Ridesharing Services Help mHealth Programs Improve Care Coordination

August 30, 2019 - Healthcare providers are finding that ridesharing services can prevent missed appointments and boost patient morale and realizing additional benefits beyond access to care and patient satisfaction. As part of their mobile health programs, they are looking to ridesharing apps to improve care coordination and clinical outcomes as well.

With national no-show rates ranging from 10 percent to 30 percent, health systems can no longer expect all patients to arrive at hospitals or clinics for scheduled appointments. In both urban and rural areas and especially with underserved populations, transportation is a challenge.

Vehicles can be unreliable. Traffic and weather can create havoc with buses and taxis. Some people simply lack the time necessary for a trip to the hospital. Still others lack the money to afford transportation or feel the trip is too great an inconvenience.

These challenges affect providers. Missed appointments cost time and money — as in undelivered and unbillable care. Absenteeism forces hospital and office staff to change schedules and modify workflows. In turn, this has a negative effect on office morale and productivity.

Finally, there’s the impact on clinical outcomes. Missed appointments due to transportation issues have negative repercussions for care management and ultimately health outcomes. That interruption in the care plan might mean a new treatment isn’t started, a prescription isn’t renewed, a test or image isn’t analyzed and acted on in a timely fashion. In short, a health issue isn’t addressed properly and promptly. In this manner, a missed appointment for a cough might become a chest cold, bronchitis, or pneumonia, possibly leading to a costly ER visit or an inpatient stay.

In a connected world and with mobile health platforms now at their disposal, hospitals and health systems are tapping into transportation services to help patients keep their appointments, including follow-up visits, x-rays and tests and pharmacy visits. They’re seeing positive results from provider workflows and office morale to patient engagement and clinical outcomes.

ADDRESSING A MOBILE HEALTH PAIN POINT

The concept of providing transportation to and from medical appointments isn’t new. Medicaid programs have long offered reimbursement for non-emergency medical transportation, and many hospitals and health plans offer vouchers for public transportation or cab fare.

But there’s a difference between offering reimbursement for transportation and actually helping people get the rides they need.

“Health systems are finding that they have to take action to meet their patients’ needs, and that doesn’t mean just giving them a voucher,” said Gyre Renwick, a vice president with Lyft, the ride-sharing company that broke out its own healthcare transportation service in 2016.

Renwick says companies like Lyft and Uber entered the healthcare market to address a specific pain point: the negative effect of a missed appointment. Hospitals are seeing an estimated 3.6 million missed appointments each year due to transportation issues, at a cost of roughly $150 billion in missed care and downstream healthcare spending.

Source: Second Measure

“Take an MRI, for instance,” he observed. “They cost $10,000 to $20,000. That’s a lot of money lost if the patient can’t get there.”

But the losses are more than financial. As Renwick noted, “it’s the patients who are suffering when they can’t get the care they need.”

Research shows that patients missing dialysis sessions are at greater risk for adverse health outcomes. Expect similar negative outcomes, Renwick added, for people who miss chemotherapy treatments, follow-up care after hospitalization for a major illness or surgery, and those who miss mental health appointments.

Reimbursing patients for transportation or paying them to take a cab or bus doesn’t necessarily mean they will follow through on the appointment, Renwick pointed out. But giving providers and patients a mHealth platform to schedule transportation boosts the odds.

The value of an on-demand rideshare program was born out of a 2018 study by Lyft and Hitch Health at Minneapolis-based Hennepin Healthcare. According to the analysis of a one-year rideshare program at a downtown clinic, the service reduced no-shows by 27 percent, boosting the clinic’s revenues by some $270,000.

In addition, a September 2018 Health Affairs blog reported that when California-based CareMore Health added Lyft to its Medicare Advantage plan, ride costs decreased by 39 percent, wait times for ride arrivals dropped by 45 percent, and patient satisfaction exceeded 95 percent.

Lyft has been joining forces with several payers, including Blue Cross Blue Shield and Humana, to include transportation services in health plan offerings.

“At Humana, we understand that health is about more than what happens in the doctor's office — many other social factors, like transportation, can have a direct impact on health and well-being,” Alan Wheatley, president of Humana's retail segment, told HealthPayer Intelligence.com.

Lyft and Uber (which launched Uber Health in 2018) have modified their consumer platforms to target healthcare services, and those uses constitute a small but growing fraction of Uber’s almost 42 million annual trips and Lyft’s 19 million users as of 2018. Other companies have sprung up over the past few years with the sole focus of providing transportation to and from healthcare services, including Logisticare, American Medical Response, Circulation, Veyo, the National Medtrans Network and Medical Response. In some cases, Uber and Lyft are partnering with these companies.

The service is especially helpful to seniors, as evidenced by a recent study by researchers at the Center for Body Computing at the University of Southern California’s Keck School of Medicine. Access to transportation via a mHealth app not only helped seniors reduce missed medical appointments, but it also improved their mobility, reducing social isolation and improving their overall health and wellness.

"Access to transportation is more than getting from point A to point B. It encompasses multiple human facets of life," said Leslie Saxon, MD, the center’s executive director and study’s principal investigator. "This research underscores how ride-sharing platforms can provide a significant benefit to the well-being of older adults, empowering them to become active participants in their own care as well as in other areas of their lives."

INTEGRATING WITH HOSPITAL INFORMATION SYSTEMS

Because access to transportation has a profound impact on patient care, it is now included in the list of social determinants of health, which the Kaiser Family Foundation defines as “the structural determinants and conditions in which people are born, grow, live, work and age. SDoH include physical environment, education, employment, and social support networks.

With evidence building that these factors are affecting the health of individuals and populations, providers are looking for ways to address them in the medical record.

“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,” Circulation CEO Robin Heffernan told PatientEngagementHIT.com.

In 2018, Arizona-based Banner Health launched an mHealth-enabled ridesharing program with Lyft, tying the service directly to its EHR platform.

“EHR integration was surprisingly easy,” revealed Joan Thiel, vice president of ambulatory services for the 27-hospital network. Connecting the service with the patient’s medical record gives the health system an opportunity to manage transportation for the patient and anticipate problems.

Thiel sees many opportunities to deploy a ridesharing service. Along with helping patients to and from scheduled appointments and follow-up care, it could also help hospital personnel ensure that patients being discharged have a ride home. At the same time as these ridesharing services avoid missed appointments and wasted expense, they reduce stress on patients,

The service not only cuts down on no-shows and the wasted expenses related to missed appointments, but it reduces stress on patients. Less stress leads to improved mental health, said Thiel, which in turn leads to better care management and a better chance that the patient will follow doctor’s orders.

There are also employee benefits. In a health system with some 55,000 employees scattered across six states, that’s a pretty sizable benefit. Employees can call for a ride if their car breaks down or they can’t find transportation, relieving hospital administrators of the burden of finding replacements for missing staff. Likewise, the service could be used by those working overnight or off-hours or to ensure that on-call and emergency personnel are able to get in as quickly as possible.

“You’re solving a problem that can really affect patients and staff,” she stated. Hospitals and health systems “are really starting to realize how important it is to have transportation” available at a moment’s notice.

Integrating a ridesharing service in the EHR gives hospitals and health systems the opportunity at Banner Health to manage the service, identifying when and where transportation is needed.

Success integrating ridesharing into the EHR is prompting vendors to leverage the services to improve outcomes and reduce costs for other customers.

In 2018, Allscripts joined forces with Lyft, giving providers access to the Lyft Concierge app through the Sunrise EHR platform. At any point during the continuum of care — in the hospital, at the doctor’s office, or at home while connecting via telemedicine — a rules-based engine or a care team member can schedule a ride for a patient.

“When patients’ transportation needs are noted in Sunrise, an automated workflow would schedule Lyft transportation for that patient,” the two companies said in a press release. “Additionally, tracking boards would provide real-time notifications of patient pickup, ETA and arrival for providers and other members of the care team. We expect that this first-of-its-kind integration will provide reliable and easy functionality to schedule transportation for patients to ensure they do not miss critical follow-up care.” 

In essence, the service becomes as easy as scheduling an X-ray or other test, a part of the care coordination process.

Some health systems integrate the service through a patient portal or communications platform.

In 2016, the Nemours Children’s Health System partnered with RoundTrip to provide transportation services for patients at its Alfred I. duPont Hospital for Children in Wilmington, Delaware. Care coordinators at the hospital can use an online portal to book transportation for patients and their families, map out routes and arrival and departure times, and provide a channel for rating the transportation experience.

In Florida, care providers at Sarasota Health can access the Uber app on their smartphones through the Voalte platform to schedule rides for their patients. "Transportation can be a challenge for older patients who no longer drive and don't have a family member or caregiver immediately available to take them to their appointments," said President & CEO David Verinder in a public statement.

In both cases, the service is pointed at the healthcare provider, giving him or her the leeway to make transportation arrangements, and mobile, enabling them to schedule those services when and where it’s most convenient.

The service does have to be planned carefully.

In a 2018 blog, Darren Coates of the Husch Blackwell law firm advised health systems to make sure their ridesharing programs are legally compliant and not abused by either patients or staff looking for a free ride.

“Primarily, providers should adhere as closely as possible to the OIG’s (Office of the Inspector General) safe harbor regulations which require, among other things, that there be a written policy in place which restricts how transportation services are used and advertised,” he wrote.

“Additionally, since drivers will have access to individually identifiable and/or protected health information, providers must have appropriate business associate agreements in place to comply with the Health Insurance Portability and Accountability Act. Providers should consult with legal counsel well-versed in these laws before implementing a patient rideshare program.”

What Is a Business Associate Agreement?

Any individual or entity that performs functions or activities on behalf of a covered entity that requires the business associate to access PHI is considered a business associate, according to HHS.

This individual or organization may also provide services to a covered entity. Examples include a consultant who does hospital utilization reviews or an attorney who has PHI access as he provides legal services to a healthcare provider.

“Covered entities may disclose protected health information to an entity in its role as a business associate only to help the covered entity carry out its health care functions – not for the business associate’s independent use or purposes, except as needed for the proper management and administration of the business associate,” HHS states.

SOURCE: HealthITSecurity.com

MOBILITY ADDS THE ‘M’ TO MHEALTH

The technology is there to implement such services for patients, especially with the widespread adoption of smartphones and other smart technologies. Ridesharing services will be an essential tool for addressing transportation access – a major social determinant of health impacting patient outcomes and population health management.

But providers will need to go beyond just offering the services to their patients. Identifying who truly needs transportation will be a major next step for many providers. Screening for transportation access and other social determinants of health will be key to integrating effectively into routine care delivery.

The capability will add another layer of data collection and patient management. However, going forward, health systems that neglect to make transportation part of the care and coordination plans run the risk of seeing less-than-optimal clinical outcomes — not to mention losing both patients and staff to other providers who are willing to literally go that extra mile.

Special thanks to Second Measure for allowing us to reproduce their image in this article.