Uber recently announced the launch of Uber Health. This transportation platform allows healthcare professionals to schedule rides for patients that need to go to or from medical appointments. A similar program with Lyft has been rolling out nationwide including a partnership with Blue Cross and Blue Shield. The idea behind it is relatively simple: People that need to get to the doctor but cannot get there are more likely to become sicker and in the end, they are going to need more intensive and more expensive care. Since the normal non-emergency methods of medical transport are often quite expensive, why not utilize a service that is often-times quicker to arrive and much less expensive. Enter Uber and Lyft for what could be seen as a win-win-win-win for patients, healthcare providers, health insurers, and these well-known transportation providers.
One health system, CareMore, has reported that through its partnership with Lyft, it has decreased the time waiting for transportation by 30% and the cost per ride has decreased by 1/3rd compared to traditional medical transportation services. They are reporting a savings of over $1 million in one year by switching the transport model. In the pilot study, the average cost of transportation dropped from more than $31 per ride to about $21 per ride.
The convenience factor cannot be overstated for those that are accustomed to using these services. Need a ride somewhere? Take out your phone, open the app, request a pick-up, and the car comes right to your location while you are able to track the car's location and estimated time of arrival. All this in a few clicks of a button and often at a rate both in terms of speed and cost, that beats all other alternatives like shuttles and standard taxi services.
A 2005 study by the Transit Cooperative Research Program estimated that 3.6 million people miss or delay medical care every year in the US because of either the lack of transportation or the inability to afford it. They found it cost-effective to provide Non-Emergency Medical Transportation(NEMT) for the 12 medical conditions they studied as not receiving the transportation and subsequent care led to increased need for higher cost care later on.
These missed appointments also have a negative effect on healthcare practitioners. No-show patient rates will vary from practice to practice. I have found rates down in the single digits to as high as the upper 30% range. Each of these missed appointments is income that a medical practice depends on to cover its overhead costs of staffing and facility maintenance. Any method of lessening the no-show rate should be welcomed by practices and health systems nationwide.
While it may be cost-effective to provide NEMT, even the cost of providing that transportation is complicated and expensive. While there are few good estimates, Texas A & M Transportation Institute estimated that $2.9 billion was spent just in the Medicaid system alone on NEMT in 2013. Now that is quite a chunk of change. And some of this spend is believed to be partly fraudulent by the providers of such services. State Medicaid Fraud Control Units investigate hundreds of Non-Emergency Medical Transportation fraud and abuse cases yearly.
We can improve access to care which can decrease the cost of care overall but also use a less expensive transportation model.
The Uber and Lyft method of improving access to medical care has some very appetizing potential. The simplicity of the service is attractive. Uber has released an API(Application Programming Interface) which would allow a health practice or system integrate directly with Uber to request a patient transport directly from the electronic medical record system or appointment scheduling dashboard used.
For metro populations, particularly in cities like New York, where most of the residents do not even own vehicles, the potential here is massive. Many other urban population centers that also have a high Medicaid population would benefit immensely from this program.
However, in rural America where 20% of the US population lives yet we only have about 10% of our physicians practicing there, this will probably do little if anything. Ride-sharing services such as Uber and Lyft are generally limited to metropolitan areas and as such do little for the transportation issues facing rural Americans.
Even if the service is available to patients, there is no guarantee that it will be effective. While some data is positive, one recent study out of Philadelphia where patients were offered a free Lyft ride to and from a Primary Care Doctor's appointment, the high percentage (36.5%) of missed appointments did not decrease when offered the free ride service.
Having access to smartphones may also be another sticking point. Patients who may want to self-schedule a ride may be unable to do so if they do not own a smartphone. The new Uber Health system helps by-pass this obstacle a bit by allowing the healthcare provider to schedule the ride on behalf of the patient. If the patient does not have a smartphone but can receive texts, the patient will receive text based communication about the ride. Even if they do not have a phone at all, the ride coordination can be communicated directly to the healthcare provider.
I foresee a not so distant realization of healthcare coordination which uses various services that help minimize the time and cost involved in obtaining and engaging in medical care. Patients could initially obtain their non-emergency medical evaluation through a telemedicine service where the need to travel can potentially be avoided completely. However, if further testing or in-person care is needed, a host of options can be triggered. Some of these options might include geolocation-based identification of and scheduling with available in-person services to care for the patient, overnight shipping of lab tests with free return shipping, electronic prescribing of needed meds to the nearby pharmacy, or mobile lab, x-ray, visiting nurse, and medical house-call services. Additionally, by using ride-sharing options like Uber or Lyft, we can get the patient from home to the lab testing center, radiology center, doctor's appointment, or hospital.
While the coordination will have some hiccups along the way, we are definitely heading towards a more patient-centric, coordinated, and cost & time efficient healthcare system.
