The patient had started chemotherapy at 1pm in the afternoon, but by 5pm had not summoned his ride to go back home. The clock crossed 6pm, and then 7pm, and then 8pm. What could be going on? Most patients called for their return trip within four hours at the most. For patients who face transportation barriers, such rides are a lifeline to reaching care – and getting home.
Around 8:30pm, we checked in with the patient. “Hello, Timothy? We’re helping your provider arrange transportation to and from your treatments, and wanted to check in since we noticed you haven’t called the ride home yet.”
[bctt tweet=”The patient had started chemotherapy at 1 pm in the afternoon, but by 8 pm had not summoned his ride to go back home. What could be going on?” username=”healthfurther”]
“Oh, hello. I’m actually in the Emergency Room. They sent me over here because I was more light-headed and nauseous than usual after the chemo. I’ve been here a few hours now.”
“We are sorry to hear that, and hope you feel better. Do you need us to update anything about the ride, or are you having issues with the messages?”
“I actually saw your message earlier, so I’m just planning to press ‘1’ when I’m all done here. That will still work then, right?”
“Yes, that works. Just tell the driver you’re at the ER instead of the Cancer Center. You can call us at this number if anything else changes, and take care in the meantime.”
Later, we saw Timothy trigger the ride home and arrive safely about 30 minutes later. Though we never envisioned such a circumstance, this flexible process simplified the care experience for a patient going through a stressful and uncertain time. It made life easier for the care coordinator, who could go home earlier in the day with peace of mind, and the driver, who might have gone to the wrong place at the wrong time if the ride were scheduled for the late afternoon.
Though the process – allowing care coordinators to arrange rides, and sending text messages to patients with information about those rides – seems simple, what thousands of patients across the country experience every day is anything but seamless.
Most of us take transportation for granted, but for many people, it is a barrier to good healthcare. Each year in the United States about 4 million people miss 24 million appointments, resulting in $40 billion in avoidable downstream costs. Low-income, elderly and disabled people are hardest hit by transportation difficulties – due to the cost of travel, distance from care, physical disability or lack of accessible public transportation – and contend with a disproportionate burden of chronic disease that is compounded by an array of other social determinants and barriers to care.
Medicaid, Medicare, clinical trial sponsors and hospitals spend about $6 billion on non-emergency medical transportation (NEMT) each year to get people to and from their appointments. Despite this investment, NEMT fails the patients and coordinators it is supposed to serve. Patients have to schedule rides 48 – 72 hours in advance via a call center and often wait hours for late or missed pickups. Hard-working drivers are given unrealistic routes and schedules, with little in the way of software to optimize and coordinate pick-ups.
[bctt tweet=”Transportation is the beginning and end of the patient experience – the first and last impression.” username=”healthfurther”]
Transportation is the beginning and end of the patient experience – the first and last impression. As providers begin to take a greater interest in conditions beyond their four walls, transportation is a good place to start: it is an immediate factor in access to care, it can be easily measured and tracked, and a safe harbor introduced in January 2017 allows providers to sponsor transportation for established patients. Providers now have an opportunity to shift ride coordination from a cost center provided as a courtesy into an asset that can help reduce no-shows, late cancellations, and delayed hospital discharge.
Solutions have started to emerge, such as healthcare-focused partnerships and tools from Uber and Lyft, aimed at making it easier for providers to summon on-demand ride-sharing services. While these are important steps and indicators of growing attention to the problem, there are five reasons why complex health systems need more than just a desktop portal to call an on-demand ride.
1. Solutions need transportation services that work for all patients, including those with wheelchairs and those who require door-to-door or door-through-door assistance. Solving first- and last-mile problems for public transit can also be cost-effective and value-adding.
2. Solutions should help health systems identify which patients actually need transportation, based on block-group level “transportation desert” data. Instead of offering transportation in an ad hoc and reactive manner, organizations can be proactive.
3. Solutions should enable thoughtful reimbursement arrangements. There is no billing code for a ride-share trip, but health systems should not have to pay the full cost of transportation that also benefits Medicaid managed care and Medicare Advantage plans.
4. Solutions should include EMR integrations, as social workers and care coordinators do not want to log into separate interfaces. In order to maximize choice and patient inclusion, integrations should be flexible and not tailored for a particular transportation provider.
5. Solutions must include flexible options for communication include SMS with the patient or alternate contact, as well as voice calls to mobile phone and home landlines; communication difficulties contribute to transportation barriers to begin with.
The healthcare industry is in the first steps of a revolution in how patients access care, with new models emerging in categories as diverse as telemedicine and patient transportation for in-person appointments. As complex health systems determine their patient transportation strategies, leaders should consider solutions that meet the broad needs of their patients, identify where transportation will have the most impact, assist with obtaining reimbursement, integrate with current workflows, and work through a variety of patient contact methods. As with most aspects of healthcare, creating simple and streamlined patient experiences in the area of patient transportation will require significant planning, effort and a spirit of continuous measurement and improvement.
Imran Cronk is co-founder and CEO of Ride Health, an organization that helps healthcare providers, ACOs and payers build effective patient transportation programs.