Need non-emergency medical transportation? These companies are in the driver's seat

Because they lack transportation, about 3.6 million patients miss medical appointments every year. So healthcare systems and payers are turning to the same ride-sharing companies that bring on-demand transportation to the masses, but with a twist.

Companies like Circulation and Roundtrip are jumping in the middle, hoping to help providers create hassle-free experiences for patients.

With Circulation, social workers, case managers and others on the provider side log into the system on patients' behalf to request rides. Then, they can watch as the rides happen, making sure patients get to where they're supposed to go. The Boston-based company has partnerships with Lyft, Uber and Fallon Ambulance and operates in 48 states. Circulation launched in September 2016. To date, it's raised $10.5 million in Series A financing.

Like Circulation, Roundtrip also partners with Lyft. The company, which recently raised $1.9 million in seed funding, also offers rides from non-emergency ambulance companies and others. "We offer a single touch point to the full spectrum of medical transportation," said Mark Switaj, founder and CEO of Roundtrip. The service can act either as a stand-alone or as an integration with electronic health records from Epic, Cerner and others.

Circulation and Roundtrip allow patients to book rides directly—Circulation through phone calls, text messages and emails; Roundtrip through an app—but most of the rides are arranged by providers.

"It's sort of a no-brainer when you think about the rationale for adding transportation to a medical benefit or clinical protocol," said Erik Swanson, executive director in EY's health customer practice. "How you pay for it is what matters," he said. "The challenge has always been reimbursement."

With Circulation and others, patients don't pay for rides—payers (mostly Medicaid and Medicare) and sometimes providers do. In Circulation's case, it's mainly providers. "We're definitely seeing what used to just be a market of state Medicaid rides expanding to Medicare, Medicare Advantage and some larger payers," said Robin Heffernan, co-founder and CEO of Circulation. "Folks are starting to think differently about transportation as a real benefit."

But it's hard to find a commercial payer that has broad reimbursement for this kind of transportation. One is the Blue Cross Blue Shield Association, which in mid-2017 partnered with Lyft to provide rides to commercially insured patients for certain Blues plans in areas considered "transportation deserts."

In addition to reimbursement, the Health Insurance Portability and Accountability Act is another sticking point, albeit one that's more easily overcome. Uber, Lyft, Circulation, and Roundtrip all abide by the law, making sure their platforms are HIPAA-compliant. Circulation, for instance, has business associate agreements with all of its transportation partners, including Uber and Lyft.

"We try to provide the bare minimum of information to Uber and Lyft," Heffernan said. The company provides only the first name and pickup and drop-off information, she said. "It looks like a ride from any other rider."

Uber worked with an outside firm, Clearwater Compliance, to make sure its HIPAA policies were up to snuff. "This is about the privacy, security and breach notification rules, and it's also about patient safety and patient care," said Bob Chaput, Clearwater's CEO. "It's about safeguarding this very personal sensitive information."

Generally, patients have been receptive to getting rides through Uber, said Dr. Andrew Fine, a physician at Boston Children's Hospital. "I think it's a really exciting concept to think about ways we can use technology to help make the system more efficient," he said. "People are using Uber more and more, so I feel like this is a natural extension of it."

Still, some patients are resistant, particularly those who don't use ride-sharing apps in their day-to-day lives. For these patients, some hospitals still offer taxi vouchers, as they long have.

The next frontier, Swanson said, could be transportation between healthcare facilities, such as between a hospital and a skilled-nursing facility—a trip that today might be done by ambulance. "Increasingly, patients are getting pushed to the home and skilled-nursing facilities with lots of support," Swanson said. "The ability to quickly and safely move folks back to a hospital or a higher-acuity setting is going to be really important."