Transportation is something that many of us take for granted.
But for 4 million people in the United States each year, the lack of it is the reason they miss medical appointments and more importantly, much-needed access to care that can affect their health.
This critical need for change paved the way for Ride Health, a digital platform that medical providers and social care workers can use to arrange transportation on behalf of patients, making sure they get to their medical appointments safely and on time.
Joining us on HealthRedesigned is Imran Cronk, the Co-founder and CEO of Ride Health. He tells us about his personal experience and how it turned compassion and empathy into an idea that’s helping thousands of patients access the treatment and care they need for better lives.
Witnessing the problem first-hand
Your mission is to ensure that every patient everywhere can access the care they need. How did you get to this point?
When I was a volunteer in a hospital, a patient was discharged from the emergency department late one night and didn’t have a way to get home. He was wandering around aimlessly. I asked him what he planned to do and he said that he might try to walk home—he lived eight or nine miles away from the hospital. He was perhaps 60 or 65 years old and said that his vision had been compromised by some medication he’d been given that night.
None of this really sounded like a good idea, so when my shift ended a few minutes later, I gave him a ride home. Everything worked out okay but it was an indication that there might be something going on that I haven’t really considered before because transportation is something a lot of people take for granted.
After looking more into it, I realized that there are millions of people who miss care every year just because they don’t have a way to get there or get back home conveniently. Whether it’s a regular checkup or a treatment, missing an appointment is going to have an impact on people’s ability to take care of themselves— leading to more sickness and death.
That experience helped me learn more about this and I did more research and writing in the years after it. A couple of years ago, I became inspired to start Ride Health.
Improving on an existing system
In one of your articles, you wrote about how the NEMT was broken. Could you tell us more?
NEMT stands for non-emergency medical transportation and is currently funded through health insurance programs and healthcare providers. The typical model is for a U.S. state or county to identify a broker who then subcontracts with several hundred transportation services in that state. They are then responsible for arranging rides to and from appointments for tens of thousands, or hundreds of thousands of beneficiaries.
From the patient’s perspective, this system gives them a lack of transparency about when and whether their ride will show up at all. To access rides through these programs, patients often dial a call centre and speak to a dispatcher up to a week in advance. After sharing their information and verifying their eligibility, they are told that before their appointment, within perhaps a one to two-hour window, somebody will show up and get them to their appointment. Sometimes somebody does show up and they get there just fine, but a lot of times patients are stuck waiting. The healthcare provider is also out of the loop and often doesn’t know whether and when patients will show up.
How is Ride Health fixing this as a service and digital platform?
The ultimate vision for Ride Health is to be a platform that a care coordinator or a social worker within a hospital or a practice could use to arrange rides on behalf of patients. Patients would receive an SMS to confirm the ride and receive information on the day of the ride. Then, an automated message informs the transportation provider to let them know where they need to go to pick up the patient or to drop them off.
Keeping everyone in the loop
What does a patient’s and coordinator’s experience with Ride Health look like?
When coordinators note that the patient has an appointment coming up and that patient tends to face transportation barriers, they go into our web-based platform, which is HIPAA compliant (the Health Insurance Portability and Accountability Act is the United States legislation that sets data privacy and security provisions for safeguarding medical information, such as medical records and other identifiable health information). They then enter the patient’s basic information to coordinate rides for them, including whether they need a wheelchair accessible vehicle or a door-to-door or door-through-door service. This is a one-time process and they can then put in the first drive request for that patient.
When the ride has been set up, the patient receives an SMS or a call to their landline if they’re home. That’s to confirm 24 hours in advance of a scheduled appointment whether they still need a ride the next day. The patient then has an opportunity to confirm. Because not all patients have smartphones, we allow them to confirm by pressing 1 if yes or 2 if no. If a patient confirms, an hour before the driver is scheduled to arrive the next day, we use the dynamic algorithm that takes into account traffic and the distance from the patient to the facility to determine when that driver should arrive.
One hour before the pickup time, the patient is reminded again so that they can be sure that they’ll be ready to go. When the driver is on the way, the patient receives information about who the driver is, the make and model of the vehicle, the license plate, the estimated time of arrival and the driver’s phone number in case they need to get in touch with them.
All of this information helps the patient feel more empowered and aware of what’s going on. When the driver arrives and the patient is on route to their appointment, the platform updates the coordinator. Everything happens in real time and everybody can be on the same page.
Feedback from users
How has user feedback helped shape Ride Health’s UX and overall design?
Because many of the coordinators we were speaking to regularly used computers, we thought that the best format would be a desktop application. Then we had some conversations with care coordinators who were very mobile enabled. We realized that they wanted to be able to arrange and edit rides from their smartphone while they are walking from place to place or while they are at home at night. We needed to build something that was a little bit more flexible and cross-platform—a mobile browser experience.
One of the things we learned was that often times, especially with cancer, a patient might not start their chemotherapy treatment until 3:00 PM or 4:00 PM and they may not finish until 7:00 PM or 8:00 PM. By then, the social worker or care coordinator who’s coordinating the ride would’ve left for the day. It seems obvious once you hear it.
At the start, we had a ‘scheduled ride’ option and an ‘instant ride’ option. We thought that an ‘instant ride’ would be enough to help with the rides home but we learned that it would be helpful to send an in-between note to a patient saying, “Your provider arranged a ride home. When you’re ready, press 1.” That would enable patients to get a ride home whether it’s at 4:00 PM or 5:00 PM or all the way up until almost midnight. It was something that we only could have learned by speaking with the users.
We’ve also avoided cluttering the user interface with lots of tools and requirements for information. It would be very easy to make this extremely complex and be able to do all kinds of different things, but it would create an overwhelming user experience for people who are only going to be spending a few minutes a day on the platform and just want to get in, setup the rides, and get out. That’s what actually determines user adoption which is what determines your actual impact.
Creating paths for better access to care
What is Ride Health working towards?
We’d like to be the global infrastructure for access to care, whether it’s through transportation or other types of barriers that need to be addressed. In the nearer term though, we’re really interested in understanding how we can help providers be more predictive and proactive in regards to which patients are likely to miss appointments or are likely to be in the hospital for longer than needed because they’re unable to get a ride home.
Healthcare information technology is not exactly very easy to share and collaborate around. We’re also thinking through our EMR integration strategy because it would be really great if you can click once to import the patient’s information into the Ride Health platform and click again to set up a ride for an appointment that you see in the appointment scheduling interface. It ensures great data integrity and automates the data entry process.
A lot of providers have also asked us if it’s possible to allow patients or family members to arrange their own rides. Right now, we have a set of users who are within a hospital or within a practice who we’ve trained and who have regulated the access control to the platform. We’re thinking hard about what does it look like when suddenly this is opened up to many different endpoints of users, patients, family members; what are the implications for the kind of support we need to provide and to whom; how do we make sure that if we’re allowing patients to pay for their own rides that we’re protecting financial information.
If there’s anyone who’s inspired by the challenge Ride Health solving, Imran is happy to talk about ways to get involved as the company grows—it’s not just something that’s useful for care coordinators but also for patients and family members. There’s a lot of thoughtful work that needs to be done around the UX and UI design.