Where is cost sharing headed?

By Liz Carey

Seen by some as chipping away at the missing doctors’ appointments senior care problem, Uber this week officially launched Uber Health, a new theme in its on-demand ride service.

Chris Weber, general manager of Uber Health, said more than 100 health care organizations in the U.S., including hospitals, clinics, rehab centers, senior care facilities, homecare companies and physical therapy centers are using the service as part of the company’s beta program.

Uber describes product features, such as flexible ride scheduling, where coordinators can schedule rides on short notice and in advance; access for patients without a smartphone; simple billing, reporting and management; and designed with HIPAA in mind. Health care partners work through business associate agreements, or BAAs.

Nonmedical homecare agency Georgetown Home Care in the Washington, D.C., area offers driving services to offset some of the hardships that are presented by impaired vision and mobility. It is one of the companies that is testing Uber Health, and pays the Uber fee upfront for the rider, then bills the client for the service.

On the other hand, from Renown Health in rural Nevada, for qualifying patients, Uber served free rides home as far as 300 miles away from the care facility.

“Many of these customers are pulling the money to pay for these trips out of some sort of operational budget, or they may have a privately financed source of money for the trips,” Weber said. “If they want to pass those costs on to another cost center, and some of them pass it along to the riders, that is up to them.”

Health care organizations care about nonemergency medical transportation (NEMT). CMS states that NEMT is an important benefit for Medicaid beneficiaries, which can include the elderly. Uber’s Weber says his company is careful to distinguish this service as distinctly separate from NEMT programs, which are state specific.

Transportation to medical appointments has been viewed as a health care challenge. Mobility issues, declining vision and lack of transportation have a history of keeping people from following through on their doctors’ appointments, especially seniors. Lack of transportation can also hinder hospital discharge. Uber Health is a business product that integrates into systems that vary in their sophistication. And Weber added, the Uber Health experience is focused on an ambulatory health population.

Related >> What is the association between offering rideshare-based transportation services and missed appointment rates for primary care patients? JAMA Network reported recently on a clinical study completed in November 2017.

The Code of Federal Regulations requires states to ensure eligible, qualified Medicaid beneficiaries have NEMT to take them to and from providers. Many people are eligible, and every state’s Medicaid program is different.

In 2014, the Government Accounting Office (GAO) reported that NEMT was not well coordinated, and additional federal leadership was needed. Half of programs at the time were administered or overseen by HHS, with the type of funding provided varying, but including capital investments (such as bus purchases) and reimbursements of transportation costs (e.g. bus passes). At the time, state and local officials noted a variety of ways they facilitate coordination of NEMT. These included state coordinating bodies, regional coordinating bodies, local metropolitan planning organizations and local transit agencies. Cost and ride sharing and one-call/one-click information centers were also used to coordinate NEMT services.

Related >> No car, no care from Kaiser Health News

Birmingham, Alabama-based nonprofit Senior Ride works with the city’s Max public transit service to support low-income elderly adults and people with disabilities getting to their medical appointments. Over the past three years, the organization (which is a member of the national Travelers Aid organization affiliation) has nearly doubled the number of rides it provides, and demand stays steady, said director Mollie Hester.

“The problem is not just lack of transportation, it’s also the cost,” Hester said. “Even a nominal fee can be unmanageable. Having free transportation to their doctors means they are more likely to manage their health better which also means extending their ability to remain independent, which I think is the most important thing to them.”

Senior Ride in Birmingham makes available free rides to health care appointments. Ride services are funded through United Way, agency fundraisers, grants and donations, and federal Section 5310 Elderly and Disabled Transportation funds. In 2017, the Senior Ride service logged more than 102,000 miles, with an average trip cost of $14.33 for each average-9-mile trip. It is just one example of a small, local organization making a difference in its community.

In metropolitan Atlanta, Common Courtesy (another nonprofit) developed its own model for affordable transportation. In 2017, Common Courtesy helped to form a meaningful use case—the organization piloted Uber as not only a health care support service but to help expand mobility, freedom and independence for seniors in general, using Lyft as well. In this example, riders pay a nominal expense with additional funds acquired from various sources—examples include community grants, foundations and pharmaceutical companies—and light assistance factored in when needed.

Technology plays a key role in connecting those in need with transportation service providers. Some connectors are more health care-centric than others. Boston-based Circulation built a platform to manage logistics and transportation, and coordinate non-emergency transportation that is used by patients, caregivers, providers, staff and volunteers. The product is said to seamlessly integrate all transportation capabilities, such as outsourced transportation, owned fleets and other medical logistics services, thereby creating a single coordinated exchange platform to schedule, monitor, control and manage all ride types.

Circulation is supported by health care leaders such as Humana, LabCorp, Boston Children’s Hospital, Intermountain Healthcare and BCBS North Carolina and Cambia. In December 2017, Lyft became a ride provider, and more recently, Massachusetts-based Fallon Ambulance was added to this suite of services that includes wheelchair options.

Ride ordering through Circulation is, currently, only handled through health care facilities. The digital platform integrates into electronic medical records (EMR) systems and reaches more than 1,500 clinical locations nationwide, including payers, hospitals, clinics, community health centers and other health care organizations.