Can Psilocybin-Assisted Therapy Be the Magic Key to Link Value Added NEMT Services to Higher Pay?

By: Dan Reid, President/Managing Member, Grove Transit 

Far too often healthcare-related transportation, commonly referred to as NEMT or non-emergency medical transportation, is treated as a commodity rather than a value-added part of an individual’s medical treatment.  For sure there are instances where all an individual needs is a ride from the curb near their residence to the close proximity of their medical appointment (and back), and if specific instances then perhaps the transportation can be assigned to the lowest cost provider able to perform the trip on time.  However, this “commodity” approach often gets misapplied to trips where transportation is an integral and sometimes critical piece of the healthcare ecosystem for an individual.

Steve Newman at 360 Care & Comfort in St. Louis has written and spoken often about de-commoditizing NEMT by providing premium services, and more importantly being paid a premium price, when a passenger requires more than “just a ride to the doctors”.   Seldom have I heard anyone disagree with Steve’s approach, including paying sources. Unfortunately, as Steve readily concedes, getting someone to agree that value-based pay for NEMT is appropriate and actually paying a premium for high-value service can be quite a challenge.

This past month I attended a TTA Open House at Kelly Milan’s Sunshine Rides based out of Grand Junction, Colorado.  I’ve always contended that I have never attended an open house where I didn’t take away more value in terms of new ideas and information than I ever spent attending.  This open house once again confirmed my contention when the discussion turned to transportation for individuals receiving psilocybin-assisted therapy, a topic Alan Currie, Sunshine Rides, and Jeremy Oliver, Oliver Northwest Services, were familiar with due to the increasing presence of this type of therapy in their home states.   Additionally, it was noted that psilocybin-assisted therapy is increasing being recognized as a Medicaid approved treatment.

What is Psilocybin-Assisted Therapy

Psilocybin-Assisted Therapy is a form of treatment that combines the controlled use of psilocybin with structured psychological support to address conditions such as depression, anxiety, PTSD, addiction, and end-of-life distress.  Psilocybin naturally occurs in certain varieties of mushrooms (often referred to as magic-mushrooms) but is increasingly produced synthetically in labs for use in research and therapy treatments.

Research from institutions like Johns Hopkins[1] and NYU[2] shows that psilocybin, when combined with professional therapeutic guidance, can produce long-lasting improvements in mood, well-being, and emotional resilience[3]. Unlike recreational use, psilocybin-assisted therapy is highly structured, emphasizing safety, preparation, and integration to maximize therapeutic outcomes, also known as “set and setting”.  For a successful therapeutic outcome, proper set and setting are critical.

• Set – the patient’s mindset, emotional state, intentions, and expectations

• Setting – your environment, including people, space, sounds, and overall atmosphere.

This concept was first developed by Timothy Leary in his 1961 paper discussing the importance of having the proper setting before conducing psychopharmacological treatments.  Later researchers expanded the concept to include the post-experience (therapy) environment.[4] 

Inherent in the concept of set and setting is that how a patient arrives to their session and how a patient leaves the clinic is as important as what happens during the treatment.   For this reason, many clinics discourage the use of TNCs for their patients as the clinic cannot have one on one coordination with the drivers, they are concerned about whether a TNC driver will provide an appropriate environment (stress-free, no loud noises, proper vehicles, and a driver attuned the passenger’s unique needs).  Alan and Jeremy discussed developing a standardized protocol and training for drivers transporting individuals to and from psilocybin-assisted therapy sessions, and equally as important the clinics’ understanding for the importance of using properly trained drivers.

Recognition that transportation is part of the medical ecosystem

Where is this leading us too?  Could it be that such an unlikely procedure as psilocybin-assisted therapy could be the key to finally achieving value-based pay for NEMT?   I do believe that could be the case.  

We’re seeing that long sought after holy-grail where the health care providers understand that to maximize the health outcomes for their patients, they need to specifically request NEMT drivers with the proper training, equipment, and understanding of their passenger’s needs to provide such results.  NEMT providers who provide comfortable vehicles, perhaps with tinted windows, a soothing interior environment including avoiding loud music, non-stop talk radio, and properly controlled temperatures, and with procedures in place (notifications, timeliness, drivers avoiding anxiety producing driving with tendencies) should be able to capture the market share of trips for these types of therapies and command a price that reflects the value of these services. 

As an industry, NEMT providers need to develop the necessary training, service protocols, and perhaps even standards through organizations such as NEMTAC to be at the forefront of defining NEMT services for these types of therapies.

An outline for tailoring NEMT transportation to accommodate passengers receiving psilocybin-assisted therapy might include some of the following steps

1. Require mandatory transportation plans designed for the individual and requiring the use of clinic-arranged drivers trained in post-psychedelic care, rather than those randomly assigned via a rideshare app.

   
   

2. Use only vetted, trained drivers who understand basic therapeutic boundaries, privacy, and emotional neutrality.

   
   

3. Ensure that drivers arrive in sensory-safe vehicles with quiet environments, minimal conversation, and soft lighting to reduce overstimulation.

   
   

4. Avoid curb-to-curb levels of service.  Instead require hand-to-hand with direct coordination with therapists so that drivers receive handoffs and emergency contacts, ensuring continuity of care.

   
   

5. Ensue policy integration through incorporating transportation protocols into licensure and compliance audits.

   
   

As the concept of viewing the NEMT service as an integral piece of an individual’s psilocybin-assisted therapy, and therefore contributing to more positive health outcomes, takes hold, we should find it easier to apply this notion to the more established areas of healthcare where NEMT has long played role such as dialysis, chemotherapy, and acute wound care, to name a few.

We’re all familiar with studies indicating that transportation related missed dialysis sessions increase the risk of hospitalization by 23%[5].   Additionally, stressful or unreliable rides can elevate patient anxiety, compounding hypertension and fatigue, which can worsen ESRD symptoms[6].  Similarly, the American Cancer Society reports that one in five cancer patients delay or miss treatments due to transportation issues, other studies have pointed out that patients using unpredictable rideshare services may be exposed to infectious environments, inappropriate driver interactions, or long delays when they are immune compromised and exhausted.  There is no less importance on safe, reliable transportation for patients receiving wound care treatments.   The Journal of Wound Care reported that missed wound appointments increase complication rates by 42%, often leading to prolonged recovery or amputation.  Further studies have shown that stress, such as what one might incur from unreliable or unsafe transportation can lead to elevated cortisol levels and impair wound healing[7].

Conclusion

No one disputes the positive impact quality NEMT services can have on patient outcomes, and as we can tie the successful health outcomes for patients receiving psilocybin-assisted therapy to quality NEMT services, we can hopefully begin to convince the industry, and specifically the paying sources, of the benefits to all for paying for premium value-added services in all instances where the transportation piece of an individual’s medical appointment is more than just a commodity or “a ride to the doctor’s”.  Maybe then the value-based premium NEMT services Steve Newman talks about won’t be a concept, rather it will become standard practice.

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Dan Reid serves as President of The Transportation Alliance and on NEMTAC’s Board of Directors.  Dan is Co-Chair of NEMTAC’s Certification and Standards Advisory Committee and serves on the NEMTAC’s Accreditation Advisory Committee, Compliance & Regulatory Advisory Committee, and Technology Advisory Committee.  He operates two NEMT companies in Mississippi and Louisiana and is a frequent author and speaker on issues related to the passenger ground transportation industry.

[1] John Hopins Medicine, February 15, 2022, https://www.hopkinsmedicine.org/news/newsroom/news-releases/2022/02/psilocybin-treatment-for-major-depression-effective-for-up-to-a-year-for-most-patients-study-shows

[2] Petridis, Petros MD, Ross, Stephen MD, Bogenschutz, Micheal MD, O’Donnell, Kelly MD, Psychedelic Drug Therapy May Address Mental Health Concerns in People with Cancer & Addition, NYU Langome Health, January 2, 2024

[3] Davis, Alan PhD, Barrett, Fredick PhD, May, Darrick MD, Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder, A Randomized Clinical Trial, JAMA Psychiatry, November 4, 2020, doi:10.1001/jamapsychiatry.2020.3285

[4] Hartogsohn, Ido. (2017). Constructing drug effects: A history of set and setting. Drug Science, Policy and Law. 3. 205032451668332. 10.1177/2050324516683325..

[5] Fotheringham, J., Smith, M.T., Froissart, M. et al. Hospitalization and mortality following non-attendance for hemodialysis according to dialysis day of the week: a European cohort study. BMC Nephrol 21, 218 (2020). https://doi.org/10.1186/s12882-020-01874-x

[6] Diamant MJ, Harwood L, Movva S, et al. A comparison of quality of life and travel-related factors between in-center and satellite-based hemodialysis patients. Clin J Am Soc Nephrol. 2010;5(2):268-274. doi:10.2215/CJN.05190709 

[7] Blossett, Marie, Assistant Editor, Psychological stress impairs wound healing and collagen production, July 22, 2025, Dermatology Times.