Getting to medical appointments on time is challenging when you feel sick, don’t drive or have limited means of transportation. Too often, patients spend long hours traveling back and forth for crucial treatments or routine…
Getting to medical appointments on time is challenging when you feel sick, don’t drive or have limited means of transportation. Too often, patients spend long hours traveling back and forth for crucial treatments or routine check-ups.
Older patients, low-income patients and those with multiple medical conditions are particularly vulnerable to gaps in timely transportation options.
In response, on-demand, ride-hailing services such as Uber and Lyft are playing a growing role in nonemergency medical transportation. Health care providers, insurers and others are working with these services to make better use of their resources and reduce transportation frustration for patients.
In 2017, Penn Medicine’s Abramson Cancer Center launched Ride Health, a pilot program that works with Uber to offer transportation to patients who lack other means of getting to appointments for treatments like chemotherapy.
“Most of the patients who we use this for are low-income and cannot afford to get here,” says Tiffany Raroha, an oncology social worker with the Perelman Center for Advanced Medicine, part of Penn Medicine. “Sometimes they’re on Medicaid, and through Medicaid, medical transport is provided for free.”
Last-minute appointments can arise, Raroha says. “Maybe the doctor calls the patient to say, ‘I need you here today because of the lab results,'” she explains. “The Medicaid transportation service doesn’t work for same-day requests. So, it’ll leave a patient, who literally does not have funding, to pay for the bus to get here. It leaves them with no option. Those are typical times when we will utilize this service.” Patients receive a round trip, with an Uber taking them home as well.
Consequences of missed appointments could be serious for patients. “It could be less effectiveness of their treatment to cure their cancer,” Raroha says. “It could mean a hospitalization if they can’t get here for a blood transfusion that’s needed.”
The program doesn’t necessarily fit certain patients with complex needs. “It’s not a medical service; it’s a transportation service,” Raroha says. “If it’s someone who requires a higher level of care, or they’re wheelchair bound, we have paratransit services for them.”
With traditional shared ride van services, patients are at the mercy of the driver’s schedule. They often face long delays when getting picked up for appointments and waiting to go home. “It can be very taxing for patients, particularly one who is on treatment or is just not feeling well,” Raroha says. “It lengthens their time at the clinic and it’s hard on them physically.”
In addition to improving accessibility for patients, Raroha says, the ride-share program reduces the time social workers must spend to come up with transportation solutions. Penn Medicine has since expanded the program to include certain other patient groups.
For patients who qualify, Medicaid and Medicare provide nonemergency medical transportation benefits. That means covering rides for doctors’ office visits, in-clinic treatments such as chemotherapy and dialysis and other types of routine care. Typically, broker companies coordinate and dispatch taxis, private cars or specialized vehicles, like vans, to bring patients to the appointments.
A recent blog, published Sept. 13 in the journal Health Affairs, describes why and how nonemergency treatment is shifting. Poor customer service and inadequate responsiveness are among reasons health care organizations and payers are rethinking how to deliver transportation to patients, and increasingly turning to ride-hailing services such as Uber or Lyft, according to the authors.
One example is CareMore Health, an integrated care delivery system led by physicians. In 2016, CareMore launched a program to evaluate free Lyft-based rides for members in Medicaid Advantage plans in two of its Southern California locations.
Cars Not Vans
Barbara Emry, 94, of Downey, California, had heard of Lyft (and Uber) but never got a chance to try it out until last year through the CareMore program. Before then, she says, “They had me travel in vans, and Lyft sounded a whole lot better.”
With vans, Emry says, she tended to get to appointments far too early. However, moving in and out of the vehicle was the main problem. “The vans had ramps and I was used to being in a car,” she says. “The vans were uncomfortable.”
Emry lives less than a mile from the CareMore center where she goes for diabetes management, as well as the co-located “Nifty After Fifty” gym program. Rides aren’t very long, but she still enjoys chatting with drivers. “Usually, I ask how long they’ve been driving,” she says. “For one gal, I was her third customer ever.”
One limitation is that Emry can’t use the Lyft program to see her primary care physician, who isn’t part of CareMore, because she’s used up the maximum allotment of outside rides. “I’ll have to find some other way to get to my doctor,” she says. “I don’t know how to get Lyft on my own.”
The CareMore system has expanded to offer Lyft-based rides to all its Medicare Advantage patients, through a partnership with American Logistics Corporation, which brokers the rides.
Wider-scale results have been highly encouraging, says Scott Rinefort, senior director of product design at CareMore Health and a Health Affairs blog co-author. Patient wait times have decreased, he says, with 92 percent on-time performance with Lyft rides. With program tweaks that incorporated feedback from users, patient satisfaction in the transportation experience has risen to 98 percent.
Certain adjustments were needed to put patients more at ease. “With our senior patients, when we first rolled it out, we saw that some patients were reticent to get into an unmarked car without a sign on the side,” Rinefort says. One added feature was letting members know which kind of vehicle would pick them up, so they’d feel safer and more comfortable with their ride.
Rather than using an app, patients arrange rides by calling the CareMore-based call center. Drivers also receive an extra heads-up. “When a CareMore ride comes in to a Lyft driver, there’s a notice to tell that driver that it’s a health care ride,” Rinefort says. That allows drivers to shift gears, so to speak, and feel better prepared when dealing with passengers.
The program is seeing cost savings, allowing reinvestment to expand it. “We’ve been able to give 12 percent more rides year over year without increasing the capital outlay for the company.” Rinefort says.
Gaps in nonemergency transportation and effects on patients who miss out on needed health care delivery have been an ongoing concern for public health experts. A 2012 project, funded in part by the Department of Transportation and the National Center on Senior Transportation, delved into the issue of U.S. nonemergency medical transportation.
The project and resulting study, led by Thomas Prohaska, then a professor in the School of Public Health at the University of Illinois at Chicago, focused on Medicaid patients in Delaware and Oklahoma who were eligible for free nonemergency transportation.
For adults ages 65 and older, dialysis was the most common reason for trips, followed by mental-health appointments. Researchers found a cancellation rate of about 17 percent. Some patients didn’t realize they had access to transportation benefits.
For rural patients, access to affordable medical transportation has always been even more challenging. Ride-hailing services are also less accessible as well, so rural patients must continue to rely largely on traditional services.
It’s still unclear whether offering Lyft- or Uber-based services reduces the rate of missed appointments for nonemergency medical care. In a recent clinical study of nearly 790 West Philadelphia patients on Medicaid, about half were randomly assigned to receive Lyft transportation benefits. Researchers found little difference in the rate of missed appointments.
However, the convenience of ride-hailing transportation programs can benefit patients when keeping appointments, says Dr. Krisda Chaiyachati, an assistant professor of medicine at the University of Pennsylvania and co-author of the study published in the March 2018 issue of JAMA Internal Medicine.
With traditional nonemergency transportation using shared vans, patients must do significant advance legwork to get the ride, Chaiyachati says. As a physician, he sees the difficulties they go through in getting to and from their appointments. A late-running appointment and transportation reshuffling can lead to a cascade of events, he says, in which “for a half-hour appointment, you’ve basically sucked up your whole day.”
Partnerships using ride-hailing services for nonemergency medical transportation seem to be gaining traction. A June 9 article on the CNBC website described related partnerships with assisted living communities. In March, Uber launched the Uber Health dashboard, which lets health care workers order rides for patients to travel to and from doctors’ appointments.
In May 2017, Lyft and Blue Cross Blue Shield launched a nationwide partnership offering BCBS members free rides to doctors’ appointments, in an effort to reduce missed appointments for nonemergency medical care.