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Friday, January 19, 2018

Uberizing Nonemergency Medical Transportation

I suppose you know you are well on your way to becoming a cultural icon when others invoke your brand as the avatar of a kind of disruptive force needed in other industries, hence all the declarations of the need for an Uber for health care.  At this point, I think health care services that connect patients/consumers via gig-economy style apps for the provision of on-demand health care are interesting but not as immediately interesting as the development and application of Uber's transportation revolution principals to non-emergency health care transportation.  Actually, it is Lyft that has been more fashion forward in this area, though I've yet to find the assertion that we need to "Lyftize" non-emergency health care transportation.

What is NEMT? Well, it is a roughly $2.7 billion a year industry. Historically, this has meant the ride share van or voucherized taxi ride for the government funded health insurance beneficiary who needs, for example, periodic and regular transportation to a dialysis clinic or an infusion center.  Eligibility for this program  was targeted toward those without a driver's license or a car or access to a family member or friend who might provide this service and who was deemed too low income to buy needed nonemergency medical transportation in the open market. This targets a demographic that is older, low income, and  chronically ill. The system was famously creaky for the same reason all taxi services, before the scramble to try to adopt Uber-Style booking, were so creaky.  A fair number of rides booked in advance never occurred.  Wait times in excess of an hour at both ends of the transport were not uncommon.  Missed dialysis or infusion appointments, as a result, were also not uncommon for NEMT eligible patients.

Interestingly, it was provider restlessness with the status quo ante as much as patient/consumer activation that prompted attempts to Uberize nonemergency medical transportation. A missed medical appointment represents lost reimbursement for a provider and, essentially, dead time in a daily appointment calendar.  The provider desire to wean its NEMT population away from van and taxi vouchers required acknowledging that the targeted patient/consumer population was not overwhelmed with smart phone access or use.  Making the Uber/Lyft business model work for this population required modifying the business model: organizing ways that individuals could call for a ride; setting up a system for third parties to schedule rides; developing highly visible placards for the summoned cars; training drivers to offer assistance in and out of the vehicle, etc.  

Lyft's precedent setting contract to provide medical appointment transportation to CareMore Health System, in two locations including one in California,  was a natural fit. CareMore's target demographic is older individuals.  Uber has not been far behind with its partnership with Boston-based Circulation.  Interestingly, Uber is also piloting transportation for older individuals to Gainesville Florida's senior centers under a program called Freedom in Motion.  This might also be seen as health care transportation Uberization, given what we are learning about some of the health care implications of social isolation. 

All of this is so interesting and potentially so promising for improving health care access and outcomes for low income non-drivers going to nonemergency medical appointments, I have to wonder if it might also help to relieve some of the financial pressure on older individuals who, desiring urgent care for something like a sprained or broken finger, and not understanding Medicare's stringent general emergency medical care reimbursement rules, call 911 and are whisked away for that care in an ambulance that may be overkill for their needs.  They will think about it more at their leisure when, weeks or months later, Medicare denies emergency medical transport coverage and they are presented with an out of pocket bill for anywhere from several hundred to several thousand dollars.  Surprise ambulance bills, at present, are endemic to Medicare. 





Posted by Ann Marie Marciarille on January 19, 2018 at 06:00 AM in Current Affairs | Permalink


I used Uber and Lyft for about 6 months when I was not permitted to drive due to a medical condition...it was very helpful for getting to appointment.s

Posted by: jimf | Mar 19, 2018 12:08:06 PM

Yes. In some jurisdictions, a more diverse group of Medicaid beneficiaries are using or trying to use NEMT. It has, of course, always served a diverse group of Medicaid beneficiaries in other jurisdictions -- New York, for example, where the expense of car ownership makes the NEMT population large and diverse. Still, dialysis treatment is the classic example of NEMT focus and purpose because it is the single most common diagnosis code for those using NEMT to travel for health care. And dialysis patients do tend to be older, lower income, and chronically ill. The really expensive dialysis patients of course, are those using NEMT to travel from rural areas to receive dialysis in more densely populated areas. You also make a good point about the capacity constraints of NEMT, though a significant number of states have sought and received or are currently seeking waivers from NEMT requirements (Indiana, Iowa, Arizona, Kentucky). In NEMT, as in so many things involving health care, geography is destiny.

Posted by: Ann Marie Marciarille | Jan 21, 2018 8:31:30 PM

"This targets a demographic that is older, low income, and chronically ill. "

This used to be true but with the expansion of Medicaid to cover able bodied adults these companies now see people of all ages and conditions. Indeed, it is this expansion which has to a large extent driven the need for new services. The existing system simply was not designed to handle the transportation workload expansion entailed. Indeed, there are those who would argue that it still can't handle the new work load.

Posted by: James | Jan 21, 2018 3:35:27 PM

this is very interesting, one of my closest friends in san diego is part of a san diegan start up in this field.

Posted by: Orly Lobel | Jan 19, 2018 8:09:16 PM

this is very interesting, one of my closest friends in san diego is part of a san diegan start up in this field.

Posted by: Orly Lobel | Jan 19, 2018 8:09:15 PM

this is very interesting, one of my closest friends in san diego is part of a san diegan start up in this field.

Posted by: Orly Lobel | Jan 19, 2018 8:09:14 PM

this is very interesting, one of my closest friends in san diego is part of a san diegan start up in this field.

Posted by: Orly Lobel | Jan 19, 2018 8:09:07 PM

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