Insights

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.

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