Virtual Delivery, Steps Better (and Fewer) than Ride-Share Services

Hope Warshaw
March 26, 2018

Uber and oth­er ride-share com­pa­nies have been test­ing out and launch­ing new ser­vices to solve the per­sis­tent prob­lem of get­ting peo­ple to their health­care appoint­ments. But from our dig­i­tal health per­spec­tive, we ask: is this an opti­mal solu­tion?

In today’s in-per­son health­care deliv­ery world, there are real and prac­ti­cal rea­sons to employ ride-share ser­vices. For the per­son in need of that easy to sched­ule, cost-free ride it could be the dif­fer­ence between get­ting crit­i­cal health­care ser­vices and being a no-show. On the part of health­care providers and insti­tu­tions, foot­ing the bill for ride-share ser­vices becomes a small price to pay to keep providers’ sched­ules filled, max­i­mize pro­duc­tiv­i­ty and use expen­sive equip­ment; all to gen­er­ate ade­quate rev­enue.

For sure, many rea­sons exist for face-to-face health­care ser­vices from appoint­ments with health­care providers, lab and med­ical tests, acute med­ical prob­lems neces­si­tat­ing urgent care, med­ical pro­ce­dures, day surgery or hos­pi­tal­iza­tion for surgery, are just a few.

Ride-Share has Pluses and Minuses

While ride-share ser­vices sound like a promis­ing solu­tion to the no-show chal­lenge, they’re not a cure-all. A study con­duct­ed by U Penn and pub­lished in JAMA, report­ed that among about 800 Med­ic­aid recip­i­ents offered free Lyft rides to and from pri­ma­ry care appoint­ments, the num­ber of missed appoint­ments did not decrease com­pared to the con­trol group. A par­tic­u­lar­ly press­ing health­care prob­lem is missed appoint­ments to pri­ma­ry care providers.

Oth­er dis­ad­van­tages may turn out to be a scarci­ty of dri­vers in rur­al and low-income com­mu­ni­ties and the lack of wheel-chair acces­si­ble vehi­cles. The U Penn researchers not­ed that ride-share ser­vices could prove ben­e­fi­cial to indi­vid­u­als who need reg­u­lar in-per­son health­care ser­vices, such as kid­ney dial­y­sis or can­cer treat­ments.

Alternative Solutions to the No-Show Dilemma

Back to the ques­tion: Is increas­ing the avail­abil­i­ty of ride-share ser­vices a cost and time-effi­cient solu­tion to the no-show chal­lenge?

The answer is no for some health­care ser­vices, par­tic­u­lar­ly the man­age­ment of chron­ic dis­eases, like dia­betes, asth­ma, high blood pres­sure, con­ges­tive heart fail­ure and oth­ers. This is impor­tant since the man­age­ment of chron­ic dis­eases con­tributes to rough­ly half of U.S. health­care costs.

Aspects of many chron­ic dis­eases can increas­ing­ly be man­aged remote­ly with clin­i­cal­ly val­i­dat­ed and FDA-cleared dig­i­tal ther­a­peu­tics. A recent New York Times arti­cle, “Take This App and Call Me in the Morn­ing,” describes this new cat­e­go­ry of dig­i­tal health tools. WellDoc’s FDA-cleared BlueS­tar is one of the dig­i­tal ther­a­peu­tics men­tioned in the arti­cle.

Why make peo­ple unnec­es­sar­i­ly trek to their providers when they can con­nect vir­tu­al­ly? The ben­e­fits far out­weigh using a ride-share ser­vice both for the rid­er and enti­ty pick­ing up the tab. Vir­tu­al vis­its negate trav­el time, don’t use cost­ly fuel, min­i­mize time from work and oth­er life activ­i­ties, decrease work­site absen­teeism , lim­it stress and strain on care­givers, to name a few.

Virtual Plan A, In-Person Plan B

A recent New Eng­land Jour­nal of Med­i­cine per­spec­tive, “In-Per­son Health Care as Option B” by Sean Duffy, CEO of Oma­da Health and Thomas Lee, MD, push­es the enve­lope fur­ther and asks this ques­tion: “What if health care were designed so that in-per­son vis­its were the sec­ond, third, or even last option for meet­ing rou­tine patient needs, rather than the first?” The authors sug­gest a first step is to place greater empha­sis on the val­ue of people’s time. Hear, hear!

When float­ing the use of dig­i­tal ther­a­peu­tics, remote mon­i­tor­ing and vir­tu­al care deliv­ery the ques­tion about reim­burse­ment is often top of mind for health­care providers. There’s good news to share on this front. Pri­vate health­care plans and Medicare are slow­ly increas­ing cov­er­age for remote patient mon­i­tor­ing. Insights cov­ered this top­ic recent­ly in “Medicare Now Reim­burs­es for Remote Care.”

Oth­er health­care providers, like Kaiser Per­ma­nente, an inte­grat­ed health care sys­tem, are fur­ther along. Duffy and Lee note that at over half of Kaiser’s 100 mil­lion annu­al patient encoun­ters are vir­tu­al vis­its enabled by huge spend­ing on infor­ma­tion tech­nol­o­gy. As pay­ment mod­els evolve from fee-for-ser­vice to val­ue-based, this will incen­tivize the use of dig­i­tal health tools and vir­tu­al deliv­ery is like­ly to grow expo­nen­tial­ly.

Duffy and Lee con­clude their NEJM per­spec­tive stat­ing: “View­ing in-per­son physi­cian vis­its as a last resort sounds rad­i­cal, but it just rep­re­sents a deep­ened com­mit­ment to patient-cen­tered care.”

Let’s spend more resources and col­lec­tive brain pow­er to enable the use of vir­tu­al care deliv­ery instead of invest­ing in rel­a­tive­ly expen­sive and inef­fi­cient ride-share options for those with chron­ic dis­eases and oth­er mal­adies that can be effi­cient­ly and effec­tive­ly man­aged with dig­i­tal ther­a­peu­tics.