In the conversation around America’s disorganized healthcare system, high costs come up as the most obvious barrier to treatment and services. But for many people, even if they can arrange affordable care, actually making it to an appointment poses yet another difficulty. They may not own a car or another mode of transit; public transportation in their area may be unreliable or nonexistent. Each year, around 3.6 million people miss an appointment because they simply can’t make it to the doctor’s office.
As in many situations where transportation is an issue, on-demand services like Uber have a way of edging in as the obvious solution. Robin Heffernan, a former venture capitalist and entrepreneur in the healthcare space, saw an opportunity to link ride-share services with healthcare providers, and founded Circulation in 2016 as a partnership between Uber and a handful of Boston-based medical practices to provide free rides to non-emergency medical appointments. After a successful pilot launch in Boston late last year, the company has since raised nearly $10 million and expanded to around 1,000 healthcare facilities around the country. Compared to the industry-wide no-show rate of around 25%, those facilities that use Circulation have brought that number down to 8%.
Prior to launching Circulation, Heffernan spent some time as a consultant for the Commonwealth Care Alliance of Massachusetts, a healthcare plan whose approximately 20,000 members all qualify for both Medicare and Medicaid, meaning, as Heffernan tells Fast Company, they were very sick; many were nursing-home certifiable. CCA’s focuses on keeping patients out of facilities and in their homes, “but the only way for them to do that is to facilitate a ton of logistics–to ensure patients make it to and from appointments, to deliver their prescriptions, you name it,” Heffernan says. To do so, CCA contracted with car service brokers, who did not operate on demand, so deliveries and pickups had to be scheduled several days in advance, and last-minute changes were impossible.
As Uber and other ride-share services became more ubiquitous, Heffernan began to eye the on-demand model as an alternative to the brokers utilized by CCA. “We built Circulation on the premise that we can build an exchange platform that will handle all transportation needs across healthcare,” Heffernan says. While Circulation will eventually expand into prescription delivery and provider home visits, for the time being, it’s focusing on bringing patients to their appointments.
Circulation is launching a consumer-facing app later this year, in which patients will be able to coordinate their own transit to health facilities. Now, it’s focused on the provider side; healthcare facilities that use Circulation book patient pickups on a dashboard integrated with Uber and other ride options, like hospital-operated vans, at the same time a patient calls to make an appointment and indicates that they need help with transportation.
Because plans like Medicaid cover transportation to an appointment, patients can avail themselves of Circulation at no additional cost. The Circulation dashboard, Heffernan says, is able to aggregate information about patients’ insurance coverage to determine if their healthcare will cover the rides, and if that’s not the case, the facilities themselves will pay for the transportation. “So far, we’ve not had one patient who has had to pay for a ride using Circulation,” Heffernan says.
Circulation initially partnered with Uber “to gain access to a nationwide fleet,” Heffernan says, and Uber remains Circulation’s sole ride-share partner, though it’s now also integrated with local non-emergency ambulance providers and medical facility vehicles. While the Uber partnership is undeniably beneficial from the hospital and patient perspective for the ease of booking transport, it does also shine a light on the extent to which private companies are becoming entangled with public services. Uber has taken control of the ride-sharing market by capitalizing off gaps in public transit infrastructure; it now seems to be doing the same with healthcare. Of course, the ideal solution to increase funding for public health facilities so that they could provide adequate transit independent of private companies, but with the federal government incapable of cobbling together anything that resembles a comprehensive national healthcare system, adding on transportation resources within that system feels unlikely.
Over the past year, Circulation has spread to the typical healthcare facilities–large hospitals, private clinics. But Heffernan has also noticed an uptick in interest from homeless shelters, and clinics focused on behavioral health and addiction treatment. “Particularly in the drug rehabilitation and behavioral health space, people have to go in for appointments several times a week–with methadone, it’s sometimes twice a day,” Heffernan says.
Independently arranging transit for all of those appointments is exhausting for patients, she adds, and when people are trying to recover from addiction, the privacy of a personal car is far preferable to public transportation, where patients often feel stigmatized or exposed. “If you can get a car to just show up in front of their house, take them to their appointment, and bring them home, that really can be the difference between them accessing treatment or not, and potentially relapsing,” Heffernan says.
At the Samuel U. Rodgers Health Center, a federally qualified treatment facility in Kansas City, Missouri, the impact of Circulation, particularly on addiction and behavioral health patients, has been pronounced. Samuel U. Rodgers serves around 25,000 patients a year, which levels out to around 70,000 total visits, all of which are reimbursed by the federal Bureau of Primary Health Care and Medicare and Medicaid. Around 6.7% of visits to the health center are for behavioral health needs, controller Chris Walker tells Fast Company. But since launching the Circulation integration four months ago, he’s noticed that 18% of the ridership is coming to the clinic for addiction treatment and behavioral healthcare. The free transportation, and the ease of scheduling and actually getting to same-day appointments, Walker says, is driving down missed appointment numbers, and encouraging patients in need of ongoing treatment to make and keep their follow-ups.
As Circulation continues to scale up, Heffernan says the company’s focus is partnering with more facilities and looking into partnering with mobile diagnostic and prescription providers to bring tests and medications to patients in their homes, instead of requiring that they come into a facility. And for Walker, the response to Circulation has been positive enough in Kansas City that he’d like to “get a little more muscle behind this” and advocate that more insurance companies and managed care plans incorporate on-demand transportation into their patient coverage.