Health Tech: Lyft for Patient Transportation An Interview with the Sachin H. Jain, MD | Shiv Gaglani

CardioSource WorldNews | Sachin H. Jain, MD, has an impressive track record of innovation within health care. His career has spanned academic, public, and private roles, having served as the Chief Medical Information & Innovation Officer at Merck, the Senior Advisor to Donald Berwick during his tenure as the head of Center for Medicare & Medicaid Services (CMS), Editor-in-Chief of Healthcare: The Science of Delivery & Innovation, and now, president of CareMore which delivers care to a population of 100,000 Medicare and Medicaid patients with approximately 1,700 staff. He was also the founding columnist for the Health Tech section in CardioSource WorldNews. Dr. Jain recently co-authored a piece in JAMA about an innovative collaboration between CareMore and the ride-sharing platform, Lyft, to deliver non-emergent medical transportation to CareMore’s patient population. We had the opportunity to speak with him about this specific collaboration as well as where he’s been and where he wants to go.

Can you describe what attracted you to CareMore?

I first heard about CareMore while I was at CMS. We were looking around the country for examples of organizations that had achieved the Triple Aim, and kept getting pointed in CareMore’s direction. The exciting thing about the organization was that they had successfully built differentiated care models for some of the most vulnerable patient populations. When I received a call about 2 years ago to explore a role at CareMore, I was very excited because I believe strongly that what they’re focused on is where health care needs to go: customizing care for specific populations. I joined them in January 2015 as Chief Medical Officer and spent the subsequent 1.5 years familiarizing myself with the organization. Over the past 7 years, the organization has grown from one state to eight. In late 2014, we began working with the Medicaid population in Memphis, TN and subsequently, in Iowa. We also began working to help other healthcare systems to implement value-based care, for example with Emory Healthcare.

That was my focus for the first 15 months. Then our CEO made the difficult decision to retire and asked me to be her successor, which I accepted in April 2016. It’s been a really exciting few months because I feel we have a unique opportunity to do innovative and creative things given that we’re both a payer and provider. Whereas many health care systems spend months debating what to do and how it may affect their relationships with payers, we’re able to sit down and ask the question, “What’s right for our patients.” That’s how we got into the business of providing generous transportation benefits for our patients, which helps us lower the barriers for patients to access healthcare services.

I understand CareMore has been providing transportation benefits to your patients for years; how did the Lyft partnership come about?

About a year ago we started observing some of the changes in the transportation landscape, namely the emergence of ridesharing with Uber and Lyft. We began thinking this would have significant implications for the healthcare system more broadly, by not only reducing overall costs in terms of accessing healthcare services, but also improving quality. One of the most important moments for me at CareMore was when I was taking care of a patient with chronic obstructive pulmonary disease (COPD) at the hospital, and I asked him why he didn’t participate in our COPD disease management and exercise programs. He said he had a hard time getting there from a transportation perspective. He turned to me and asked if I had ever used the rides provided by our transportation. He explained that the service was great at picking him up on time, but he had real issues with the return trips, which would be ordered after the appointment was completed. Thus, he’d sometimes be waiting as long as an hour after the appointment was over. If you have breathing issues, standing outside by yourself for hours on end could feel like an eternity. That story really stuck with me and influenced our decision to innovate in the patient transportation space.

We reached out broadly across the ridesharing industry. What we found with Lyft was a willingness to go deep and understand the population we’re serving. They were willing to really customize the delivery of services to the population we serve. Ultimately, giving rides to people coming home from restaurants is different from giving rides to seniors (e.g., our patients may take longer getting from the home to the curbside for pickup). They have different communications expectations. Earlier this year we actually held a seminar on senior sensitivity training for more than 70 Lyft drivers, and we’re continuing these seminars. One of the keys to the partnership is that Lyft works in collaboration with some of the national non-emergency vehicle providers; it’s not just about deploying the same vehicles that general consumers may take, but also about taking the excess capacity that exists for non-emergency medical transport vehicles and bringing them into ridesharing networks.

The JAMA article highlights our results, though in short we found that we were able to reduce both wait times and costs by about 30 percent (wait time average went from 12.52 minutes to 8.77 minutes; cost declined from $31.54 to $21.32). Customer satisfaction is at 80 percent, and we think it can go higher towards the 95 percent range. We see this partnership as a work in progress; we’re the first Medicare Advantage program in the country to partner with a ridesharing service.

What are your goals moving forward in terms of innovation at CareMore?

One thing we’re really excited about is integrating dental and primary care to make accessing both easier for seniors. To our knowledge there hasn’t been too much work to integrate primary care into the dental setting. Starting in January 2017, we’ll be piloting this effort, opening a dental office in our Montebello Care Center, where a CareMore Nurse Practitioner will serve alongside dentists to help provide continuous and integrated care.  For instance, we’ll have nurse practitioners check our patient’s HbA1c levels during their dental appointments, so they can provide diabetes or prediabetes care.

This is based off of an interesting dynamic: many senior patients report caring more about their teeth (a visible indicator of health) to managing their blood pressure or blood sugar (often invisible). One philosophy we’ve always had at CareMore that we’re doubling down on is the notion of “no wrong door”. Whatever health experience you seek out is used as an opportunity for managing chronic disease, which is not about episodic and periodic check-ins. We think we can use every single health care encounter that a patient goes through to improve the patient’s overall care.

Another innovation is this notion of the extensivist. One of the things that CareMore recognized early is that if you break up the outpatient and inpatient encounters


Shiv Gaglani is an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. He writes about trends in medicine and technology and has had his work published in Medgadget, The Atlantic, and Emergency Physicians Monthly.

Read the full October issue of CardioSource WorldNews at ACC.org/CSWN

Keywords: CardioSource WorldNews, Centers for Medicare and Medicaid Services (U.S.), Cooperative Behavior, Delivery of Health Care, Medicaid, Medicare, Organizations, Transportation


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