Lyft and Uber’s big tech twists on a Social Determinant of Health–medical-related transportation

Social determinants of health (SDOH), that widely-discussed concept often dismissed as the turf of social workers and small do-good companies such as Healthify, are receiving a substantial boost from two profit-oriented, on-demand transportation companies: Uber and Lyft. Several years ago, smaller companies such as Circulation and Veyo [TTA 21 Feb, 26 Apr 17] entered the non-emergency medical transportation (NEMT) field with their on-demand services. These proved to be valuable links in the continuum of care–valuable in helping patients make their appointments, at generally a lower cost than Access-a-Ride or taxis, while collecting a wealth of data on usage.

Uber and Lyft’s recent announcements take the NEMT concept further with integration into discharge planning, chronic care management in practices, and EHRs while keeping it simple for patients and caregivers.

  • The launch of Uber Health, targeted to healthcare organizations (and just in time for HIMSS). The ride booking for both patients and caregivers uses a HIPAA-compliant dashboard for the health manager to book the ride, and text messaging to the patient for confirmations and pickup. Over 100 healthcare organizations are piloting the service. MedCityNews
  • Lyft Business inked a deal with Allscripts to integrate booking transportation into appointment setting. The Allscripts EHR is in 45,000 physician practices and 2,500 hospitals (which doesn’t include newly-acquired Practice Fusion’s 30,000 small ambulatory sites). Besides its own driver base, Lyft also has used its Concierge API to facilitate partnerships with NEMT brokers working with providers such as Circulation, National MedTrans (the NEMT provider for Anthem’s CareMore Health Plan HMO), and American Medical Response for drivers and more specialized vehicles. Hitch Health works with Lyft and independently integrates into Epic and Athenahealth. MedCityNews, POLITICO Morning eHealth (scroll down).

But does providing transport for appointments save money? The logic behind it is that missed appointments can exacerbate existing conditions; a direct example is dialysis, where missing an appointment could result in a hospital admission. Another area is patient avoidance of making appointments. The CareMore Health Plan study reduced waiting times and ride cost, increasing patient satisfaction–great for HEDIS and ACO quality scores, but the longer-term cost saving is still to be determined.

Another attraction for Lyft and Uber: steady revenue. In Medicare Advantage, 70 percent of members are covered and all state Medicaid programs reimburse their members for qualifying transportation.

Sustainable transportation models for patient access to care at lower cost

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics) returns to the transportation aspect of social determinants of health earlier explored in her article on Veyo [TTA 21 Feb]. New on-demand services provide affordable ‘a to b’ transportation not only which is clean, safe and tailored to the patient’s needs, but also accountable to the health system or provider. A surprise here is that Circulation’s service is not smartphone dependent. 

Circulation, Inc. launched its Non-Emergency Medical Transportation (NEMT) system with just a few hospitals back in September 2016. This game changer company provides on-demand rides with a healthcare transportation platform and an Uber app.  To date, they have expanded significantly with over 30 new clients and ride access in over 25 states. Last week, I had the pleasure to speak with Robin Heffernan, PhD., the co-founder and CEO of Circulation, to learn how they have been able to achieve a successful cost-effective and reliable transportation system for patients and providers. A gently edited version of our conversation follows below.

How has Circulation reduced the cost of a ride with an NEMT system? How will cost savings trickle down?

Heffernan: Our health facility clients are saving costs on the ride component only.  When someone transitions from mostly using taxis to being able to use Uber rides, the cost of that ride is 40 to 50 percent less. We have not yet calculated the bigger total cost savings for our clients. When patients actually make their ride appointment, the savings begin because they are not missing a primary care appointment. Without a scheduled ride, they may decide to take an ambulance the next day to the ER for a basic cough.  I think this is a huge advance for this industry. From day one you are going to achieve significant savings on a pure ride cost basis, get increased patient satisfaction and see your patients actually getting to appointments on time. Health facilities can track for the first time a whole downstream value proposition, and actually tie transportation to appointments to costs like ED utilization. Our solution tracks this component with our clients.

How does Circulation’s transportation model impact value-based care? (more…)