No-show appointments are one of the healthcare industry's conundrums—costing physician practices millions of dollars per year.
Roughly 3.6 million people miss necessary medical care every year because they can't get to their appointments. These patients are usually low-income individuals with chronic conditions who live in rural or urban areas.
In an effort to decrease the number of no-show visits, the non-emergency medical transportation industry has found rideshare companies to be helpful partners.
Traditionally, NEMTs contract with taxi companies to provide patients with rides to scheduled doctors appointments. Medicaid and some Medicare Advantage and commercial plans reimburse NEMTs for the rides.
But that model is plagued with inefficiencies, NEMT leaders say. NEMTs don't have the technology to make sure taxi drivers pick up patients on time and take them to the right place. Patients are often left waiting far too long for their ride and still miss appointments as a result.
NEMT leaders say the rideshare model addresses these issues. These companies increasingly are trying to partner with rideshare companies like Uber and Lyft to provide quicker, more reliable transportation to patients. Rideshare companies offer the needed technology that tracks their drivers and books appointments in real-time.
These companies can also save health plans and providers some money since the cost of a rideshare trip is often cheaper than a taxi ride.
So, it's no surprise the new model is catching on. NEMT provider Circulation, which has an agreement with Uber, announced on Thursday it has expanded the rideshare services to 25 states, up from nine a year ago. Its most recent partners include Stanford Health Care, Roper St. Francis Hospital and Commonwealth Care Alliance.
Circulation allows providers to book rides on-demand or in advance for its most complex patients insured under Medicaid, Medicare and even some commercial health plans.
Circulation claims 95% of patients arrive to their appointments on time, saving participating health plans and providers up to 50% on rides.
"The patient gets a better experience and health outcomes are improved," said Robin Heffernan, CEO and co-founder of Circulation. "It is one of those things where it truly is a win-win all around."
The allure of cost savings and reduced inefficiencies has motivated many other NEMTs to jump on the rideshare platform. Earlier this year, LogistiCare, a national NEMT provider, announced an agreement with Lyft to offer select Medicaid and Medicare Advantage beneficiaries in 31 states with transportation services.
John Zimmer, president and co-founder of Lyft, said in an email that partnerships with LogistiCare and others allow the company "to raise awareness for elderly communities and people with disabilities who deserve reliable, safe and on-demand transportation solutions to get them where they need to be."
Albert Cortina, CEO of LogistiCare, said patients will only have to wait between five and seven minutes for a Lyft ride that is ordered on the same-day. Ordering same-day taxi rides aren't as fast. Additionally, if a patient isn't picked up or if a driver is late, that information is passed along to the providers.
"We can assist other parts of the healthcare delivery system to be more effective and efficient," said Steven Linowes, executive vice president of LogistiCare.
CareMore Health System, an Anthem subsidiary that partnered with Lyft last May through its NEMT provider National MedTrans, has been saving money and patients' time.
Average wait times decreased by 30% from 12.25 minutes to 8.77 minutes and average per-ride costs reduced by 32.4% from $31.54 to $21.32, according to a JAMA study published in September 2016 that analyzed CareMore's partnership with Lyft.
"This is one of those rare innovations where you can both improve the service and reduce cost at the same time," said Dr. Sachin Jain, president and CEO of CareMore.
But rideshare partnerships are not without challenges.
Uber and Lyft drivers don't have the training or expertise to handle complex patients who may need help walking from their door to the vehicle, said Josh Komenda, president and co-founder of Veyo, a NEMT provider based in San Diego that offers rideshare services but trains its drivers to work with complex patients.
Veyo, which operates in six states, delivers about 8,200 rides per day via rideshare. The company has saved its customers, which includes health plans and state Medicaid agencies, about $7 million per year compared to other NEMT providers without rideshare benefits.
"We think it's critical the drivers understand the population they are working with," Komenda said. "They need drivers who understand the challenges they are facing."
Patients with behavioral health concerns or elderly patients can also be confused by frequently changing drivers and cars that arrive to pick them up, said Cortina at LogistiCare. That's why the company has limited its agreement with Lyft to only include a specific segment of its customers.
Lyft rides will largely be offered to patients that order an NEMT for same day appointments, which accounts for roughly 5% to 7% of LogistiCare's 69 million rides provided annually. Patients who usually book same-day visits do so to care for a sick child or to address an unexpected illness. "There is a continuity of care that is supported by the relationship between the driver and the member so we want to make sure the appropriate structure has been developed," Cortina said.
To ease confusion among its members, CareMore has set up distinct wait stations for Lyft rides outside facilities, Jain said. They have also worked with Lyft to train its drivers about how to work with patients. "It's an evolving area for us but something we think is promising as it relates to improving quality for our members," he said.
