As we get older, our parents rely on us to take care of them. There’s a sense of responsibility in this: The roles are reversed, and now it’s up to us to make sure our parents are healthy and safe. In part, that means helping our parents manage their health, including getting them to doctor appointments. While most of us wish we could be there in person, sometimes that’s not possible. With those aged 65 and older expected to make up over 20 percent of America’s population by 2040, according to the Administration on Aging, new companies are stepping in to assist senior citizens when family members can’t. Companies like CareCar.
“When you get to a certain age, we’ve all had our parents call us for help getting to an appointment,” says Joshua Itano, founder of CareCar—which seeks to redefine the non-emergency medical transportation industry with the goal of keeping patients safe, healthy, and independent.
“The majority…don’t trust untrained strangers coming to their house,” Itano continues, referring to taxi or rideshare drivers who do not specialize in transporting frail or special-needs customers. “So we wanted to fix that.”
Another goal of CareCar is making customers and their families aware that transportation to and from appointments may be covered by Medicare, and working with government and insurance providers to increase that benefit’s annual limit, which Itano says many patients exhaust within the first half of the year.
But first, Itano and CareCar just want to get patients to their appointments. Aging often correlates with a decline in the ability to drive or navigate public transportation, making the elderly particularly vulnerable to missing necessary medical appointments. But current leaders in the non-emergency transportation market are brokers who do little to ensure their fleet of drivers succeed in picking up their patients. Often, patients who use the transportation benefit still miss their appointments due to driver no-shows or late pickups, absences that concerned family members may not learn of until it’s too late.
According to a recent Government Accountability Office study, the non-emergency medical transport industry “is at high risk for fraud and abuse,” and billions of dollars are spent by the government paying for trips that no one can confirm even happened. If they do make their appointment, patients can be left for hours at clinics and hospitals waiting to be driven home. With such a low quality of care and service, many prefer to not use the benefit at all, resulting in preventable and costly hospitalizations.
In March, Uber launched the platform UberHealth, which allows doctors to book rides to the hospital on behalf of patients. The problem is that Uber isn’t exactly known for accommodating customers with special needs, which, if you’re dealing with riders who cannot drive themselves, seem likely. Even before the rideshare company ventured into health care, Uber faced lawsuits that accused UberWAV—the service that provides wheelchair-friendly vehicles—of subpar service compared to its flagship product. Last July, Disability Rights Advocates sued Uber for discrimination, claiming UberWAV provides inconsistent access to accessible vehicles and imposes long wait times.
Unlike transportation apps like Uber and Lyft, which rely on their everyday drivers to transport sick, aging, and mobility-challenged patients, CareCar matches patients to drivers based on their level of need. If a patient is in a wheelchair, on a gurney, or requires assistance walking, CareCar drivers are trained CNAs—a certification that involves basic medical and CPR training—and equipped to handle it. The Uber drivers are also unaware if they are driving for Uber or UberHealth, so rules that apply for Uber riders would also apply to UberHealth customers—like the three-minute wait time limit. Unlike Uber and Lyft drivers, who are paid per mile, CareCar drivers are paid by shift, with bonuses when they successfully deliver a patient to their appointment and home. In contrast, Lyft and Uber drivers might rush on to the next rider if their wait-time limit is exceeded, without ever realizing the damage they might cause when the patient misses their appointment.
All that aside, it’s not always the ride that prevents these people from making it to their appointments. Krisda Chaiyachati, the Medical Director for Penn Medicine’s FirstCall Virtual Care and a primary care provider at the University of Pennsylvania, published a study in JAMA Internal Medicine in March that offered around 800 Medicaid patients in West Philadelphia free Lyft rides to and from doctor appointments and found that the free rides did not decrease the number of missed appointments. “We really thought ride-shares would be super convenient,” Chaiyachati said. “We were pretty surprised, actually, it did not work out. … I think we [as providers] tend to apply our choices of how we live our lives, and we kind of impose it on our patients’ lives. … We think the same thing is going to apply to a sick person or a poor person, and that might not be true.”
Itano believes a solution as simple as UberHealth or free Lyft rides isn’t good enough. “It’s more than logistics to run a health care company. We aren’t trying to just get people from A to B. We want to take care of people better,” he says.
For CareCar drivers, nothing is taken lightly when it comes to maintaining a sick or elderly person’s dignity while taking them to a hospital. Itano says, “If the patient is wobbly, do you carry them or offer an arm? If they’re struggling with bags, do you offer to take them, or let them do it themselves? Health care professionals are trained to communicate in a specific, almost therapeutic, way. Lay people are not. We train our drivers to do this.”
Sometimes these appointments are confusing. In addition to driving patients from point A to point B and back, CareCar drivers are trained to ask their patients if they understood everything that went on at the appointment. If the answer is no, CareCar coordinators pass that info on to the responsible clinical teams so they can follow up.
CareCar also creates patient profiles based on the rides they’ve taken and tracks things like mobility, cognitive and behavioral information, and appointment type. From there, CareCar makes recommendations to the drivers to ensure both parties are comfortable and safe. If a patient has a history of getting car sick or gets anxiety before doctor’s appointments, that’s in the profile so the CareCar drivers—all of whom have been through HIPAA compliance training and are trained to mitigate and prevent any incidents—aren’t caught unawares.
If CareCar knows the patient has a condition that requires frequent visits, the company can easily see if that person is missing appointments. Itano gives the example of a dialysis patient. If that person misses those appointments, it’s like forgetting to take crucial medication, and it can lead to hospitalization or death. If CareCar notices that the patient hasn’t scheduled their normal rides, they reach out to the patient, primary care doctor, or case manager for a follow-up. For someone in need of dialysis, this sort of attention can prevent a long hospitalization, hefty medical bills, or worse.
The number of senior citizens in America is rapidly increasing, and their missed appointments are costing billions of dollars a year in preventable hospitalizations and complications. Coupled with the U.S. doctor shortage, the consequences patients face by not making doctor’s appointments can be deadly. Even if these patients have family members willing to help out, they may not always be able to given the demands of work and raising kids of their own. That makes a solution for these seniors imperative, and it has to be malleable enough to ensure the patients’ unique needs are met.
Isn’t that better than just calling your grandma an Uber and hoping she gets in the car on time?
This is a reposted article by Liz Biscevic. Originally published May 4, 2018 on Make Change