members have consistent, reliable transportation with trained drivers they recognize and trust, they are more likely to attend follow-up appointments after hospitalization (FUH), follow-up after emergency department visits (FUM), comprehensive diabetes care visits, medication management appointments, and preventive screenings. The consistency of a direct partnership — same drivers, same vehicles, same service standards — reduces no-shows and cancellations compared to the variable experience of brokered transportation where a different subcontractor handles each trip.

In most cases, a direct partnership costs less than a brokered arrangement because the broker's margin — typically 15% to 30% of the per-trip rate — is eliminated. When a health plan contracts directly with an NEMT provider, the full payment goes to the organization actually performing the transportation. Direct providers can also offer volume-based pricing, contract rates, and hybrid payment structures (per-trip, monthly retainer, or blended models) that are tailored to the plan's utilization patterns. The plan also gains cost visibility: instead of receiving a single per-trip invoice from the broker with the margin hidden inside, the plan sees exactly what transportation costs and can identify opportunities for efficiency.

The number of direct providers a plan needs depends on its geographic footprint and member distribution. For plans concentrated in metropolitan areas, a single provider with broad coverage can handle the majority of trip volume. Dream Care Rides, for example, covers 80+ cities across Illinois and Indiana from a single in-house fleet. Plans with members spread across rural or multi-state areas may need two to four direct providers to ensure full geographic coverage. The key advantage is that even with multiple direct providers, the plan maintains direct relationships, quality oversight, and pricing transparency with each one — something lost in the brokered model where the plan has no relationship with the actual transportation companies.

A direct NEMT provider should hold a National Provider Identifier (NPI) number, maintain commercial auto liability insurance of at least $1.5 million, carry general liability and workers' compensation coverage, demonstrate HIPAA compliance with documented policies and procedures, execute a Business Associate Agreement (BAA) with the health plan, maintain proper state operating authority and vehicle registrations, provide documented driver qualification files including background checks, drug testing, driving record reviews, and current certifications (CPR, First Aid, PASS wheelchair securement), and carry FIFCA (Federal Insurance Contributions Act) documentation confirming proper employee classification. The provider should also be able to supply a complete credentialing packet within a reasonable timeframe — typically 24 to 48 hours for an organized provider.

Standard onboarding for a direct NEMT provider takes 30 to 60 days and includes credentialing verification, contract negotiation, BAA execution, technology integration for trip scheduling and tracking, driver roster review, and a pilot period to validate service quality. For health plans with urgent transportation needs, many providers offer expedited onboarding that compresses the timeline to two to three weeks by parallelizing credentialing steps, using standardized contract templates, and beginning pilot trips while final documentation is being finalized. Dream Care Rides maintains a ready-to-deploy credentialing packet and can begin pilot service within days of initial contact.

Dream Care Rides works directly with health plans, managed care organizations, hospitals, and skilled nursing facilities. We operate our own in-house fleet across Illinois and Indiana — we do not subcontract trips to third-party drivers. This means the health plan contracts directly with the organization that owns the vehicles, employs the drivers, and is accountable for every trip. Our direct model gives health plans full transparency into pricing, performance metrics, driver qualifications, and member experience. We also maintain broker credentialing for plans that currently use the brokered model and are transitioning to direct relationships. Contact our provider relations team at (866) 507-5724 to discuss a direct partnership.

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