How Uber and Lyft are Driving Patient Access to Care
The ride-sharing giants and Uber and Lyft have clearly set their sights on the Non-Emergency Medical Transportation (NEMT) market, which arose from the 1966 Medicaid mandate that transportation be provided to and from healthcare service providers. A couple of statistics explain why they’re moving into NEMT.
With the aging of the population, and the expansion of healthcare access accomplished under the ACA, came a considerable increase in demand for patient transportation. Another factor is the rise of Managed Care Organizations (MCOs) covering Medicaid patients, which has brought an explosive increase. MCOs, which in 1991 covered some 10 percent of Medicaid beneficiaries, today cover about 75 percent of a patient population of more than 70 million. According to one estimate, NEMT covered some 104 million medical trips in 2013. The Kaiser Family Foundation reports that annual NEMT spending has reached some $3 billion. Additionally, a study by the National Academies of Science Transportation Review Board estimates NEMT spending will need to increase by a low-end estimate of $100 million per year.
A 2014 CMS survey of Medicaid revealed that lack of transportation was the third highest barrier to care for adults with disabilities, with 12.2% reporting they couldn’t get a ride to a doctor’s office. Adults who lack transportation to medical care are more likely to have chronic health conditions that can escalate to a need for emergency care, according to another study. Some 3.6 million adults miss or delay non-emergency medical care annually due to transportation barriers. No-shows result in significant financial consequences for health systems. A 2010 post in the Harvard Business Review found that missed appointments are likely costing the healthcare system over $150 billion annually.
Enter The Disruptors
Here’s a snapshot of rideshare inroads in NEMT:
In May 2018, about a year before going public, Uber launched a medical-transportation division called Uber Health, which works with the provider’s appointment schedule to set up a pre-booked ride to and from the appointment. Uber’s system works this way:
As the patient appointment is set, the provider’s scheduling associate books a ride for the patient via a custom Uber Health dashboard. On receiving the booking, Uber sends ride details to the patient via text or call. The patient gets an alert when their driver is on the way. The patient is picked up and dropped off on schedule, without further action from the provider. The Uber Health web site asserts that privacy compliance and patient safety are top concerns.
Lyft has also moved from pilot programs to community health partnerships with hospitals and health systems across the country. Lyft’s Wheels for All program responds to natural disasters and other crises and offers rides to low-income individuals in need of transportation to medical appointments. In 2017 Lyft entered partnerships with LogistiCare, the nation’s largest NEMT manager, and American Medical Response, the largest dedicated medical transportation provider.
Other Players In The Segment
Other players tie in with health providers and transportation services. Boston-based Circulation is a nationwide manager of NEMT programs for state government agencies and managed care organizations. The company has a network of transport providers that offer sedan/livery, wheelchair van, and non-emergency ambulance rides. In 2016, Circulation joined with Uber in a pilot program to coordinate NEMT services. A 2017 startup called Ride Health, created by University of Pennsylvania and Wharton School graduates, works with Penn Medicine’s Abramson Cancer Center to arrange Uber and Lyft rides for patients.
Surveys indicate successful outcomes
A pilot program involving Lyft and CareMore, a network model health maintenance organization operating Medicare Advantage plans in California, yielded encouraging results. A survey of 479 rides in a month’s time in 2016 showed that average wait times fell by 30%, average per-ride costs fell by 32.4%, composite patient measures yielded an 80.8% satisfaction rate. CareMore also saved $1 million by switching to Lyft.
A study, recapped in the Advisory Board Daily Briefing, reported that by using automated SMS technology from Hitch Health, Minneapolis’s Hennepin Healthcare, reduced no-shows by 27%, and increased the clinic’s revenue by an estimated $270,000 with an estimated ROI of 297%.
The same article reported Boston Medical Center’s finding that it achieved both greater patient satisfaction — and $500,000 in transportation savings — by using Uber Health.
Battle Of The Rideshare Giants
Lyft lists partnerships with 9 health care systems including the 141-hospital system Ascension and Denver Health.
Uber touts arrangements with 100 healthcare organizations including MedStar Health, LifeBridge Health, NYU Perlmutter Cancer Center and Yale New Haven Health. In some cities, the Uber app accommodates wheelchair passengers with a dropdown option to specify a ride via UberWAV (WAV=Wheelchair Accessible Vehicle).
Patients Choose Convenience
As the consumerization of healthcare advances, new segments of the provider-patient relationship are adapting to the preferences of patients who want their health care experience to be as simple and convenient as their online interactions with banks, retailers, hotels, and – well, Uber and Lyft. In response, Uber and Lyft have created concierge services that reach for markets beyond Medicaid and Medicare Advantage, by helping healthcare providers routinely offer a pre-arranged ride when the appointment is booked. This is especially useful when lead time is tight, such as when test results indicate the need for prompt follow-up consultation, therapy or surgery. In an environment where non-emergency transportation needed considerable lead time, Uber and Lyft bring well-honed tools for delivering transportation on demand.
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