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Uberification of healthcare: A mutation towards consumer centric health

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Mani Kumar, MD, West Monroe Partners

Given the ever-rising cost and not-so-ever-rising quality of healthcare, our healthcare ecosystem is now in need of massive change. Some characterize this change as an evolution, while some believe slow evolution is not the answer and a revolution is needed. Yet others believe systemic mutations in how we perceive and consume healthcare is what is needed. One such mutation is an on-demand, crowdsourced focus on the patient and each interaction with that patient, a concept we refer to as ‘Uberification’. The Uberification of healthcare may provoke change towards a more consumer centric healthcare ecosystem.

Over the years, advances in the field of medicine have undoubtedly led to better clinical capabilities. Often times, however, the challenge remains simply that of access. In the U.S. healthcare system, many patients simply lack access because they are not able to physically transport themselves to healthcare facilities. Such non-clinical aspects of care can be key levers that transform the cost and clinical outcomes for patients towards a more consumer centric healthcare system.

Challenges of access have long been known with some studies estimating the cost of missed medical appointments in the U.S. to be upwards of $150 billion annually. Transportation remains a key challenge for many patients especially as doctor deserts (ex. dual eligible population) remain a reality in many geographies.

Many non-profit organizations – especially those servicing the Medicaid or dual populations – are well known to service such doctor deserts where any kind of medical care is hard to find. They not only provide care centers in such doctor deserts, but also creating their own transportation solutions to either bring patients to the right facilities or taking medical care teams to where the patients live. Some state Medicaid programs have elected to provide non-emergency medical transportation (NEMT) as a benefit to Medicaid beneficiaries.

Total federal spending on NEMT is unknown because federal departments do not separately track this spend. However, the department of Health and Human Services (HHS) estimates that it spent at least $1.3 billion on NEMT in fiscal year 2012. States have historically used different approaches to provide NEMT to their Medicaid beneficiaries.  Some states use transportation brokers, some contract with managed care plans while others contract with independent transportation providers (e.g., public transit, taxis, and state-approved volunteers). So how can we solve this pervasive problem of transportation in our new world?

In today’s age, many innovations have repurposed the use of established ideas to solve new problems. The two most repurposed ideas of recent are “on demand” and “crowdsourcing.” The combination of the two has produced ridesharing innovations such as Uber and Lyft. On demand services demonstrate the ever growing expectations of consumers and crowdsourcing exemplifies the cultural trend towards matching service providers efficiently. These cultural shifts towards consumer expectations and efficiency align with the consumer centric triple aim of healthcare – quality, access, and cost reduction.

As a result, it is no surprise to see healthcare companies leveraging such innovations. In the state of New York, National Medtrans Network, a coordinator of NEMT, has partnered with Lyft to provide free rides on demand for its patients. Last year, through a pilot program, Uber partnered with Passport Health to bring flu shots to the community. During this one-day run across Boston, New York, Washington DC, and Chicago, approximately 2,050 people were vaccinated, according to a study published in Annals of Internal Medicine.

Leveraging solutions like Uber and Lyft provide some quick and easy benefits – no setup time, no high inventory cost for managing vehicles or drivers, and accessing services only when needed. However, there are some areas of concern that should be kept in mind. For example, not everyone in the Medicaid or Dual population may have smartphones or mobile phones to access such services. And in some cases, the Uber or Lyft applications are tailored towards a tech savvy consumer. Some anecdotal evidence exists to show that dual population is not always as tech savvy.

Another concern with such solutions is medical liability. There’s risk of providing rides for critically ill patients where companies may be held liable for a ride that took longer than usual or failing to find the right hospital or clinic. As a result, careful consideration must be given before such a solution is adopted. However, with careful planning and consideration, such solutions can be effective for a niche population for niche healthcare services.

The concept of on demand and crowdsourcing continues to be repurposed within healthcare in ways well beyond transportation. For example, similar services are being applied to improve study participation and information gathering, by doctors conducting independent medical examination or peer reviewing each other’s work, and by food banks ensuring both diversely balanced and efficient distribution of donated food. As our healthcare ecosystem mutates toward consumerism, the key focus must remain on the patient and each service interaction with the patient. As such, true change is still brought about one patient and one ride (patient interaction) at a time.

 

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