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How Rideshare Companies Can Address Social Determinants of Health
Rideshare companies have become an important vehicle for driving better patient care access and addressing the social determinants of health.
Rideshare companies, such as Uber and Lyft, are cruising into the healthcare spotlight. As medical professionals focus on improving patient access to care and addressing the social determinants of health (SDOH), these rideshare services are a cheap and effective option for meeting industry needs.
For millions of patients across the country, getting a ride to a medical appointment is a genuine challenge. Public transportation can be unreliable or unavailable, many individuals lack access to their own vehicles, and patients may not always be able to secure a ride from a friend or family member at the right time.
Access to transportation is one of the most important social determinants of health (SDOH), according to the CDC.
Social determinants are defined as the “social structures and economic systems [that] include the social environment, physical environment, health services, and structural and societal factors,” the CDC says on its website.
“Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world.”
Addressing transportation barriers can be a challenge for healthcare providers and policymakers. Non-emergency medical transportation (NEMT) is already a Medicaid covered benefit, but gaps still persist.
Not all Medicaid beneficiaries can access NEMT services in their communities, and individuals who are not eligible for the public payer program still have few options.
Most Medicare beneficiaries do not have access to transportation services through the program, either, despite the fact that this population might face mental and physical health barriers to driving themselves to the doctor.
Currently, ambulance transportation is covered under Medicare Part B, but that requires patients to use an ambulance for NEMT and to provide proof of necessity from a provider.
For years, NEMT broker companies have worked to fill these gaps. Transportation brokers assess a patient’s unique transportation needs and connects that patient with the appropriate type of transportation, such as an ambulance or a wheelchair accessible van.
But these offerings tend to be limited and exceptionally costly for Medicaid, especially for patients who don’t need special services, just a ride to the clinic, according to Robin Heffernan, CEO of NEMT broker company Circulation.
“Previously, the bulk of transportation was really either state-sponsored or managed care organization-sponsored,” Heffernan said in an interview. “They offered rides for medical appointments, largely for Medicaid members a little bit of Medicare. That spending totaled at about $5 billion on an annual basis.”
The rise of rideshare companies such as Uber and Lyft in the consumer transportation market has changed all of that.
Now, many NEMT companies, including Circulation, have partnerships with rideshare organizations. This has brought transportation costs down while improving access for all patients, not just those who receive Medicaid benefits.
Uber and Lyft have also entered into the healthcare space in their own right. Through individual partnerships with healthcare organizations and the development of their own tools, these rideshare companies have emerged as key players in addressing the social determinants of health.
Integrating rideshares into the healthcare environment
As of 2017, medical transportation was the leading cause of patient no-shows, according to data from the American Hospital Association (AHA).
Nearly 3.6 million individuals did not access medical care because they did not have a ride. Four percent of all children currently miss a medical appointment because of transportation barriers.
Around 2016, rideshare companies began finding themselves filling a healthcare need they may not have anticipated. What was once a mission to offer a taxi cab alternative has quickly become a lifeline for some patients who need a ride to the doctor.
Uber and Lyft capitalized on the opportunity to address this core social determinant of health and began establishing community health partnerships with hospitals, NEMT companies, and other healthcare groups.
These partnerships quickly displayed their potential to accomplish key healthcare goals, including keeping costs low.
A 2016 article in the Journal of the American Medical Association showed that a rideshare deal between Lyft and patient advocacy group CareMore reduced transportation costs by about $10 per patient per ride.
Now, these rideshare partnerships span organizations of all types and sizes across the country. Notably, provider organizations such as MedStar Health and Sutter Physician Services have partnered with Uber and Lyft, respectively, to make sure their patients can attend their appointments.
NEMT companies, including American Medical Response, Logisticare, and Circulation, also have partnerships with one of the two rideshare groups.
And BlueCross BlueShield has established ties with Lyft to make sure its beneficiaries can access their care.
The success of rideshare companies in the healthcare space have led both Uber and Lyft to take a step further and create their own individual systems targeted directly at the healthcare industry.
At the HIMSS 2018 conference, both companies announced plans to expand their footprints in the healthcare industry by way of tailored digital healthcare platforms.
Uber announced the launch of Uber Health at the start of the conference, unveiling a new platform within the Uber app that allows patients, providers, and other healthcare stakeholders to access rides specifically for healthcare. Uber Health offers its own dashboard through which providers can book a ride for a patient after assessing the patient’s specific medical needs.
For Uber, this move made sense considering their expertise and nearly endless resources in the transportation market, according to Uber Health’s head of strategy Lauren Steingold.
“When we thought about this problem, it was very clear to us that Uber has rides in spades,” Steingold said to PatientEngagementHIT.com. “If we can help provide that to the people who really need it most, we can help them get to the care they need and connect those dots and make it so that transportation is the least of their worries.”
The Uber Health platform is its most efficient strategy for supporting the healthcare industry, Steingold said, although Uber will continue to support its hospital partnerships.
“We started using the Uber APIs to work with different healthcare or patient and caregiver transport organizations,” Steingold explained.
“While those partnerships are great and some of them are still going today, we saw there was a lot of demand coming from healthcare organizations all over the world. We felt that if we really wanted to make a difference in this space, it was important for us to have a direct offering ourselves.”
Lyft made a similar announcement during HIMSS18. The company unveiled a new partnership with EHR vendor Allscripts, which was geared toward integrating the Lyft app into the EHR workflow. A provider can then order a patient a Lyft right from within the EHR, making the process seamless.
Lyft also vowed to reduce care gaps caused by transportation barriers by 50 percent within one year.
Lyft’s efforts in this area are about making their services accessible for patients, according to Gyre Renwick, the vice president of Lyft Business.
“Many individuals on Medicaid don't have a smartphone or don't have the means to actually pay for transportation,” Renwick said.
“We wanted to pull the traditional Lyft experience that existed on the phone out of the hands of the actual consumer and put it more in the hands of the providers, the health systems, the payers, and others to be able to administer that transportation for those members.”
Lyft also offers a patient-facing healthcare tool called Concierge, but most of the company’s efforts for now appear to be about connecting the Lyft API to providers. This should make the transportation process simpler, Renwick explained.
“The challenges we're solving for these hospitals started out by replacing taxi voucher programs, where providers were using taxi vouchers as a paper-and-pen-based way of requesting rides or giving rides out to their members,” he said.
“But as we started to grow these partnerships, we realized there are other challenges to face around both moving patients to the facility as well as moving staff and physicians to the facilities. We really expanded our partnerships for patients and the actual hospital staff themselves and expanded those across the country today.”
Considerations for the proper use for rideshare services
Despite the potential for rideshare companies to close healthcare transportation gaps, there are some important caveats.
Some public health officials have questioned whether rideshare partnerships actually improve patient attendance to appointments. A 2018 JAMA article indicated that patient attendance remains the same, even after a hospital employs rideshare services.
However, those results may not adequately consider Uber and Lyft’s limited accessibility for patients with complex health needs. These companies don’t have many services for patients who must travel with bulky medical equipment or mobility devices - nor do they claim to.
“Anyone who is riding as part of Uber Health – and this is something that we communicate with all of our health care organizations including the patient or caregiver – should be both ambulatory and lucid,” Steingold asserted.
“These rides are happening when the people who need transportation are folks who would otherwise be getting a ride with a friend or family member. These are not patients who are sedated or are in some sort of condition that is a risk.”
Lyft has a similar policy, Renwick said.
“We put it on our providers to determine if someone is the right level of acuity or at the right level of medical care to be appropriate for a Lyft ride,” Renwick stated. “We're not going to be a fit for 100 percent of the members, but we are really strongly focused on the population that is appropriate for Lyft, which is the majority of those ambulatory patient trips.”
Providers must bear that in mind and use these services for the right purposes. Requesting an Uber or Lyft ride for a patient with complex medical equipment won’t improve patient attendance, but focusing on an ambulatory patient population might.
Of course, there are some situations during which patients may use Uber or Lyft to get to the hospital that are not necessarily associated with any healthcare partnership or health-specific app. A patient might hurt herself in her home and use the traditional Uber or Lyft apps to get to urgent care, for example.
Rideshare companies recognize the importance of educating users and drivers in these situations to ensure both are protected should something go wrong during the ride.
“We encourage both riders and drivers that if it’s an emergency situation, 911 is always the best option,” Steingold said.
Uber drivers work as independent contractors, therefore it is up to their discretion - and the discretion of the rider - to follow recommendations and guidelines around emergency health situations.
Although Uber and Lyft have done a great deal to improve care access for generally well patients, challenges remain for those who need more assistance during the transportation process.
NEMT brokers have the resources necessary to ensure all patients have access to a ride, regardless of the additional support they need, said Heffernan.
Circulation, for example, collects ample patient information to give providers the tools to determine the most appropriate ride for a patient. Knowing the patient’s insurance benefits, health needs, preferences, and other special circumstances helps the broker decide which ride option best suits the patient: a Lyft, a van, an ambulance, or another vehicle.
“Based on the specifics of that ride request, we look at our whole network and filter out which services are appropriate for this ride,” Heffernan explained. “Then we show a drop down list to the client of all those different options.”
How rideshare services have impacted other healthcare offerings
On the whole, rideshare services have set a new standard for non-emergency transportation across the country. The emergence of Uber and Lyft in the healthcare space has followed a growing demand for consumerism in healthcare, and other transportation brokers and medical providers are responding in kind.
The 2016 JAMA article featuring CareMore showed that in addition to cost savings, rideshare services have improved patient satisfaction. This is likely because riding with Uber or Lyft can be convenient and is familiar for patients who use the apps for other purposes.
The ability to see who is driving the car, the license plate number, and the estimated time of arrival have delivered on key patient preferences, especially as consumerism takes hold in the healthcare space.
Those features have also have a positive impact on more specialized ride services, according to Heffernan.
“Ride sharing, including Uber and Lyft, changed the expectations in this market so that folks – both providers, call centers, and patients – want their rides to be convenient to schedule,” she pointed out. “They want rides to show up right away. They want them to be easily trackable. They want the billing and receipts to be handled pretty seamlessly on the backside.”
The consumer-centric nature of rideshare services has even begun to influence Circulation’s more specialized rides.
“We’ve done a lot of work to improve these traditional door-to-door services, wheelchair vans, ambulance, non-emergency stretchers that have traditionally operated by the call center model,” Heffernan continued. “We’ve had to help them digitize their own fleet and then get those fleets integrated into our platform.”
All of Circulation’s rides -- not just those offered by Lyft -- arrive within thirty minutes of a call, she added. Some of those rides also offer driver headshots and other consumer-facing information that could help make the ride more comfortable.
The ease of integrating Uber and Lyft rides into healthcare has made these services a much more realistic benefit.
While there is certainly a focus on addressing the social determinants of health, Renwick said payers and hospitals are also using rideshare to improve the consumer experiences and drive satisfaction.
“Providers are looking at adding transportation as a value-added service to be able to not only lower their cost but also improve the experience of those members as well as the overall health outcomes for those members,” he said.
Heffernan agreed, noting that rideshare offerings are a win-win solution.
“For a hospital, medical transportation reduces no-show rates,” she stated. “It helps improve my bed utilization if I can discharge someone and get them home. It helps with overall cost that someone is going to bear on the system. It’s better if I can make sure they get their proactive appointments because then they won’t develop a cough and take an ambulance to the ED the next day.”
This is just the beginning for rideshare companies. Uber and Lyft are in the nascent stages of developing their healthcare-specific products. And as the healthcare industry shifts to meet more consumer needs, rideshare tools will likely shift as well.
As medical professionals continue their work to address the many social determinants of health -- which can include food security, social isolation, and housing security -- the transportation safety net will become even more important. Using transportation to improve health will impact other SDOH, making the services from Uber, Lyft, and NEMT brokers essential.
“What we’ve found just over these last couple of years is there’s a wealth of other instances and use cases for transportation support,” Heffernan concluded.
“They run the gamut from medical appointments, behavioral health appointments, substance abuse, and general community activities, such as grocery store runs or church visits. All of those things are what helps someone stay healthy.”
