While all of our readers have likely taken a Lyft or heard of the company’s transportation platform, many may not know that the company has been in the healthcare space since 2016. Lyft has a business to business platform that allows healthcare systems and transportation brokers to book rides on behalf of patients. The Pulse sat down with Megan Callahan, Healthcare at Lyft, to discuss the history of non-emergency medical transportation (NEMT) and its potential to influence social determinants of health.

The Pulse: Why did Lyft decide to get into healthcare? What is the problem that Lyft is trying to solve and how does the business work?

We got into healthcare in 2016 to reimagine the way patients get to care. Annually over 3.6 million people can’t get the care they need because they lack transportation. Lyft’s mission is to improve people’s lives with the world’s best transportation, and we are committed on the healthcare side to reducing the transportation gap and ensuring that transportation doesn’t stand in the way of care. This is an issue that we are uniquely positioned to address through our work with healthcare organizations across the country. We believe we not only have the potential to improve healthcare outcomes but also to create significant savings. In general, Lyft is about 30% cheaper than other NEMT providers. We offer a fast on-demand experience in a space that has historically generated low patient satisfaction.

Let me explain how the business works and talk about the value proposition. It is important to clarify that Lyft Healthcare does not work the same way it works for a consumer who calls a Lyft on their phone to go to dinner. We have created a separate product which allows a sponsoring organization to call the ride for the member or patient. This is important for a couple reasons: First, it means someone has a vested interest in making sure the patient gets to care. Whether that entity is an insurance company, health plan or health system, someone else is paying for the ride and has indicated that they want the rider to stick to her care plan. The other important thing is that the rider doesn’t necessarily need to have a smartphone. The ride is being called by either a discharge nurse, case manager or customer service agent in a call center. If the rider has a smartphone, we send notifications to them through text. If they don’t have a smartphone, we can send automated calls to a landline, which as you can imagine is important for seniors. This enables our partners to seamlessly order a ride on behalf of their patients that is reliable and provides better insight into their transportation.

There is a healthcare perspective and a business perspective for why sponsoring organizations would want to invest in things like transportation for their members. If you are a health system or provider, anytime someone doesn’t show up is a missed care and revenue opportunity. As a health plan, you want to make sure patients are as healthy as possible. A 2016 analysis of the NEMT space by the GAO found that the industry is highly fragmented and does not have a lot of automation. These two factors create an opportunity for fraud, waste and abuse. Lyft is bringing technology that provides the ultimate transparency on where someone started, how long it took them, and where they stopped. We also offer transparency from a business standpoint by providing up-front pricing for our partners.

The Pulse: You have a Masters in Public Health from UCLA, which is a degree we rarely see in the technology industry. How did you make your way into tech? How do you see your public health background translating to your work at a fast growing technology company?

During my MPH I focused on epidemiology–the study of disease and populations, and healthcare services–the business side of healthcare. I knew that the business side of healthcare was where I wanted to go. After graduate school I worked in business development for a large healthcare system and foundation. I then went into healthcare consulting and dove into utilization management, case management, and disease management and the software solutions to automate these services. The rest is history.

So much of healthcare is how you support someone on their healthcare journey. Before social determinants of health became an in-vogue buzzword, my joke was that a lot of healthcare was a microwave and a bath. My goal is to contribute to the Triple Aim by focusing on targeting vulnerable populations like Medicaid and Medicare Advantage populations. My MPH translates well as I look at who is experiencing transportation as a barrier to care and falling through the cracks.

The Pulse: Lyft’s healthcare team started by partnering with state Medicaid programs and now also partners with Medicare Advantage plans. Transportation is a little known benefit covered under public insurance. Can you walk us through the history of how transportation has been treated under public insurance?

Medicaid has had transportation as a benefit since the program’s inception in the 1960’s. Medicaid is funded 50% by federal dollars and 50% by state dollars. This means if you have seen one Medicaid program you have seen one Medicaid program. Just because Medicaid allows transportation to be a benefit does not mean that everyone has the benefit. States can highly customize Medicaid to meet the needs of their population. Of course, for lower socioeconomic groups, mothers with children, and people with disabilities, it is not uncommon that transportation is a barrier to care, and therefore Medicaid has often paid for it.

Fee-for-service Medicare has some transportation benefits but doesn’t do much with NEMT. However, Medicare Advantage, which is the fastest growing program in Medicare does allow transportation to medical appointments. In 2018 and then again in 2019, CMS provided more flexibility to Medicare Advantage plans to include things like transportation for services that are not necessarily medical care but support overall health. Having said that, this increase in flexibility did not come with additional dollars, so every Medicare Advantage plan has to deal with tradeoffs with what they think will help the most with ensuring the health of their population. Finally, commercial or employer sponsored insurance typically does not include NEMT as a benefit.

The Pulse: The medical transportation industry has historically been conducted in an informal, “pen and paper” fashion. What has it been like to introduce technology from a non-healthcare company to NEMT brokers?

It has been very positive. We partner with 9 out of the top 10 transportation brokers, the top 10 health systems, and the top 10 payers. The reception that we have gotten in terms of who wants to work with us and our partners speaks to the value that Lyft can bring to them.

Historically, health systems, particularly in the emergency department, would have taxi vouchers which were literally pieces of paper from a taxi company. If you went to the emergency department and you couldn’t drive home, they would rip off a piece of paper and call a taxi for you, you would go out and get the taxi and they would have no idea what that ride was going to cost. Early on, Lyft went to emergency departments and had them use our platform to replace taxi vouchers.

The transportation brokers who manage the majority of the rides are fairly sophisticated–they manage millions of rides a year and coordinate everything from eligibility and benefits with the health system to making sure the ride can be paid for all the way through to ride dispatch and managing complaints and grievances on the back end. These brokers create a network in a local area with transportation providers that vary in sophistication, from local car service organizations all the way to national companies. Working with Lyft gives them a transportation provider on a national scale with a strong technology product and single entity for contracting, billing, transparency, and reporting. These companies still work with local providers–not every patient or member is appropriate for a Lyft. You have to be able to walk to the car and get in and out of a car. For patients who are appropriate for a Lyft, it frees up the capacity for the higher order vehicles and rides to be available to the people who really need them.

The Pulse: The idea of social determinants of health has come to the forefront of healthcare recently. Social determinants include factors like access to transportation, as well as loneliness and isolation. Has your team conducted internal research to understand how Lyft’s transportation platform is improving these social determinants for its riders?

We did a joint study with USC, AARP of California and United Health Group where we gave unlimited Lyft rides to seniors in the LA area. We were trying to assess a couple of things: First, would seniors use ride share? Secondly, if they did, how would it impact their quality of life? Quality of life can be assessed through a validated tool. The study showed that there was a 90% improvement in the quality of life of seniors. What I thought was interesting was that only 15% of the rides were taken to medical care. 85% of the rides were to see a relative, go to social events, the gym, etc. There are some poignant videos on YouTube where study participants were interviewed after and talked about what these Lyft rides gave to them. The ability to not feel isolated socially, which is highly correlated with chronic disease was huge. I think that Lyft and rideshare can be such a helpful tool to seniors and really help them lead a high quality of life.

The Pulse: How would you like to see technology address issues of health equity over the next decade?

I think that digital health can play a role in improving health equity. There is great promise in rural communities for telehealth. The sheer amount of data we are now able to track has the potential to improve health outcomes for people’s experiences. However, we have a much bigger issue in this country around coverage. Seeing the increases in deductibles and out of pocket costs shows that there is a much larger systemic issue that we need to deal with around health equity. In the future I want technology to be available to more than who it is available to today.

Interview by Monica Adibe, January 2020