Ride Sharing: The First Mile Toward Solving Medical Transportation

This post was written by Sumun Khetpal, Ride Health's Chief Medical Officer.

Two summers ago, I was nearing the end of my shift as a volunteer at the Children’s Hospital of Philadelphia. I encountered a family of three in the lobby and learned that their little boy had just undergone a round of chemotherapy. His eyes were sunken, and he struggled to stand. His father mentioned that their scheduled ride had just cancelled on them, and that they had no way of returning home.

My reaction was instinctive. Like any college student in need of a ride, I whipped out my cell phone, called an Uber, and soon, the family was on its way home. I soon discovered that this simple issue – not being able to find a ride – turns out to be an enormous hidden cost for patients, caregivers, providers, insurers and taxpayers alike. Each year, 3.6 million low-income, elderly and disabled patients miss about 24 million appointments due to insufficient access to transportation. These missed appointments lead to $40 billion in avoidable downstream costs to the healthcare system, and represent approximately $4.1 billion in lost revenue for doctors.  

Can ride-sharing companies single-handedly solve transportation barriers to care? Uber and Lyft have a stated goal to expand access to their services among people with limited transportation options. Their large driver networks and on-demand nature make them a compelling alternative to traditional non-emergency medical transportation (NEMT) providers. These companies provide new opportunities to address the persistent, difficult problem of transportation barriers among low-resource populations. It is remarkable how they have adapted processes and business models to address needs of vulnerable patients.

Therefore, it is not surprising that many people regard ride-sharing as the natural solution for healthcare transportation. However, there are a number of complexities – inherent within the healthcare industry and other social conditions that inhibit access to care – that might preclude these companies from being able to address the entire healthcare sector. The answer is to view ride sharing not as an answer for all situations, but rather as an important piece of a broader transportation solution.

1)    Translating Technology into Healthcare

Healthcare has fallen behind other industries in the adoption of new technology. Similarly, transportation was and still is facilitated by telephone calls and paper printouts – not automated communications and GPS location services. This state of affairs creates a clear opportunity for positive disruption. While on-demand transportation services no doubt improve the current standard of NEMT, new tools cannot be dropped into a healthcare facility as a one-size-fits-all solution. Instead, technology must be deployed in a way that meets the specific needs of the patient and provider. In the case of transportation, does the patient need a wheelchair-accessible vehicle, or assistance getting in or out of the vehicle? How many of the patients have access to a smartphone, or even a flip phone? Innovation is important, but we must implement change in conscientious and effective manner.

2)    Building a Transportation Marketplace

While more than 75 percent of Americans have access to a ride sharing service, what happens to those patients who live outside of those services areas, or require more sophisticated transportation due to disability? Traditional NEMT services, taxi companies, trains, buses, and even volunteer flights should be integrated as part of a broader transportation marketplace. In addition to choosing among modes, there is an opportunity to combine different modes. Rural patients might utilize a cab to reach the doctor, while suburban patients might resort to an over-ground rail service to the city’s main station, then switch to a ride sharing option for the last mile. Ride sharing services are part of a wave of medical transportation modernization. As other kinds of transportation providers go digital, healthcare providers will need a single solution that integrates all available options.

3)    Investing in Provider Relationships

In healthcare, a key word is “relationships.” To integrate any technology into a clinical setting, it takes multiple conversations with diverse stakeholders to earn trust and support to the point of successful adoption. Gaining buy-in from everyone -- social workers, practice managers, nurses physicians, C-suite executives and more -- requires an understanding of how technology will meet a wide range of needs, concerns, priorities and incentives. While on-demand transportation companies are amazing at building scalable networks of connected drivers, it takes a relentless focus and large investments of time to build strong relationships with healthcare providers.

Thinking back to my volunteer experience at CHOP, I recognize that ride sharing companies will be an important part of breaking down transportation barriers to care. However, it will take a village – of healthcare providers, of transportation providers, and of insurers – to develop sustainable and practical solutions. With patience, grit, and humility, we can connect the dots between these stakeholders so that together, we can solve transportation barriers and ensure that every patient, everywhere, has access to the care they need.