Shifting Non-Emergency Medical Transportation to Lyft

Shifting Non-Emergency Medical Transportation To Lyft Improves Patient Experience And Lowers Costs

Limited access to reliable transportation causes millions of Americans to forgo important medical care every year. Transportation barriers are most prominent among the poor, elderly, and chronically ill—populations for whom routine access to ambulatory and preventive care is most important.

Payers that focus on vulnerable populations have taken steps to address transportation barriers by providing non-emergency medical transportation (NEMT) benefits to select beneficiaries.  A majority of Medicare Advantage (MA) plans and state Medicaid programs currently provide NEMT benefits.

NEMT benefits are typically administered by specialized brokers that coordinate and dispatch private cars, taxis, or specialized vehicles to bring patients to medical appointments. Multiple reports have highlighted challenges with traditional approaches to NEMT delivery, including poor customer service, inadequate responsiveness, and fraud and abuse. In the face of these challenges, payers and health care delivery organizations have been experimenting with new strategies for delivering NEMT.

An approach that has attracted considerable attention is the use of transportation network companies (TNCs)—such as Uber or Lyft—to provide NEMT services. NEMT brokers such as such as American Logistics CorporationNational MedTransAmerican Medical Response, and Access2Care are all now piloting TNC-based rides. New companies, such as Circulation and RoundTrip, have emerged to help hospitals and health plans offer TNC-based rides. And both Lyft and Uber are contracting directly with health plans and delivery organizations to provide NEMT services.

Despite the proliferation of these programs, there is scant data regarding their impact. Here we report the results from a large-scale, system-wide implementation of Lyft-based NEMT services at CareMore Health.

Partnering With Lyft And ALC To Provide Transportation

CareMore Health is a physician-founded, physician-led integrated care delivery system. For many patients enrolled in its MA plans, CareMore provides a diverse range of NEMT services free of charge. Curb-to-curb (C2C) rides are most similar to traditional taxi or private car services. Patients that require extra assistance or specialized transport have access to door-to-door (D2D) and wheelchair accessible van (WAV) services.

As is typical for MA plans, CareMore contracts with brokers to administer its NEMT benefits. Historically, these NEMT brokers arranged for rides using private car services. In 2016, CareMore launched a pilot program to evaluate the impact of Lyft-based C2C rides on patient experience and costs. The pilot ran for two months at select CareMore locations in Southern California, during which a total of 479 rides were provided. Results were encouraging: wait times decreased by 30 percent and per-ride costs decreased by 32 percent, and satisfaction rates were 80 percent.

In light of the encouraging results from the pilot, CareMore expanded the program system wide. Partnering with NEMT broker American Logistics Corporation (ALC), CareMore began offering Lyft-based rides throughout all MA markets in August 2016, which included 75,000 members across 18 counties in California, Nevada, Arizona, and Virginia. 

During the pilot, Lyft-based services occasionally led to confusion. Accustomed to branded vehicles, and inexperienced with Lyft and other TNCs, patients were sometimes confused when an unfamiliar car arrived to bring them to their medical appointments.

Based on this feedback, adjustments were made to improve patient experience. First, the experience of booking did not change—patients call a CareMore associate who takes down information regarding time, pick-up, and drop-off locations. This information is then securely relayed to ALC, who uses custom-built software to schedule a Lyft driver at the requested time. Second, CareMore makes clear that Lyft, not the car services that patients may be accustomed to, will be providing the ride. This occurs when the ride is booked, and again when CareMore calls to confirm the ride. Members that would like to know the specific make and model of the car that has been dispatched are able to call a CareMore associate to obtain that information. Third, CareMore and ALC released a smart phone application—MyRide Manager—that allows patients, caregivers, and care team members to track and manage rides via an interface that resembles Lyft’s or other TNCs’ native applications. 

Impact And Results

The CareMore-Lyft-ALC partnership was launched across all CareMore MA markets in August 2016. Within three months, half of all C2C rides were Lyft-based. By the end of 2017, CareMore provided 91 percent of all C2C rides through Lyft, accounting for up to 7,000 rides per month, and a total of 68,993 rides over the course of 2017 (See Exhibit 1). At this point, the absence of Lyft availability in certain counties has limited the ability to scale the program any further.

Exhibit 1: Percentage Of CareMore NEMT Rides Provided By Lyft 

Source: CareMore Health

Results through the end of 2017 are in line with those reported during the pilot:

  • On Time Performance: On time performance (rides arriving within 20 minutes of scheduled pick-up time) for Lyft-based C2C rides was 92 percent, compared to 74 percent for non-Lyft rides. 

  • Wait Times: The average wait time for Lyft-based C2C rides was 9.2 minutes, compared to 16.6 minutes for non-Lyft C2C rides, a 45 percent decrease. Reductions in wait times were most pronounced among “on-demand,” return rides from clinics or other health care settings.

  • Patient Experience: Patient satisfaction results exceeded those from the pilot program, possibly reflecting the strategies discussed above aimed at reducing confusion. In a survey of CareMore patients using Lyft-based rides, 96 percent reported feeling “Safe” or “Very Safe” during their ride and 98 percent reported being “Satisfied” or “Very Satisfied” with the service (timeliness, cleanliness, and professionalism of the driver).

  • Costs: Lyft-based C2C rides cost CareMore 39 percent less, on average, than non-Lyft C2C rides. Reducing per-ride costs allowed CareMore to expand its NEMT benefit throughout the course of 2017, providing an additional 28,000 rides (a 12 percent increase) at no additional cost to the system.

Next Steps

From late 2016 through 2017, CareMore Health rapidly scaled access to Lyft-based NEMT rides across its MA patients. Lyft now provides the vast majority of C2C rides for CareMore patients, and doing so has improved patient experience, reduced wait times, and increased the overall efficiency of CareMore’s NEMT benefit.

Although these results are encouraging, it is important to remember that TNC-based NEMT is not a panacea. Rural areas remain under-served by TNCs and there does not yet exist a robust TNC offering for older, sicker patients who require D2D or WAV services. Nonetheless, the cost-savings generated by switching to Lyft for C2C rides can help support increased access to NEMT for patients requiring specialized services.

It remains to be seen whether or not the benefits of TNC-based NEMT extend beyond improved satisfaction and lower costs to fewer missed appointments and better health outcomes. The structure of the CareMore-Lyft-ALC partnership did not permit a formal evaluation on these dimensions. Though there are anecdotal reports that TNC-based NEMT can reduce missed appointments, rigorous analyses have not shown an effect. As TNC-based NEMT grows, attention should be paid to better clarifying this potential impact.

21 Unvarnished Truths About Retirement, by Jonathan Look

Six years ago, at 50, I took early retirement, sold almost everything I owned and began traveling the world. I had been living a good life but longed for something more. My passions have always been travel, photography and writing, so I decided to take a calculated risk and create a new life on "the road less traveled."

Hunter S. Thompson said it better than I ever could: “Life should not be a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!” I am fortunate to have done many extraordinary things since I retired, but none of them would have happened had I not dared to take a few tentative first steps and begin to live differently.

Next AvenueWhere grown-ups keep growing  Opinions expressed by Forbes Contributors are their own.

 Next Avenue , Contributor

By Jonathan Look, Next Avenue Contributor

Credit: Jonathan Look | lifepart2.com

Jonathan Look being "attacked" by baby elephants in Chiang Mai, Thailand

Six years ago, at 50, I took early retirement, sold almost everything I owned and began traveling the world. I had been living a good life but longed for something more. My passions have always been travel, photography and writing, so I decided to take a calculated risk and create a new life on "the road less traveled."

Hunter S. Thompson said it better than I ever could: “Life should not be a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!” I am fortunate to have done many extraordinary things since I retired, but none of them would have happened had I not dared to take a few tentative first steps and begin to live differently.

 

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Life still holds many more lessons for me. I have probably missed some stuff and gotten a few things wrong, but I havebeen paying attention. Here are 21 things I’ve learned since I retired; maybe they’ll help you in your retirement:

  1. We ain't gettin' out of this alive. With retirement, you have more time to do things you love, but the extra time is wasted unless you are using it productively and actually living your dreams. The road doesn't go on forever.
  2. In the end, we are all dead. Make that phone call or send an email to let someone know you are thinking of him or her. Better yet, go visit. Mend fences, hug, show appreciation, be kind to people. Don't be complacent; you never know when the people you thought would be there forever will be gone.
  3. Money is overrated. Money is a tool. To see it as anything else is folly. Yes, we all need some, but money is a means to an end, not an end in itself. Spend wisely and remember; superfluous wealth only buys superfluities.
  4. Time is your most valuable asset. You only get so much, and that is it. You can't horde it. You can't get it back. You can't turn back the clock. The best you can do is to start investing your time wisely.
  5. Stop searching for happiness. The only place you can be happy is in the present. Stop chasing tomorrow and fully experience happiness today.
  6. Your bucket list is crap. Putting things on a bucket list can be just another way of deferring your aspirations. Sure, go ahead and make a list but remember: life goes on while you are making plans. Lists are useless unless we utilize them.
  7. Comfort is overrated. The magic in life takes place at the edges of our comfort zones. Memories are made by pushing yourself and trying new things. Challenging yourself and growing your boundaries is more rewarding than security and comfort.
  8. Go with your feelings. You don't have to intellectualize or justify everything you want to do. It is okay to do things solely because you want to. Take dance lessons. Learn to play the zither. Who cares about the critics? You have earned it.
  9. You are responsible. You may not be at fault for what happens, but you get to choose how you respond to everything. Yes, everything. Your response to anything is a choice. You are response-able.
  10. You get to choose what matters. You didn't get this far to keep jumping through other people's hoops. Don't forget the importance of yourself.
  11. You can't make people happy. You can listen. You can be kind. You can smile. You can respect. You can offer assistance. You can contribute tools. But people are responsible for their own happiness (see No. 9).
  12. Let it go. Everyone has regrets, but don't live a life of sorrow. The past is gone; find a way to come to terms with it. You may be able to reverse a bad situation that haunts you from the past, but you can't turn back time.
  13. Stop complaining. Most people don't care about your problems; some are happy you have them. Complaining only serves to keep negatives at the center of your life.
  14. Your aspirations mean nothing. Well, they mean nothing if you don't make an effort to realize them. Take action to get the things you want.
  15. Ambition can be a killer. I hate to break it to you, but you aren't going to be Number One in everything you do. Breathe, and be satisfied, with the act of living today. Don't let blind ambition cause you to lose sight of what is important. Savour all of life's moments, even the bad ones, because you only get so many and you may wish you had paid more attention.
  16. Take care of yourself. You aren't much use to yourself or anyone else if you don't. Looking out for your health and happiness is not the same as being selfish. This is fundamental.
  17. It is okay to fail. Failure is part of life even in retirement. Failure teaches valuable lessons. In fact, we learn more from our failures than our successes. Expect success, but don't worry about it too much. It is the journey that matters.
  18. You don't have to wait for an apology to forgive.We have all been wronged at one time or another. Waiting for an apology from someone who may never give offer one is a waste of life. Who cares? Hell, if this is a gray area and it’s possible the other person is waiting for an apology from you, apologize first. What does it matter? Life is too precious to play those kind of games.
  19. Negativity wastes life. Being positive and optimistic in the present has a favorable impact on the future. Yes, bad things happen, but so do good ones, and we tend to steer toward the things on which concentrate.
  20. Be curious. See both sides. Stubbornness is not strength. When given new information, strong people develop and evolve their opinions. We can grow when we can admit we are wrong. Your life stagnates when you are wrong, but you refuse to admit it.
  21. Even though you are retired, you don't have enough time for everything. Everyone dies with things in their inbox. Do the best you can and live your definition of a full life.

 

 

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"Retired people over 55 may apply to participate in the ReServe Program. Candidates will be interviewed by ReServe, who will match a candidate's skills with a specific short-term project in a New York City agency or a non-profit organization. Selected participants, called "ReServists," work on projects for 10 to 15 hours a week and receive a small stipend for their contribution."

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