ModivCare Inc. (ModivCare), a technology-enabled healthcare services company, which provides a suite of integrated supportive care solutions for public and private payors and their members.
The company's value-based solutions address the social determinants of health (SDoH) by connecting members to essential care services. By doing so, ModivCare helps health plans manage risks, and improve health outcomes. ModivCare provides non-emergency medical transportation (NEMT), personal care services (P...
ModivCare Inc. (ModivCare), a technology-enabled healthcare services company, which provides a suite of integrated supportive care solutions for public and private payors and their members.
The company's value-based solutions address the social determinants of health (SDoH) by connecting members to essential care services. By doing so, ModivCare helps health plans manage risks, and improve health outcomes. ModivCare provides non-emergency medical transportation (NEMT), personal care services (PCS), and in-home monitoring solutions (Monitoring), which serve similar, highly vulnerable patient populations.
The technology-enabled operating model in its NEMT segment includes the coordination of non-emergency medical transportation services, supported by an infrastructure of core competencies in risk underwriting, contact center management, network credentialing, and claims management. Additionally, the company's personal care services in its PCS segment include placements of non-medical personal care assistants, home health aides, and nurses, primarily to Medicaid patient populations in need of care monitoring and assistance performing daily living activities in the home setting. ModivCare’s in-home monitoring solutions in its Monitoring segment include in-home clinical monitoring and quality improvement services, which leverage personal emergency response systems, vitals monitoring devices, relationship-based care, and data-driven patient engagement solutions.
ModivCare also holds a 43.6% minority interest in CCHN Group Holdings, Inc. and its subsidiaries, which operates under the Matrix Medical Network brand (Matrix). Matrix, which is included in its Corporate and Other segment, maintains a national network of community-based clinicians who deliver in-home and on-site services.
Strategies
ModivCare has grown from a stand-alone non-emergency medical transportation provider to a company with multi-faceted supportive care solutions focused on improving SDoH. The company's services include non-emergency medical transportation, personal care services, and in-home monitoring solutions. The company's strategic framework emphasizes its focus on centralizing and standardizing operations to support all of its supportive care services. ModivCare focuses on aligning its people, processes, and technology for each business segment, while integrating data across its point solutions to better serve its members and customers. ModivCare focuses on execution, growth, and results. To highlight a couple of strategic initiatives in the company’s business segments:
NEMT - The company's transportation network is selected using a partnership model with credentialed transportation providers to ensure it provides its members with high quality service and on-time performance. The company's multi-modal strategy ensures that members receive the most appropriate type of ride, whether it is a traditional sedan, ride share, public transit, or a family member driving the member and receiving mileage reimbursement. The company's focus is to make sure its members have the best transportation experience tailored to their individualized transportation needs. The company's NEMT segment strategy is to drive operational efficiencies and optimize performance, using its omnichannel member engagement model, multi-modal network strategy, and digital customer integration.
PCS - The company's personal care team remains focused on transforming its operations through centralizing and standardizing non-clinical functions and certain operational processes across its network of personal care offices. This strategy will empower and enable caregivers to focus on providing high quality services to members and minimize the time spent on administrative functions and expand the company's workforce development to improve recruiting and retention efforts. This operational advancement in PCS coupled with the recruiting and retention efforts deployed to enhance the company's caregiver engagement will drive growth and ensure increased member and caregiver satisfaction.
Monitoring – The company's monitoring team is focused on gaining market share through referral sales growth and strengthening its long-standing relationships with managed care organizations. It is continuing to innovate and invest in technology, and comprehensive data analytics, to advance its position as a leader in the in-home monitoring industry.
Operations
The company is a technology-enabled healthcare services organization that is the nation’s largest manager of non-emergency medical transportation programs for state governments and MCOs, a leading in-home personal care services provider in the seven eastern states where it provides those services, and a leading provider of in-home monitoring solutions. The company's core competencies in NEMT include contact center management, network credentialing, claims management, and non-emergency medical transport management. Its in-home personal care services include placements of non-medical personal care assistants, home health aides, and nurses, primarily to Medicaid patient populations in need of care monitoring and assistance performing daily living activities, including senior citizens and disabled adults. The company's in-home monitoring services include in-home clinical monitoring and quality improvement services, which leverage personal emergency response systems, vitals monitoring devices, relationship-based care, and data-driven patient engagement solutions.
By offering its suite of integrated supportive care solutions for its payors and members, the company focuses on becoming among the nation’s preeminent SDoH companies and delivering better care in the home, enhancing patient lives, and reducing healthcare costs. The company reports its operations, under four separate business segments: NEMT, PCS, Monitoring, and Corporate and Other.
NEMT Segment
The company provides non-emergency medical transportation solutions to its members after obtaining contracts with the third-party payors that it has relationships, including state governments and MCOs, in 48 states and the District of Columbia. Throughout 2024, approximately 29.5 million average monthly members were eligible to receive its transportation services, and it managed approximately 36.8 million trips.
The company primarily contracts with state Medicaid programs and MCOs, including Medicare Advantage plans, for the coordination of their members', who are its end-users, non-emergency medical transportation needs. The company's customers are typically Medicaid or Medicare eligible members, whose limited mobility or financial resources hinder their ability to access necessary healthcare and social services. The company provides access to non-emergency medical transportation services on a more cost-effective basis than self-administered state Medicaid or MCO transportation programs while improving the lives and health outcomes of the populations it serves.
To fulfill the transportation needs of its customers, the company applies its proprietary technology platform to an extensive network of approximately 4,100 transportation resources. This includes the company's in-network roster of fully contracted third-party transportation providers who operate sedans, wheelchair equipped vehicles, multi-passenger vans and ambulances. The company's system also utilizes relationships with on-demand transportation network companies, mass transit entities, mileage reimbursement programs, taxis and county-based emergency medical service providers. To promote safety, quality and compliance, the company's in-network transportation providers undergo an in-depth credentialing and education process.
The company's transportation management services also include fraud, waste, and abuse prevention and identification through utilization review programs designed to monitor that its transportation services are provided in compliance with Medicaid and Medicare program rules and regulations, as well as to remediate issues that are identified. Compliance controls include ongoing monitoring, auditing and remediation efforts, such as validating end-user eligibility for the requested date of service and employing a series of gatekeeping questions to verify that the treatment type is covered, and the appropriate mode of transportation is assigned. The company also conducts post-trip confirmations of attendance directly with the healthcare providers for certain repetitive trips, and it employs field monitors to inspect transportation provider vehicles and to observe transports in real time. The company's claims validation process generally limits payment to trips that are properly documented, have been authorized in advance, and is billed at the pre-trip estimated amount. The company's claims process is increasingly digital, which provides more protection to member protected health information and reduces the impact on the environment. Transportation providers are able to submit their bills and supporting documentation directly to the company through a secured web portal.
The remaining 19.1% of NEMT segment revenue was generated under other types of fee arrangements, including administrative services only and fee-for-service (FFS), under which fees are generated based upon billing rates for specific services or defined membership populations. Revenue under FFS contracts represents revenue earned under non-capitated contracts in which the company bills and collects a specified amount for each service that it provides.
Customers: In 2024, contracts with state Medicaid agencies and MCOs, including Medicare agencies, represented 100.0% of NEMT segment revenue. The NEMT segment derived approximately 10.9%of its revenue from a single state Medicaid agency for the year ended December 31, 2024, respectively. The next four largest NEMT segment customers by revenue consisted in the aggregate approximately 22.4% of NEMT segment revenue for the year ended December 31, 2024.
Development Efforts and New Product Offerings: The delivery of the company's NEMT program is dependent upon a highly integrated platform of technology and business processes, as well as the management of a multifaceted network of third-party transportation providers. The company's technology platform is purpose-built for the unique needs of its industry and is highly scalable; capable of supporting substantial growth in its clients' membership base. In addition, the company's technology platform efficiently provides a broad interconnectivity among end-users, customers, and its network of transportation providers. The company provides service offerings and technological features for end-users to improve service levels, lower costs and build the foundation for additional data analytics capabilities. The company has implemented a modern, cloud based, interactive, voice responsive automated call distribution and work force management system across all contact centers. The company's technology also allows for real time notifications to members on their mobile devices, integration with a wide variety of ATMS and transportation network companies, real time ride tracking, network management and analytics.
Competition: The company competes with a variety of national organizations that provide similar healthcare and social services related to transportation, such as Medical Transportation Management, Southeastrans (nka Verida), Access2Care, and SafeRide, as well as local and regional providers.
Seasonality: While the company experiences minor fluctuations in trip volume as a result of seasonal variations in the business, principally due to lower transportation demand during the winter season and higher demand during the summer season, its quarterly (year ended December 31, 2024) operating income and cash flows do not materially fluctuate as a result of these minor seasonal shifts.
PCS Segment
The company provides in-home personal care services to its customers through agency branches across various states, including several of the nation’s largest home care markets: New York, New Jersey, Florida, Pennsylvania, Massachusetts, West Virginia, and Connecticut. It places non-medical personal care assistants, home health aides, and skilled nurses primarily to Medicaid patient populations in need of care monitoring and assistance performing daily living activities in the home setting, including persons who are at increased risk of hospitalization or institutionalization. The company's personal care services include bathing, personal hygiene, grooming, oral care, dressing, medication reminders, meal planning, preparation and feeding, housekeeping, transportation services, prescription reminders, and assistance with dressing and ambulation, all of which enable aging-in-place and support overall wellness. Within New York, Pennsylvania, and New Jersey, its PCS Private Duty Nursing program provides services targeted to assisting medically fragile children. As of December 31, 2024, the company had approximately 18,300 trained caregivers throughout all of its branch locations, serving, on average, approximately 20,700 patients and providing approximately 28.2 million hours of patient care annually.
The company's PCS segment payor clients include federal, state and local governmental agencies, MCOs, commercial insurers and private individuals. The federal, state and local programs under which these organizations operate are subject to legislative, budgetary and other risks that can influence reimbursement rates. MCOs that operate as an extension of the company's government payors are subject to similar economic pressures.
Most of the company's personal care services are provided pursuant to agreements with state and local governmental aging services agencies, Medicaid waiver programs, and home and community based long-term living programs.
Customers: In 2024, contracts with state Medicaid agencies and MCOs represented approximately 96.7% of PCS segment revenue, with the remaining revenue derived from private pay and other contracts. The PCS segment derived approximately 12.5%of its revenue from a single state Medicaid agency for the years ended December 31, 2024. The next four largest PCS segment customers by revenue consisted in the aggregate approximately 33.5% of segment revenue for the year ended December 31, 2024.
Development Efforts and New Product Offerings: This application integrates with the enterprise technology solution Homecare Software Solutions, LLC, which operates under the HHAeXchange brand, and which the company refers to as ‘HHAeXchange.’ and has enabled caregivers to independently schedule their shifts. This application integrates with the company's existing home care platforms and applicant tracking system. The company has demonstrated success with caregiver referrals in converting to new hires in Massachusetts and sustained an increased use of electronic visit verification (EVV) in its Pennsylvania branch. In addition to these technology solutions, the company continues to identify new technologies that it can invest in to further unify its PCS segment across one streamlined technology platform. Additionally, it has invested in Nevvron for an all-in-one e-learning solution that enables required training to be delivered remotely and helps improve utilization by reducing time lost for training.
Seasonality: While the company experiences minor fluctuations in hours of care provided as a result of seasonal variations in the business, principally due to somewhat lower demand for in-home services from caregivers during the summer and periods with major holidays, as patients may spend more time with family and less time alone needing outside care during those periods, its quarterly operating income and cash flows do not materially fluctuate as a result of these minor seasonal shifts.
Monitoring Segment
This segment provides in-home monitoring services to support patient self-management and care management operations that enable seniors, the chronically ill, and persons with disabilities to maintain their independence and avoid long-term care facilities, preventable emergency room use, hospitalization, and hospital readmission. Services include in-home clinical monitoring and quality improvement services that leverage personal emergency response systems, vitals monitoring devices, relationship-based care, and data-driven patient engagement solutions. With high-touch engagement, the Monitoring segment has several million annual person-to-person interactions, which served a population of approximately 247,000 actively monitored health plan members throughout 2024.
The company markets its in-home monitoring services to national and regional health plans, government-funded benefit programs, healthcare provider organizations, and individuals.
Customers: In 2024, the company served approximately 247,000 members within national and regional health plans, government-funded benefit programs, healthcare provider organizations, and individuals across the country. It has a diverse base of customers across multiple end markets, including Medicare Advantage, State and Managed Medicaid, and Health Systems or Distributors.
Development Efforts and New Product Offerings: The company's device-agnostic technology platform allows its Monitoring segment to rapidly adopt and seamlessly integrate new products as hardware innovation continues across the industry. Currently, the company is contracted with over 30 manufacturers and integrated across more than 200 devices. The Monitoring segment continuously evaluates new products, integrating several devices annually with rapid onboarding for quick deployment in the field.
Competition: The company competes with a variety of Monitoring solution providers that include both new entrants to the healthcare industry and legacy healthcare providers. Top providers include Livongo, Omada, Medical Guardian, Connect America, and Best Buy Health.
Corporate and Other Segment
This segment supports the strategic objectives and continued growth of the ModivCare business and includes the activities related to executive, accounting, finance, internal audit, tax, legal, and certain strategic and corporate development functions for each segment. The Corporate and Other segment also includes the operating results of its non-controlling equity interest in Matrix Medical Network (Matrix). In addition, the Corporate and Other segment includes the results of the company's investment in innovation, made during the first quarter of 2023, related to expanding its virtual care, digital engagement, monitoring capabilities, and member insights and analytics. As part of this investment in innovation, such wholly-owned subsidiary also began providing virtual clinical care management services (the MSO) through an unaffiliated professional corporation (the PC) owned and operated by a licensed physician in the third quarter of 2023.
Governmental Regulations
Because the company receives Medicaid reimbursement, it is subject to applicable participation conditions including a variety of operational, conflict of interest, and structural obligations. For example, in states that have elected to obtain authority to provide NEMT as a medical service through a broker using the regulatory process permitted by the Deficit Reduction Act of 2005, or DRA, the company is prohibited from contracting with any transportation provider with which it has a financial relationship.
As the company’s PCS segment has received relief payments from the Coronavirus Aid, Relief, and Economic Security Act, (CARES Act) Provider Relief Fund (PRF) and the American Rescue Plan Act of 2021 (ARPA), Coronavirus State and Local Fiscal Recovery Fund (SLFRF), the company must comply with all reporting requirements instituted for recipients of these funds.
History
The company was founded in 1996. The company was incorporated in 1996. The company was formerly known as The Providence Service Corporation and changed its name to ModivCare Inc. in January 2021.
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