Could smartphones and ride-sharing apps solve transportation in healthcare?

Patients living in rural, suburban or urban areas with poor infrastructure often don’t have the proper means to get to the doctor’s appointment on time. In extreme cases, they have to wait even for emergency situations so much that they can call an ambulance and receive care in a hospital.

Ridesharing companies like Uber and Lyft offer non-emergency medical transportation services, while start-ups, such as Circulation or Ride Health also promise to deal with the issue. Could smartphones and networked services solve transportation in healthcare?

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Why is getting to the doctor such a hassle?

Wherever they live, in rural areas or in impoverished urban areas, people face the same issue in getting access to healthcare services: transportation. Some households don’t have a vehicle or share one among multiple family members. Moreover, for those who are disabled, obese or chronically ill, riding the bus or the subway can be a difficult undertaking.

John Lewis former CRO of the startup Circulation that since had been acquired by Modivcare, a platform that sets up transportation of any kind for patients to ensure they make it to their doctors’ appointment, told The Medical Futurist that “transportation barriers are a leading cause of gaps in healthcare in the US. Each year, around 3.6 million patients miss at least one medical appointment due to lack of access to transportation.”

Possible solutions: the US and CHWs

Each state in the US has a “non-emergency medical transport” (NEMT) benefit for people with Medicaid, covering a certain number of rides per month, and some Medicare Advantage plans also include a limited number of trips each year. Some states contract with local companies to provide rides; others enlist volunteers or hire taxis; and some even offer ride-share NEMT services like the above-mentioned Lyft (since 2016) and Uber (since 2018), and kept on doing so even during the pandemic, under CDC guidance. Several private insurers also have transportation benefits, but there might be certain preliminary conditions to meet, or may involve co-pays.

There is also the system of community health workers (CHWs) helping patients navigate the healthcare system. CHWs, caregivers typically without health-care backgrounds, will coordinate transportation for patients to and from appointments, motivate them to take their medications, and help them implement positive lifestyle habits. In 2020, nearly 60,000 CHWs were employed in urban, rural, and tribal areas of the United States, but given the fact that they are often volunteers, they thus don’t appear as CHWs in statistics.

In Europe: the government hand-in-hand with hospitals

On the old continent, it’s usually the government and medical facilities who are responsible for patient transportation. In the UK, when patient transport service (PTS) is required, healthcare providers will connect their patients with an appropriate service provider. The government provides some regional PTS services through National Health Service ambulances. However, currently, small and large private businesses run most patient transport services in Britain. Yet, the system has serious flaws wherein patients wait long hours, miss appointments, etc.

In France, patient transportation services are provided in three different ways, by ambulance, by light medical vehicles (VSL) and by taxi. When a patient needs transport to or from a doctor or hospital, they can take a cab, VSL or ambulance, then make a claim to Social Security for the cost to be reimbursed. The patient’s facility or physician chooses whatever approved service with which they have contacts. In the past few years, this model has been attacked by the French government because of the spiralling costs of taxis.

Yawning gaps to fill

So far governments, healthcare providers and traditional businesses contracting with medical facilities for patient transportation could not give a comforting solution to the issues of getting patients to their doctor’s appointments on time. High costs, long waiting times, missed visits, poor communication, administrative affairs – the list of downsides is too long. Too many people experience transportation barriers in healthcare and a too big market niche, which cannot be left out of sight.

However, it was a difficult question whether ridesharing businesses, such as Uber or Lyft could disrupt healthcare the way they did with taxi services. As the latter was unreliable, inconvenient with high prices, while the entry barriers to the market were not that high, they swept the transportation landscape.

Although entry barriers are higher in healthcare-specific regulations, industry standards and costs -, ride-share services and startups considered it as worthy to enter the non-emergency healthcare transportation market, and offer reliable, cheap services.

Rideshare moves into top gear

Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital, first came up with the idea that Uber could be used to fill gaps in patient transportation in late 2013. Brownstein left a comment in the app after a ride, and Uber called him back. Three years later, he co-founded Circulation. They partnered with Uber in 2016, and Lyft in 2017, as well as local transportation providers such as wheelchair van fleets. “We have had an extremely positive response to date. Patients appreciate the dramatic improvement in patient access, and respond favourably to the fact that we are bringing the modern conveniences they expect in everyday life to healthcare”, said Circulation’s John Lewis in our 2018 interview. 

The same year Circulation was acquired by LogistiCare Solutions of The Providence Service Corporation. Together they manage the largest non-emergency medical transportation (NEMT) programs and work for government agencies and managed care organizations under the umbrella of Modivcare.

Over 100 healthcare organizations in the US, including hospitals, clinics, rehab centers, senior care facilities, home care centers, and physical therapy centers use Uber Health services.

Lyft and start-ups eager to fill the niche, too

Uber’s biggest competition in the US, Lyft doesn’t want to lag behind either. The ride-hailing service introduced its service to healthcare providers, so doctors’ offices and hospitals could order transportation for people. It has since signed deals with several hospital systems and medical transportation companies. In May 2017, Blue Cross Blue Shield Association announced a partnership with Lyft, to provide the option to patients to get to their local pharmacies by car to pick up their prescriptions or to arrive at their primary care appointments on time. In March 2018, it partnered with Allscripts, a health IT platform provider. The company integrated Lyft’s platform into its own system, which will allow the doctors and hospitals that use Allscripts’ electronic health records to make pickup appointments for their patients.

Start-ups are also active. Beyond Circulation, there are a handful of companies offering similar services. Mindi Knebel discovered the problem of finding affordable transit to access healthcare from both sides of her family living in rural Iowa and urban Chicago, so she co-founded Kaizen Health. The startup partnered with Lyft and offers a wide range of vehicles. Another one, San Diego-based Veyo currently provides rides for Medicaid beneficiaries in eight US states. SafeRide, Round Trip or Ambulnz also aim to take part in rebuilding the US medical transportation industry, while DocGo is active in both the U.S. and in the U.K.

Besides these solutions, autonomous vehicles are also just around the corner – and they offer a promising new world in healthcare transportation. 

What are the challenges in ride-hailing in healthcare?

There will be many more startups and platforms in the following years which aim to disrupt the healthcare transportation field in the US. There are even useful tips and recommendations about how to start a non-emergency medical transportation company out there. Moreover, these companies might get to Europe in more numbers as well, against all the challenges the healthcare transportation landscape poses with regulations and traditional supplier companies. The reason is simple: they are reducing costs and improving care.

However, there are serious issues that all ride-hailing companies should take into account when entering healthcare. What happens in case of a medical emergency during a ride? From Uber, Lyft to Circulation, every one of the concerning businesses said they are focusing on non-emergency transportation. These drivers don’t provide medical attention during the ride to the hospital or doctor’s appointment. Nevertheless, as the number of ride-hailing services increases, the statistical chance of a medical emergency goes up, too.

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Overall, ride-hailing platforms seem to have found the niche where they could genuinely flourish while solving a painstakingly costly and insurmountable problem for patients. Non-emergency medical transportation services mean a more reliable and affordable means of getting to the doctor’s office for many people in rural or urban areas without appropriate infrastructure. The Medical Futurist hopes that their service will be a common practice in every corner of the world soon.

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