Uber could improve access for addiction recovery

Transportation is the largest barrier for people seeking and receiving addiction treatment.

A walk to the bus stop might be dotted with temptations. Harsh winter temperatures could dissuade someone from making the trek. A chaotic trip back could take away from time to reflect on what they've learned in treatment.

"Using a bus pass when you're in early sobriety and you've got a brain that's on fire … just wound up being more difficult than a person without addiction, living at home in their own house, with a supportive family could imagine," said Dr. Ted Parran, co-medical director of Rosary Hall.

But an Uber arriving outside their door, ready to deliver them straight to treatment, brings convenience, speed, dignity and respect to that journey. And, according to preliminary results from a pilot program at St. Vincent Charity Medical Center in Cleveland, offering free Uber transportation for addiction patients could help improve attendance rates for assessment and treatment appointments at Rosary Hall's Intensive Outpatient Treatment (IOP) program.

St. Vincent's pilot, launched in mid-June, provides transportation in partnership with Circulation, a Boston-based company that has developed a proprietary, HIPAA-compliant digital platform to connect Uber with patients and health care providers.

Thirty days into the 90-day pilot, the 11 patients enrolled in the program have received a total of 156 Uber rides to and from treatment and have not missed a single IOP or individual counseling session, which is "amazing," said Orlando S. Howard, outpatient manager at Rosary Hall.

In the 30-day period prior to the pilot, Rosary Hall saw 76% client participation in IOP and 62% participation in individual counseling sessions.

"We only see it getting better," Howard said.

In the past, Rosary Hall was able to offer some grant-funded bus passes to those in treatment, and single-ride cab vouchers, usually to transport a patient from detox to their next level of care.

But there weren't transportation support options for those not already in the program reaching out for an initial assessment. In the first several months of this year, roughly 20% of patients didn't show up for these assessments. No-shows are huge setbacks for the patients, who, upon not making their appointments, may lose the courage they had finally gathered to ask for help, Parran said. They feel guilty and worry that they won't get another appointment if they call back.

"Missing an assessment is a disaster for a patient, and it's also a disaster for the program, because the program has scheduled a counselor's hour and a half to two hours to do that assessment, and pushed other people who are calling for assessments down the road," he said.

For those who do enter treatment, there's months of regular travel. After a three- to five-day inpatient detox, patients are required to attend four three-hour IOP sessions per week for the first five weeks, as well as individual counseling sessions. And then for another eight to 12 weeks, they participate in weekly 1.5-hour sessions in the non-intensive program.

Bus passes weren't always convenient or the best option for someone in addiction treatment, and cab vouchers didn't apply to this back-and-forth. Plus, with the Cleveland Yellow Cab Co. ending operations last month, the vouchers were no longer an option.

An average of 62% of patients successfully complete the five-month IOP program at Rosary Hall. The most frequently cited reason for those who drop out of the program is a lack of access to affordable, reliable, convenient transportation.

Thom Olmstead, director of university partner collaborations at St. Vincent, was tasked with finding a way to address the transportation challenge. Using a van proved to have "almost insurmountable" logistics and would require patients riding for hours around town as everyone was picked up. He looked at other ride-sharing services, before finding and settling on Circulation.

Right now, Rosary Hall is collaborating with a few sober living houses for the pilot. Olmstead found that many were eager to participate — more than they wanted for the pilot. But, if the pilot continues to prove successful, the goal is to expand to more of those homes and potentially beyond.

Within the first year of the program, St. Vincent's objective is to provide transportation for 228 clients to access addiction treatment, which Rosary Hall already has capacity for.

Dignity and respect

After that, Olmstead said, they'll consider adding additional resources for more treatment capacity.

Currently, the hospital is internally funding the program, but the team is working to finalize a significant grant and are seeking additional funding sources for its estimated $184,000 pricetag for year one — $51,000 for administrative/staffing costs to manage the program, $18,000 in technology costs for Circulation and about $115,000 in Uber costs for the transportation itself.

Already, other areas of the hospital are looking at ways they could use the Circulation program to increase access for patients, Howard said. The pilot starting as Cleveland Yellow Cab closed was pure coincidence, but came at the right time.

University Hospitals had used Yellow Cab services for transporting ambulatory patients who don't need an ambulance or wheelchair van service, but have no other means of transportation. UH's medical transportation providers are now managing the process for transporting ambulatory patients using Lyft and Uber, according to a memo to care leaders from UH Chief Nursing Officer Jean Blake.

At St. Vincent and Rosary Hall, Howard said they'd like to continue to provide the service because, for one, patients who stay in treatment longer do better — so long as they can get there. And second, free Uber rides align with the hospital's mission to treat people with dignity and respect.

With the stigma of addiction, many patients haven't been treated with the dignity and respect that they deserve in years, he said. But something as simple as an Uber ride begins to build that, all while hopefully getting more people to treatment.

"It's going to make a huge difference," Howard said. "As long as I've been in the treatment field for over 25 years, I've never seen anything as exciting as this."

"Uber could improve access for addiction recovery" originally appeared in Crain's Cleveland Business.