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.
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…)
Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics examines one aspect of social determinants of health, transportation. Social factors have been called the missing links in population health: others are housing, food, finances, and employment. This is not only affordable ‘a to b’ transportation, but also clean, safe and tailored to the patient’s needs. Sarianne interviewed Todd Thomas, then of Veyo and now of Zendrive, a company developing data analytics to make roads safer and to save lives through measuring driver behavior and coaching. Other companies in Veyo’s area are Uber Health and Circulation [TTA 10 Nov].
More and more people are starting to have conversations around the Social Determinants of Health. And for the first time, the c-suite within healthcare companies are talking about transportation. People haven’t talked about transportation before because there haven’t been good choices, only poor and expensive service levels. Transportation has always been a low budget item and a cost center. Now people are talking about transportation as a key link in the complete continuum of care. If we are talking about treating the complete person, a huge part of that is making sure they are getting to their treatments on time every time, picking up their pharmaceuticals and shopping to get fresh, clean food. These things make a huge impact in the lives of patients and the members. It is great that people are becoming aware of transportation and talking about it. — Todd Thomas, VP Strategic Business Development at Veyo
Social Determinants of Health, as recognized by the World Health Organization, are the conditions in which people are born, grow up, live, work and age, together with “the systems” that are put in place to deal with illness. Transportation is one of those systems. In a conversation with Todd Thomas, VP of Strategic Business Development at Veyo, he chronicled how the digitization of this sector broke barriers in Non-Emergency Medical Transportation. The medical transportation, as Thomas described, was very challenged for decades with the same nationwide providers, all delivering the same levels of service and at the same price. None had any initiative to adapt to new technologies or evolve their business models. Medical professionals and companies across the US had come to expect poor service as the norm. It wasn’t until a couple of years ago when the transportation network companies, the TNCs such as Uber and Lyft, came onboard into the market and really changed transportation in the US and in the world. Thomas contends that what the TNCs did for the transportation world has really turned things upside down, and absolutely raised the level of customer expectations and raised standard of what transportation was going to be. And ultimately closed a huge care gap for transportation-dependent patients. (more…)
Now that the bustle of the holidays is over and the frigid days of winter are here, this weekend grab your cup of hot cocoa, an afghan rug or snuggie, and click through a one-page compendium of the NYeC Digital Health Conference in NYC last December. The page links to presentation slides and video; most have both. (Unfortunately, not all presentations nor the lunch breakouts are included.)
This Editor highly recommends the following:
- The Tuesday keynote on ‘The Digital Doctor’ by Dr Robert Wachter, who is influencing the NHS. (Yes, EHRs and e-prescribing have turned physicians into data entry clerks.)
- ‘Turning Impossible on Its Head’ on disrupting healthcare with technology: Robert Putrino of Burke Rehabilitation Center on a miracle of 3D printing
- DSRIP 2017 and readmissions may not sound very interesting, but the presentations by Veyo‘s Josh Komenda on how transportation assistance can also aid compliance, and the discussion on the missing link of population health may be social determinants of health care, are.
- Wednesday’s ‘Universal Patient Identity’ presentation by Tom Foley of Lenovo Health; a must-see by anyone interested in preventing identity fraud and theft at the provider level
- “The Patient Room of the Future’ by Joan Saba, partner of NBBJ Architects. Responding to this Editor’s question via Twitter on how design can prevent nosocomial (healthcare-acquired) infections, I was directed to an excellent Becker’s Hospital Review article written by two of their firm’s leaders.
- The very last presentation, ‘Resuscitating the Child’, was one of the finest and may also break your heart. Peter Antevy, MD, medical director of two EMS in Palm Beach County, Florida, presented the human cost of both EMTs/paramedics in rescue and the frustration of not having the proper tools to calibrate medication and procedures quickly on a patient who cannot be administered full doses, all in emergency situations. His company, Pediatric Emergency Standards, is developing software that can do so quickly and on-scene. Dr Antevy’s passion for his work and for applying technology to this situation is abundantly present.
NYeC Digital Health Conference final presentations page. TTA was a conference/media partner of the 2016 NYeC DHC, and thanks Jesse Giuliani and Andie Egbert for their invitation and coordination assistance.