Make your patients healthy and your ED happy with community paramedicine

Evidence shows that without reliable transportation options, patients are more likely to miss preventative, primary care appointments, increasing the risk of avoidable escalation and downstream utilization. While health care organizations have long been experimenting with augmenting shuttle services, leveraging community paramedicine, and even lobbying to improve local transit, ridesharing partnerships are becoming increasingly popular. Convenience is a big reason why—staff can schedule last-minute rides if necessary and vulnerable patients receive timely door-to-door services.

However, it's difficult to estimate whether or not rideshare partnerships are a worthwhile investment to improve access to care, as the evidence base is inconsistent. On the one hand, MedStar Health, a beta tester of Uber Health's services, reported saving time and money when it migrated from its traditional taxi service partnership. At the same time, researchers from the University of Pennsylvania published a prospective clinical trial suggesting that offering rideshare services to Medicaid beneficiaries had no significant impact on primary care appointment attendance.

The Uber Health and Lyft platforms stand out among other transportation services because of their seamless integration into the care team workflow. When using Uber Health, staff can use the HIPAA compliant online platform to schedule rides in advance or in real time, and receive detailed billing information monthly. Lyft just announced partnership with Allscripts, in which Lyft's rideshare platform will be integrated in Allscripts' EHR workflow, requiring little staff effort. Providers using the system will be notified when patients are being picked up and of their estimated time of arrival.

But is partnering with either company a worthwhile investment? It can be—at least for providers in more urban settings—if strategically executed with in-depth knowledge of specific community transit barriers. There are a few key considerations to keep in mind:

1. Addressing transportation needs alone is not the end-all, be-all solution to improving access

More often than not, investing in transportation services like rideshares will address only one of the many interlocking non-clinical challenges that restrict patient access to care. Simply offering patients a free ride doesn't account for other extenuating circumstances: a lack of childcare, shifting working schedules, or unstable housing. Rideshare partnerships should be a piece of a larger strategy for improving access to care, including investing in other non-clinical needs and driving patient engagement.

2. Transportation services must be built by consistently centering the community's nuanced needs and priorities

Like all interventions aimed at addressing the social determinants of health, rideshare services can't be one-size-fit-all, but instead must get to the root of patients' access barriers. Provider organizations should source the community for insight on which rideshare partnership (if any) is the most likely to meet community needs.

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Partnering with Uber Health—which doesn't require patients to have smartphones or be tech savvy to receive services—is a good start (it's currently unclear if Lyft offers the same flexibility). But provider organizations should dig deeper, through surveys and focus groups, to customize offerings to its unique communities. For instance, does the program's target population require rideshare vehicles to be accessible for patients with disabilities, patients with end-stage conditions, or the elderly? Do community members want vehicles to come equipped with car seats? Efforts that meaningfully incorporate community input are the most likely to inflect key outcomes like reduced costs and improved access.