How Lyft’s health business is trying to close gaps in access to care – STAT

By | September 11, 2020

When Megan Callahan was weighing whether to join Lyft’s burgeoning health care business two years ago, she was attracted by the idea of being able to work more closely with patients — and make the process of getting care easier for them.

Just a few years earlier, Callahan, now the vice president of health care at Lyft, had been diagnosed with breast cancer. She saw firsthand how much of a barrier transportation could pose to care.

“That was a moment where I thought, [this] is a problem I can get after, because I can understand what those patients are trying to deal with,” Callahan told STAT’s Erin Brodwin on Thursday at the STAT Health Tech Summit.

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In the past two years, Lyft has significantly expanded its medical transportation business, which is designed to help patients get to and from medical appointments. Callahan also spoke with STAT about how that strategy can help tackle some of the social determinants that shape a person’s access to care.

This conversation has been condensed and lightly edited for clarity.

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You’re working with some Medicaid providers, including Centene. What does an insurer get out of this partnership with Lyft?

What we’ve created is a business-to-business platform that allows for a ride to be called on behalf of the patient or a member without them using the Lyft app. So the sponsoring organization, whether that’s a Medicaid plan, whether it’s a health system, arrange the ride for the member, and they pay for the ride for the member. Medical transportation has been part of the Medicaid benefit since the program’s inception in the late 1960s. And so when we work with insurers like Centene, they are used to the traditional [non-emergency medical transportation, or NEMT] model, which is obviously not based on rideshare.

Typically those experiences are often public transport often loading patients into a multi-load vehicle so think of like, a van with six to eight people in it. That takes much, much longer to get to their appointment than it would if they were taking a direct route… That leads to a tremendous amount of patient dissatisfaction…

The other thing that it does, from a member perspective, is if instead of two hours to go to a doctor appointment, it’s going to take you four to six hours because you’re waiting on average one to three hours for your ride to show up for you. That means that you probably are going to forgo those appointments because you can’t afford the additional childcare. You can’t afford to take time off of work. And then you skip those preventative appointments, and often what happens is those people end up in some kind of an adverse event.

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We do have research that shows that actually access to transportation increases your likelihood of not ending up in the emergency department and not ending up in multiple days of inpatient visits. So there is this correlation of actually just physically able, being able to get to something, and an impact on health outcomes, which I think was a, you know, probably not something that most of us think about often it’s not something that probably impacts our lives too often, but obviously I think people can appreciate the practicality of the problem that we’re trying to solve.

Is there something specific that Lyft adds to the patient transport solution that other transportation providers are not currently providing?

I would say that the on demand solution is very timely. [With Centene], they were able to decrease wait times from 28 minutes to seven minutes.

…The way that we all expect now to interact with our life, it is not to sit on a phone with a call center agent and schedule a ride three days in advance. And then if something happens… and you have to move your appointment, [you have] to get back on that phone call with that call center agent again.

So I think that that consumerization and the democratization of the experience is something that Lyft offers that is far superior to other types of options, and then, of course, there’s much more behind our product than just the ride. There is a whole back end infrastructure right around billing and payment and other things that we believe sets us apart from more traditional options.

How can you overcome patient privacy concerns for substance use disorder patients whose records are protected by HIPAA and [other federal policies]?

So we actually do a lot within opioid use disorder… A partner of ours announced the usage of Lyft to determine the impact of rideshare on opioid use disorder and getting patients to their daily methadone appointments, which are obviously very fast… So one thing that is to note around Lyft, is that the driver population that we use for our rides are the same as our general driver population.

The drivers do not know that they are getting a health care ride, and that is by design. We do not want them to know. So if you get dropped off at a hospital, if you get dropped off at a point of care, the driver doesn’t know if you’re a patient, if you’re going in to visit your mother, if you work there, they do not know.

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How much of the fleet of Lyft automobiles can accommodate patients who use wheelchairs?

So, we have wheelchair accessible vehicles, I want to say, in 12 or 15 cities, I probably have to check to get the correct stat. And we are investigating incorporating those fleets within the health care product. But one thing I want to point out for everyone who’s listening because this is a very niche part of healthcare.. [are] the transportation managers. They’re a critical part of this ecosystem. They are contracted with the health plan. Generally, they are contracted with the state Medicaid agency. Their job, [if] you’re the patient, [is to] assess you, determine what your needs are, determine what type of car is appropriate for you.

What do you see at Lyft that you couldn’t see while you were working at McKesson?

You know, I think one of the things that really attracted me to Lyft was to get closer to the patient… I was diagnosed with breast cancer towards the end of [my time at McKesson]. And that also really impacted my decision to come to Lyft, because at that time — it was 2014 — rideshare wasn’t prevalent. I’m a fairly well off woman in the health care sector, and I was trying to figure out how I could get from my home into UCSF to get care for 18 months on an ongoing basis. And when Lyft called, that was really a moment where I thought, you know, that is a problem I can get after because I can understand what those patients are trying to deal with.

There’s a lot of people — I mean think about a Medicaid patient who is a woman with two children and Spanish-speaking, how she’s going to figure out how to navigate this. So that’s part of, I think the passion of me and the entire Lyft team.

Tell us more about what Lyft does to address social determinants of health.

Social determinants are really focused on where you live, where you work, where you play, everything around you. Your ZIP code is is much more predictive of your health than your health care and even your genetic code. So that incorporates things like transportation, your job. do you have access to healthy food. All of those things are really encompassed into social determinants of health.

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So Lyft is not only, as transportation, a social determinant of health — it’s also a conduit to many other social determinants of health. So we focus on a couple of different things.. We’ve been talking about getting people to care and medical appointments, and that is obviously one aspect that’s very important. But there’s other ways that Lyft is playing within the social determinants of health space…

We are very focused on healthy food. We have a grocery access program where we provide subsidized rides to people in low-income areas to get to the grocery store in concert with non-profit organizations. Post Covid, we launched an essential delivery service. We were getting inundated by health systems and payers and nonprofits looking for ways to get things into the home, whether that was food banks looking to get food, medical supplies, you name it.

So part of what we’ve done with AmeriHealth in Tennessee is we’ve partnered with the Second Second Harvest Food Bank and we’re bringing meals into people’s homes… AmeriHealth is actually paying for the delivery mechanism for that. We have lots of programs like that.

Another thing that we’re pretty focused on is jobs access. Income inequality is kind of the umbrella under which any kind of health disparities seems to emanate from. So we’re very focused on getting… people into job interviews [and] job programs so that they can hopefully elevate their socioeconomic position and therefore increase their healthcare. And then I’d say the last thing that we’re really focused on is last year we partnered with Unite Us, which is an organization and a platform that’s really focused on with on providing referrals to community benefit organizations and putting this closed-loop referral system. And so we are their rideshare partner..

One of the things that I think we have a challenge with is connecting social determinants of health into our clinical systems and. One thing that is become very clear to me is that we don’t have a consistent way to pay [clinicians to] evaluate people for social determinants of health issues [or] barriers that they might have that preclude them from getting to healthcare. And we don’t have a good way to code it, and often in healthcare, if you don’t code it, you can’t measure the effectiveness.

Erin Brodwin contributed reporting. 

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