By Allison Proffitt

October 5, 2016 | Last week Boston-based startup Circulation announced its non-emergency medical transportation pilot program in conjunction with Uber. The pilot program is testing Circulation’s transportation platform at hospitals and care facilities in Boston, Delaware, and Pennsylvania. 

The Circulation platform is a digital transportation platform that can be integrated with a hospital’s existing information systems. The platform is secure and HIPAA compliant, explained John Brownstein, co-founder of Circulation. The company is a standalone venture that is partnering with Uber to provide, “Uber for healthcare purposes,” Brownstein said. 

Brownstein is a researcher in digital health at Harvard Medical School and Chief Innovation Officer at Boston Children’s Hospital. His connection to Uber started like most: three years ago he hired a ride.

“You know when you get those receipts from Uber and you can respond and say how your drive was? I responded and said, ‘My drive was great, but I have this idea in healthcare.’ And that’s how it started,” Brownstein told Clinical Informatics News. “I was adamant that Uber could have a role in healthcare.”

Uber was listening, and sent representatives to visit Brownstein at Boston Children’s soon after. With the formal launch of Circulation’s pilot program last week, Uber also announced that Circulation is the Preferred Healthcare Platform Partner of the Uber Developer Platform.

Getting There

The problem that Brownstein wanted to address is a big one.

In 2005, about 3.6 million individuals failed to receive non-emergency medical care due to transportation barriers. The patients missing their appointments tend to have risk factors for both chronic disease and poor access to transportation.

“What we’re really talking about are those patient populations [that are at risk]: low-income, disabled, elderly patient populations that are on the sicker side and don’t have ready access to transportation,” Brownstein explained. “We’re really talking about that tail of patients who represent the bulk of the costs in the healthcare system, need their appointments the most, and yet don’t have the access.”

Some health insurance plans offer transportation benefits, perhaps as taxi vouchers or with transportation companies. This year, Medicare Advantage plans offer non-emergency transportation to 69.5% of its beneficiaries; and the federal government alone spends about $2.7 billion on non-emergency transportation.

But the investment saves the health system money. Getting patients to their appointments keeps them healthier, saving costs down the road. And—Brownstein contends—Uber and ridesharing are more convenient ways to do that.

“There’s incredible data to show that a quarter of all of those no-show rates are just due to a lack of transportation, not a lack of desire to get to the appointment,” he said. “Essentially the idea is that we’re trying to bring patients the modern convenience of on-demand [rides], similar to how consumer have experienced it.”

Connecting Payment With Process

Many payers are willing to invest in transportation to get their patients to appointments.

“Hospitals have an interest in reducing no-show rates, there’s the cost of the missed appointment, plus the cost of potential health issues down the road,” Brownstein explained. “The cost of an UberX ride is a small fraction of the cost of a missed appointment.”

Circulation’s piece of the puzzle is the HIPAA-compliant online dashboard that connects the hospital’s information management system to the Uber API. The booking coordinator at a hospital or insurance plan can pre-book rides for the patient setting the date, time, and pickup location, and request special categories service, like a wheelchair accessible ride, for example, or specially equipped drivers.

The Circulation platform doesn’t only match patients to Uber rides. “The Circulation platform does phenomenal triaging to match the patients to the right ride,” Brownstein said, and it all happens behind the scenes.

As far as Uber drivers are concerned, the rides look like any other. Transportation coordinators can keep track of rides, noting which driver transported which patient, when rides were picked up, and when patients arrived. Although patients don’t have the Uber app on their phones with which to leave ratings, they can give feedback at their hospital or clinic and that can be entered into Circulation.

The Circulation Pilot Program just began last week at Boston Children’s Hospital, Mercy Health System’s three acute-care hospitals and all-inclusive care program for the elderly in Pennsylvania, and Nemours Children’s Health System in Wilmington, Delaware. Circulation’s service is expected to roll out across six additional states in 2016, Brownstein said.

Road Blocks & Opportunities

Uber and Circulation aren’t the only ride sharing groups to see opportunities in healthcare. In January of this year Lyft launched a pilot of Concierge, a web-based product that lets organizations request rides for customers through the Lyft platform. The pilot phase of the project has served Medicaid enrollees in New York and Medicare Advantage beneficiaries in California.

The Concierge pilot program transfers ride requests from CareMore, a network model health maintenance organization, to National MedTrans, a non-emergency medical transportation benefit manager, which dispatches Lyft rides to patients. Early results published in the Journal of the American Medical Association last month showed that wait times have decreased by 30% and costs have been reduced by 32.4%. Concierge is booking 25,000 rides per week with National MedTrans, Dan Trigub, Strategic Account Executive, Healthcare, said during an Aging 2.0 Webinar in late September.

There are still details to be worked out.

For instance, in Uber’s pilot program, the hospital systems are paying for rides, though they have the option of passing that fee on to patient. In the future, Uber’s Brownstein predicts, there may be some cost sharing for patients.

In its first iteration, care coordinators will set one pick up point and one drop off point for patients in Circulation. “But we’re experimenting with some different models that will allow for different stops,” Brownstein said. “Especially when it comes to pharmacies, that’s a great use case where there’s an issue about adherence to picking up prescriptions. If you can add that into the mix, you’ve also solved another issue.”

Trigub, in the webinar, outlined Lyft’s vision for using Concierge to bring patients to clinical trials. “We’ve also begun to really help pharma companies like Axovant [Sciences] get their patients to and from clinical trials, ultimately helping them attract and retain the patients they need for a trial,” Trigub said. “Imagine a trial for an Alzheimer’s drug where the patient population is 65 and older and not capable of driving… They can now get [to a trial site] safely and efficiently through the Lyft platform.”

And of course there are the questions of patient satisfaction. Will on-demand ride sharing prove to be an improvement for the patient? Uber’s Brownstein hopes that after the pilot program Circulation will be able to report positive results around patient satisfaction, decreased transportation costs, and reduction in no-show rates.