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Social Determinants

One health system adopts ride sharing to address social determinants of health

Gabriel Perna | September 14, 2020

Credit: Virtua Health

For Imran Cronk, the concept behind his company, Ride Health, came to him when he was volunteering at a hospital in North Carolina. A gentleman was leaving the emergency department and Cronk found out he had no way of getting home.  

“He was wandering around and I asked him what he planned to do. He said he might try to walk home. I asked him where he lived. He described a part of town that was 8 or 9 miles away from the facility. He was an older gentleman, he was off balance, staggering around and told me his vision had been compromised by medication he was taking. So, the only thing I could think to do in that circumstance was offer him a ride home,” recalls Cronk, CEO of Ride Health.  

“It got the gears turning in my mind that something as simple as mobility, something many of us take for granted, can have a huge impact on someone’s access to care.” 

Indeed, transportation as a barrier to care is a problem that spans different types of underserved areas and patients. A 2017 study published by researchers at the VA Health System found that in urban settings, missing appointments due to a lack of transportation is a common challenge for up to 50 percent of patients. Furthermore, according to the University of Minnesota Rural Health Research Center, a study of more than 1,000 households in North Carolina found that those with a driver’s license had 2.3 times more health visits for chronic care and 1.9 times more visits for regular checkup care than those who did not have one. A well-cited paper from 2013 reviewed 61 studies and found that transportation was consistently related to missed appointments among low-income or minority patients in the U.S. across demographic groups.  

Cronk started Ride Health a few years after that encounter. The company works with health systems and payers, having its mobile app connect them with transportation companies to allow patients to get rides scheduled when going to and from an appointment. They match the patient’s needs (for instance, if they need a wheelchair ramp) with transportation companies and services within the area, ranking the ride companies based on availability and quality.  

Virtua Health  

One such organization that works with Ride Health is Virtua Health, a multihospital system based South JerseyBageshree Cheulkar, MD, who runs the community-based services team at Virtua, says that the health system has gotten into the ride sharing business as a result of an Affordable Care Act-required needs assessment 

“We’ve done three needs assessments—2013, 2016, and 2019—every single one of those assessments has showed that transportation was one of our biggest needs in the community,” says Cheulkar. Virtua was required to act on that need, not just because of the ACA but because it was costing the health system $3.6 million in no shows every year. 

“At the time we knew we had this need these ride sharing services were coming up with new programs and plans. A lot of those companies were approaching health systems to partner or contract with them. That seemed to be a better option than our cab voucher program.” 

A pilot of the ride health program was launched system wide at Virtua in 2018. After the initial success of the pilot, Virtua has begun to implement it across the entire system. Thus far, according to an article in Healthcare IT Newsthe ride sharing system has led to a 46% reduction in no-shows at Virtua Health’s Memorial Radiation Oncology clinic and a 75% reduction in patient no-shows for oncology appointments across the Virtua Health system. On the inpatient side, Cheulkar said the usage of the system helped free up beds because it reduced occupancy rates.  

Considering the outcomes, the challenges [of setting up the system] are OK to deal with,” she says. The most notable trials were getting the technology piece set up and making sure the service followed federal regulations on transportation assistance programs.  

The rise of ride sharing 

As Cheulkar noted, Uber and other ride hailing companies have had an increasingly larger presence in health care. Last year, Uber announced it was integrating its app into Cerner’s EHR system and Lyft announced a collaboration with Allscripts. Both companies have announced major partnerships with a number of health systems, payers, and other health care companies. Recently, Uber announced it was partnering with an at-home prescription drug delivery company.  

“Since the ACA went into effect, hospitals are looking at care more from a social determinants of health perspective. Those transportation, housing, food access issues have grown in importance because hospitals are required take responsibility for their community. They have to identify what their needs are and provide an action problem to solve those needs. That’s why it’s getting more attention now,” she says.  

For Ride Health’s Cronk, ride sharing companies like Uber are only part of the company’s platform and part of the solution. There are 17,000 non-emergency medical transportation providers across the company. Most of these are mom-and-pop organizations, typically with five or 10 vehicles each. There are 1,400 public transit agencies across the country,” says Cronk.  

Having multiple options is particularly important in these times, as both Cronk and Cheulkar said COVID-19 has had a major impact on the business. People are deferring care and it’s harder to find drivers, they say. Long term, though, they say that the public will be focused on safe, effective transportation and health care organizations will have to adopt as they address social determinants of health and increase access to care.  

“This not only addresses social determinants of health, but it increases the availability of services. By policy, we limit the service to patients who truly need it. We run the program more as an assistance program than a convenience one. But if your community needs assessment calls for these kinds of programs, it will provide the services needed for your patients. You’ll see that return on investment,” Cheulkar says.  

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email or on Twitter at @GabrielSPerna