June 3, 2019

Lyft Carries the Burden of Transportation for Patients Who Need It Most

Ordering a car via a rideshare app is so ubiquitous that it’s becoming passé to call it a “new trend;” however, clever folks in a wide range of industries are dreaming up new ways to leverage these transportation platforms. In health care, eyes are turning toward rideshare apps as a potential way to address a long-standing problem where medical and social needs intersect: how to get vulnerable patients from their homes to care centers in a seamless, cost-effective way.

Take, for example, Gabrielle*, a patient at one of Emerson Hospital’s primary care centers, which are part of Partners Community Physicians Organization. Gabrielle is a refugee from Uganda, who escaped an abusive marriage and came to America for a fresh start. When she got here, she was instantly enmeshed in the local Ugandan community where she fell in love and got remarried to another Ugandan refugee. Her life was happy, and her troubles seemed far behind her—until she got pregnant. Once she brought the new baby home, her husband became verbally abusive, threatening both Gabrielle and the baby. Over the course of the next few months, he started demanding that she leave the apartment the three of them shared.

“She called me at the kind of apex of it all,” says Lynn Curran, LICSW, Gabrielle’s social worker. “I’m on the phone with her and she’s saying, ‘What do I do? He’s throwing my clothes out of the apartment. He’s saying I have to leave right now. I don’t know what to do!’ The police got involved at that point and told them to cool off and separate from each other for the night. Gabrielle and her baby went to her friend’s house and then she never went back.”

Curran explains that as Gabrielle worked to escape the abuse, she moved further and further from her child’s pediatrician. When she finally settled into a women’s shelter, her and her five-month-old son were 40 miles away from his pediatrician without easily accessible public transportation options.

“I wasn’t yet comfortable changing his doctor,” says Gabrielle. “I think we’d have to take a train and then a bus. I don’t think we’d be able to make it in time. It would be very hard to get to appointments.”

Getting There

Maryann Vienneau, Program Director for Care Management at Partners Population Health explains that for high-risk care management patients, transportation issues are one of the top gaps in care.

“There are lots of missed appointments, people not getting to the clinic on time, or even people ending up in the emergency room (ER) because they couldn’t get to their doctor’s appointment,” says Vienneau. “So, we started to explore this idea of ride-sharing services.”

Vienneau was not the only one who saw ride-sharing services as a tool to address social determinants of health in a patient population. Across the Partners HealthCare system, requests were popping up to use ride-sharing services for colonoscopy appointments, transportation to the ER, and for patients undergoing cancer treatment. Peter Markell, Executive Vice-President of Administration and Finance, CFO & Treasurer at Partners HealthCare, recognized that it made sense to engage a singular preferred vendor to test these feasibility studies. After convening a work group and an in-depth review of available options, Partners decided to use Circulation-Lyft.

The service offers a HIPAA-compliant, digital platform to coordinate convenient and reliable non-emergency transportation for all areas of health care. The platform becomes a single access point for scheduling and monitoring transportation which simplifies ordering, improves reliability and efficiency, and reduces the cost of transportation.

Vienneau’s ride-share pilot focused on two of her team’s patient populations—Adult High-Risk Care Management patients and End-Stage Renal Disease (ESRD) patients. Within these population, the pilot has shown potential to help a wide-range of people, including Gabrielle.

Gabrielle’s social worker Lynn Curran signed her up for the ride-sharing program. Suddenly, with just a few clicks from Curran, Gabrielle was able to make the 40-mile trek to her pediatrician’s office with considerable ease and no money out of pocket.

“The car comes in right on time, it’s perfect,” says Gabrielle. “It’s very convenient and very helpful because I’m always getting at my appointments on time. It’s a great program.”

Curran explains that because of the ride-share intervention, Gabrielle has continued her baby’s vaccination schedule and regular well-visit appointments in addition to a couple of sick visits. She was also able to meet with Curran in person to discuss additional community supports that she might need. Gabrielle has obtained DTA assistance, signed up for WIC, and has gotten legal services to establish her residency and sort out her immigration status.

“All of these things that we got for Gabrielle wouldn’t have been available had we not had the ride-share,” says Curran. “God knows what would have happened. Her baby certainly wouldn’t be getting his shots, that’s the least of it. Now he’s a safe and healthy baby.”

Young, vulnerable mothers and their babies aren’t the only ones benefiting from this program. Patients eligible for the service are usually already enrolled in the high-risk care management program for complex medical or social needs, but the reasons for visits are varied—primary care appointments, cardiology appointments, pulmonary specialists, mammogram appointments, MRI scans, specialty surgeons, and many more.

“The list just goes on and on,” says Curran.

The Value of Cars in Care

Robert** is an 88-year-old retired judge who has been undergoing dialysis three times a week for End-Stage Renal Disease (ESRD) for about seven months. An active man for many years—running marathons and road races well into his 50s and 60s—this past winter Robert saw a steady decline in his health after fracturing his foot and hip.

“I used to be able to drive myself to dialysis,” he says. “But I’ve basically been an invalid since December.”

In order to get to the dialysis center every Tuesday, Thursday and Saturday, Robert would have either had to pay out of pocket for taxis, take an expensive ambulance service, have one of his daughters take time off work to drive him to and from the four hour appointments, or skip dialysis all together—risking an acute health emergency. There were no good options.

“It would have been a pain in the neck,” says Robert.

But after his ESRD care manager Diane Goodwin enrolled him in the Circulation-Lyft program, Robert was able to get to his appointments without much trouble. Each of Robert’s round-trip rides cost about $46 with no cost out of pocket. In comparison, an ambulance to and from the dialysis center to his house would have been $425 a ride—not including the possible co-pay attached to the service. For the three weeks he was supposed to refrain from driving, the cost of taking an ambulance would have ballooned to $3,825.

“The Lyfts were late getting me at the dialysis center a few times but other than that they’ve been great,” says Robert. “No complaints.”

If Partners builds upon this initial pilot, Vienneau predicts that not only will it be a highly rated program among patients and providers, it could also show a significant return on investment and reduction in overall health care costs—but the Population Health team will need to think critically about how to scale it to more patients.

“I would love to give everyone a ride, all 14,000 patients in high-risk care management. But we have to figure out what makes the most sense,” says Vienneau. “What would the criteria be, what patients will benefit the most? You don’t want to enroll someone who isn’t going to show up or doesn’t want to come outside. There are lots of complexities to consider, but I’m very excited to start thinking about it with my team.”

 


*Name has been changed to protect patient’s identity.

**Last name withheld to protect patient privacy.

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