How Lyft Healthcare Changed Lanes to Social Determinants of Health Work

May 31, 2022 - It was 2016, and the leadership at burgeoning rideshare company Lyft was alerted to several tripped fraud wires. What looked like fraudulent ride requests coming out of Utah for trips in New York turned out to be a medical transportation broker tapping Lyft for Medicaid’s non-emergency medical transportation benefit.

“They had dozens of burner phones thrown across the desk ordering rides for Medicaid patients in New York leveraging the Lyft app as the access point,” Buck Poropatich, the head of Lyft Healthcare, said during Xtelligent Healthcare Media’s Social Determinants of Health Virtual Event. “They had self-discovered that there was a better mousetrap, a better way to service this market and orchestrate this need.”

Zoom in six years later, and Lyft Healthcare is a fully established branch of Lyft Inc., dedicated to serving this very purpose—connecting patients with rides to medical appointments and, increasingly, resources to help solve some social determinants of health.

Transportation access is in and of itself a key social determinant of health, Poropatich said during his address. Nationwide, about 6 million people are missing or delaying medical care because they lack transportation. Meanwhile, patients who report transportation access problems are about 2.5 times more likely to have a costly emergency department visit.

And it’s a patient experience problem, too. According to the 2021 MedPAC report, transportation ranks among the top grievance areas for Medicaid enrollees.

And perhaps the most frustrating part of it all, transportation doesn’t have to be so difficult, not in the age of app-based rideshare options, Poropatich asserted. Of course, addressing the social determinants of health is a massive healthcare challenge, he acknowledged.

“Social determinants of health are incredibly important, but they can also be very difficult to address and equally hard to actually measure the impact,” Poropatich said. “That said, the challenge I would have with that statement is that transportation specifically now can be rather easy to address, or easier certainly.”

After those fraud wires were tripped in 2016, the leaders at Lyft Inc. developed Lyft Concierge, a tool that can be leveraged through an application programming interface (API) on either a mobile phone or computer. Lyft Concierge lets businesses, in this case healthcare organizations or payers, schedule rides for their clients to enable transportation.

Clients don’t need the Lyft app or even a smartphone; Lyft Concierge can push out a robocall to give riders all of the same information the Lyft app would provide, offering some transparency and a sense of safety in the experience.

In a healthcare industry increasingly embracing risk-based reimbursement contracts, while also grappling with a complex web of social needs affecting health outcomes, Poropatich argued that investment in seamless non-emergency medical transportation is essential.

“If the goal of your organization is to improve health outcomes, to not invest in transportation you're saying one of two things: either the population that I serve does not have transportation insecurity, just doesn't exist within that population; or getting to the service that your provider is not definitively promoting better health,” he contended.

And while Poropatich conceded that there could be instances in which medical transportation simply is not within a provider's purview—maybe it’s up to the insurer—it’s still incumbent upon all stakeholders to advocate for a simpler solution to transportation.

Take a Lyft case study with ChenMed, which Poropatich said takes on huge global risk for its patients. The primary care provider, which largely serves a senior population, has built a longstanding relationship with Lyft Healthcare after it examined its own NEMT solutions.

ChenMed’s van service was expensive, Poropatich continued, and it lacked the transparency needed for both the driver and the rider or patient to facilitate a good experience. The healthcare organization tapped Lyft Healthcare for its traditional services, but that came with a twist.

“They also challenged us to rethink or tweak our model a little bit, which is what drove us to introduce Lyft Assisted, which started as a pilot last year and then throughout this year, we've continued to expand with new partners and rolling it out to new regions across the country,” Poropatich said.

To be clear, Lyft Assisted is not a medical transportation service; any Lyft ride to a healthcare provider is still best for folks who are ambulatory and do not need any special services with their medical equipment. But through Lyft Assisted, patients can get a little help making it from their front door to the car, whether it be an arm or an elbow or help carrying their bags.

The service helped drop no-show rates by 20 percent, and patient satisfaction scores are sky-high, coming in just nearly at that coveted five stars.

Beyond individual healthcare organizations, Lyft Healthcare also partners with payers. Importantly, the rideshare company has partnerships with government agencies, including state Medicaid programs in 18 states and the District of Columbia, covering about 45 million of the nation’s nearly 75 million Medicaid enrollees.

Driving Better Outcomes with Lyft Healthcare from Xtelligent Healthcare Media on Vimeo.

And as it moves forward, Lyft Healthcare envisions even deeper partnerships, acknowledging that getting to and from medical appointments is only part of the social determinants of health landscape. For nearly every other social determinant of health, transportation access is a secondary concern.

“Transportation, where we focus our day-to-day here at Lyft, is unto itself a social determinant of health, but it's also a conduit to others, it's all interrelated,” Poropatich pointed out.

“And a lack of transportation is going to amplify things like food insecurity, social isolation, unemployment, et cetera,” he added. “So, transportation cannot be an afterthought, it has got to be a starting point for these conversations if you're going to think about holistically, solving or addressing some of these gaps and some of these needs.”

Take, for example, Lyft’s partnership with Martha’s Table, a DC-based non-profit that specializes in food security. The pair offered folks living in Wards 7 and 8 in DC, which represent about 80 percent of the food deserts in the District and places with limited public transit access, $2.50 rides to the grocery store.

“We had 400 families sign up and participate in the program and we took over 5,000 rides during that time period,” Poropatich said. “And the feedback again was really strong, they talked about having more affordable access to healthy foods, it was much more convenient than historically their access points to getting to the grocery, and ultimately it started to change some habits.”

Lyft Healthcare is proving beneficial for the social isolation problem that plagued older adults even before COVID-19 but worsened after the pandemic.

“This challenge is far too familiar and has really only gotten worse, unfortunately, in light of the pandemic,” Poropatich said. “Roughly 25 percent of seniors today report being socially isolated. And the impacts can certainly be devastating. About 50 percent increase in the risk of dementia, about a 30 percent increase in the risk of heart disease and stroke.”

But in a study with the University of Southern California and AARP, Lyft Healthcare determined that unlimited Lyft rides—with no strings attached in terms of destination—can help move the needle.

Lyft saw a 90 percent improvement in self-reported quality of life, and more than 90 percent of participants said they’d use rideshare again. That second finding is important, Poropatich emphasized, because it establishes that a senior population would realistically want to adopt rideshare.

What’s more, there were some tangible physical wellness improvements, with researchers using Fitbits to uncover a 35 percent increase in participant physical activity, something Poropatich credited to having mobility at their fingertips.

These are all great steps forward, Poropatich said, but there’s a long road ahead for Lyft Healthcare. For one thing, there needs to be more patient or member awareness of rideshare benefits. NEMT has been a required Medicaid benefit since the program was introduced in the 1960s, and it’s broadly needed; about 31 percent of current Medicaid beneficiaries have said they have transportation-related healthcare access issues.

But still, only about 31 percent of beneficiaries even know they can access transportation through their Medicaid coverage, a knowledge gap Poropatich asserted needs to be filled.

As healthcare continues to embrace value-based care contracts, he said more payer and provider organizations will need to consider how they can both adopt rideshare and market it to patients. For providers taking on the most risk, this will be integral to success.

“Where you are seeing full global capitated risk, they are undoubtedly leaning into transportation,” Poropatich explained. “They do not see it as an expense, they see it as an investment, they see it as part of their care plan.”

Lyft Healthcare doesn’t see itself as a panacea or an SDOH savior, Poropatich stressed. The medical industry is a complex and nuanced field, and it would be nearly impossible for a company like Lyft to be a full disruptor.

Currently, Lyft doesn’t offer full medical transportation, or rides that accommodate folks who are not fully ambulatory or who have specialized healthcare equipment. It also isn’t in charge of ride reimbursement, leaving the complexities of value-based care and payer-provider relationships to the experts.

But what Lyft Healthcare can do, in partnership with healthcare stakeholders, is streamline that door-to-door transportation experience in a way that can ease some of the most pressing social needs, Poropatich said.

“Healthcare is incredibly hard. At Lyft Healthcare, we are not naive, we understand most of the experts are on the other side of the phone today,” he concluded. “We need your help. And now this includes both commercial and government as we think about all the work that has to be done.”

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