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?

Heffernan:  I am a huge proponent of value-based care and the transition to more and more value.  We saw five years ago health plans and hospitals spending a lot of time figuring out who were the right providers to attract and retain in their network. Then they recruited members/patients to their organization. Next, they would spend a lot of time assessing the member/patient to understand their unique needs.  And, finally, they would develop care plans and a variety of services to best support the member/patient. The health plan or hospital has a sophisticated network, a care plan for the individuals and add a bunch of different care team members as well as set up all these services for their members. But then if I ‘m  a health plan or hospital, I may outsource transportation and not care about it. Guess what?  If you can’t get the patient to and from the service, it all falls apart.  So now they are becoming much more interested in how to make that process successful.  Having put so much work in on the front end for the patients to see the benefit and for our providers to be happy, and for us to actually reduce readmissions and to create better health for these members, we need to make sure we are managing the entire process. And transportation is a large part of that.

How does Circulation incorporate Social Determinants of Health strategies given the various socio-economic levels of the patients that you serve?

Heffernan:  This [Social Determinants of Health] is absolutely critical. This has been on our minds from the beginning and is particularly relevant since we support individuals with socio-economic challenges. We work with  Common Healthcare Alliance, a dual-eligible plan in Boston, as well as homeless shelters and behavioral health clinics. These patients have mental health conditions, disabilities, multiple chronic conditions and need access to other social services.  We work with a couple of different shelters and several health plans helping to get many in need of rides to either medical appointments and non-medical appointments. Whether it is a church visit that is critical, a substance abuse support group or the grocery store, we take them back and forth from the shelters. And all of these things are key. When we think about people that need these services, most of the time they have been left out.

Has the smartphone Uber technology become a game changer for healthcare?

Heffernan:  The on-demand nature that Uber has created in the world of transportation is a game changer. How you access that is really important. Circulation is essentially that layer in between. Let’s assume a health system has a ride request. How do you ultimately match that ride request with fulfillment from an Uber ride or other ride providers?  There needs to be a lot of sophistication in this matching layer including understanding someone’s eligibility and authorization for the ride, as well as their need for special requests such as a wheelchair, a non-emergency ambulance, or someone to help them get to and from the door. With all of that, you have to be able to match them to the appropriate ride for the specific day and time desired. I think Uber has been great for providing the ride option at the end, but what was missing was the full integration piece to actually match up a request to fulfillment. In respect to the smartphone, we actually have several ways that we contact our users to tell them about rides and give them reminders.  We use LAN line phone calls, text messages, and email.  We do not require users to download a separate app. We actually found that a lot of our clientele do not necessarily have a cell phone, especially the elderly.

Is Circulation tracking the rides back to the electronic health records?

Heffernan:  Yes. We tie in with various components of a health system via health records, member service files and other places. We try to close that loop between appointment and a ride. Because if someone is not going to make their ride, then they are not going to make their appointment and vice versa. And typically they’re two different systems that don’t talk to each other. We have been able to reduce the no-show base for providers. In the times where the patients can’t make their appointment, providers now have enough of an advanced notice window to reschedule open time slots.

What is the vision for Circulation the future? Thoughts on driverless cars in 2025?

Heffernan:  The vision for Circulation has always been with the logistics platforms. Our platform matches ride requests with that ride fulfillment. We are fairly agnostic on how that fulfillment gets done. It can be a local wheelchair van, a traditional-NEMT ambulance, an Uber ride or a driverless car.  In the future, it very well might be one.  For us, the critical piece is the exchange or matching platform, and we are less focused on the particular type of vehicle or driver that fulfills the request. The more options, the better actually. The other thing that we are focused on is creating a broad-based health care logistics platform, and moving people is one component of that. But there are a lot of other logistics that we plan to expand into in the future.

For more on Circulation, click here.

This article was originally published in RCM Answers and is republished here with permission and with appreciation to Sarianne plus Answers Media Company LLC’s Roberta Mullins and Carol Flagg.

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