Health systems are increasingly investing in interventions to address social determinants—and transportation is often at the top of the list. The Altarum Institute estimates 3.6 million Americans miss or delay medical appointments each year due to a lack of transportation, and many more rely on medical transport with long-wait times and high rates of driver no-shows. Therefore, many provider organizations (and health plans) have begun to partner with popular rideshare companies like Uber and Lyft, aiming to get patients to their appointments more easily (and at lower cost than traditional NEMT services).
I understand why. The opportunity to reduce costly no-show rates is vast. Missed health care appointments cost the U.S. health care system $150 billion per year, and the average clinic can have no-show rates as high as 30%. However, these partnerships hinge on a basic question: Does simply providing patients with no- or low-cost rides to appointments actually close the gap?
The reality is that there has been very little research done on the effectiveness of arranging non-emergency transportation services from patients. Earlier this year, my team systemically reviewed the peer-reviewed literature on transportation as part of our Care Delivery Innovation Reference Guide. We found that when studies do exist, they show inconsistent rates of success. Some individual case studies report benefits in improved no-show rates and reduced costs. However, other studies and randomized control trials found no significant differences in either no-show rates or ED use. Indeed, a 2018 JAMA study on the impact of rideshare for Medicaid patients found low uptake and significant drop-off rates. In the randomized control trial, 56.3% of patients were not interested in rideshare services and, even among the 32.4% of patients that scheduled rides, only 19.8% ultimately used the service.
Providing transportation is not a silver bullet to solve the challenge of no-show rates, even among lower income, vulnerable populations. Particularly if those patients do not perceive that the follow up appointment is necessary or have a relationship with the provider. We need a more targeted approach. Transportation is often only one of many underlying factors that lead to missed primary care utilization (and subsequent avoidable ED use). Rather, it's your patient outreach and engagement strategy that really matters. Organizations with successful programs typically integrate transportation services into existing care management responsibilities, as staff-patient relationships are what help surface information about when and how to offer transportation services (or address other social determinants that preclude access).
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