Episode #140: The Uberization of Healthcare – with Caitlin Donovan, Global Head of Uber Health & Michael Cantor MD, Chief Medical Officer of Uber Health

Friends,

Many of us think of Uber as simply a much more convenient and comfortable alternative to taxi cabs, or as another great app on our smartphones. Underlying that reality is a deeper understanding that Uber is actually one of the most sophisticated business & technology platforms to date. Through the use of data, analytics and digital connectivity, it brings customers and vendors together in a way that is much more accessible, convenient, customized, and cost effective, and with just as good if not better outcomes, Uber makes it easier for both customers and vendors.  

What does Uber and their platform have to do with healthcare?  For those of us who are in population health and healthcare quality, what I just wrote about Uber translates into the quadruple aim: better care, better outcomes, lower cost, and improving the experience for providers. That is what I’m referring to when I titled this episode – the ‘uberization of healthcare’. Uber Health has the potential to reframe and powerfully enable us to achieve the very aims that we have been attempting for the past couple of decades; including the quintuple aim goal of healthcare equity – which you’ll hear about early on in our dialogue.

Our guests today are both Boston-based and so when I say they’re ‘wicked smart’, you’ll forgive me for the colloquialism. They also happen to be ‘wicked’ accomplished, capable, incredibly articulate and profoundly mission-driven – all of which will become apparent as you listen to this exciting and enlightening interview.  I’ve also had the recent opportunity to meet with other members of the Uber Health team and was super impressed with the healthcare acumen they’re bringing to the table: deep knowledge in Medicare, Medicaid, population health, healthcare benefits and so on…  

Caitlin Donovan is the Global Head of Uber Health. She has held numerous chief operating roles in organizations including MyOrthos, ModivCare – previously called LogistiCare – a specialty benefits manager in non-emergency medical transportation, and CareCentrix, where she focused on home-based care and post acute care.  Early in her career, she worked in finance as an investor at Bain Capital, and as a member of the internal consulting group at Summit Partners.  She earned a bachelor’s degree in Economics from Harvard University and lives in Dover, Massachusetts with her husband and two sons. 

Dr. Mike Cantor is a geriatrician and attorney. He is Chief Medical Officer (CMO) of Uber Health and CEO of The Cantor Group. Previously he has held positions as CMO for Bright Health Plan, CMO for CareCentrix, and CMO for the New England Quality Care Alliance (NEQCA). He still makes house calls one day a month in the Boston area, and has practiced for many years – in nursing homes, long term acute care facilities & the hospital setting. He trained in Internal Medicine at Beth Israel Hospital in Boston and completed a geriatrics fellowship at Harvard Medical School. He holds degrees in law and medicine from the University of Illinois.

In this interview, we’ll hear:

1. How devastating an issue access to care is in our country, and the incredible health and financial costs that accrue because patients aren’t able to show up to their scheduled appointments.
2. The basic transport services that Uber Health is already offering to patients, healthcare providers, payers & health plans. 
3. How Uber has expanded its transport to include providers – think ‘home health nurses’ and community health workers for starters.
4. How Uber is reframing its transport to also include medications, testing, groceries and meals. 
5. What Uber is doing in order to enable and engage low income and digitally challenged individuals who may not have access to smartphones, apps or even basic texting capabilities. 

There are so many amazing discoveries that you’ll encounter in this interview.  

The initial discovery that struck me is that Uber is a transport enablement platform which is expanding into adjancenies. Initially focused on transporting patients in the traditional service they offer to the public, they are now expanding by curating non-emergency medical transport (NEMT), and also expanding into the transport of groceries, meals, home testing devices and importantly medications.  In addition, they’re also transporting healthcare workers and providers of care.

What is important to recognize is that Uber health is attempting to solve some of the immediate core challenges facing American healthcare.

By focusing on food, medications and home testing, they are directly addressing the non-clinical (or social) determinants of health, which have a much greater impact on outcomes of care than even medical treatment. 

By focusing on the transport of healthcare workers, they are addressing one of the critical issues we are facing today, which is the frightening shortage of providers as well as other care workers – a problem which is literally plaguing healthcare systems and communities across the country.  And, they are addressing the issue of healthcare burnout – again, a growing dis-ease within healthcare.

By focusing on the transport of patients, soon to include NEMT, they are addressing a problem that has yet to be solved in American healthcare: access to care. During our dialogue, Caitlin states, “the number we often cite is that there’s $150 billion of loss annually in our healthcare system because of missed appointments.”  Leading up to that statement, she shares that a lot of the focus of Uber Health is on helping patients get to high frequency, high cost, high risk, high ‘no show’ appointments such as radiation treatments, chemotherapy and hemodialysis. This issue has a devastating impact on patients and their families, and represents a tremendous loss in terms of productivity, revenue and capacity for healthcare systems – all of which can never be reclaimed or recaptured. 

A second discovery you’ll encounter in this interview is the digital enablement that Uber Health is bringing to the healthcare system. Up until this point, transportation has been a manual, mom-and-pop business. Provider practices and even large healthcare systems and health plans rely on local vendors to transport patients. All of this is conducted manually, often with antiquated technology. One of the major challenges in transport relates to patients’ benefits and eligibility.  In order to access transport, a patient has to have the insurance benefits and meet eligibility requirements. In a busy medical practice, having a nurse, care coordinator or medical assistant take the time to check a patient’s healthcare plan, their transport benefits and the specific eligibility they currently have, can literally bring the practice to a grinding halt. With its digital platform, Uber is attempting to make all of that happen automatically and at the speed of electrons. Imagine if an appointment was scheduled and the Uber platform automatically checked every patients’ benefits & eligibility and was able to schedule the pick up and drop off. That’s the magic of platforms and that’s the magic that Uber is attempting to embed into healthcare delivery. Keep in mind that these are not naive explorations. Caitlin spent years working in the domain of healthcare benefits and eligibility, so she knows, firsthand, what she’s talking about. 

The other side of the platform effect is the ability to make it easier, not only for providers but also for patients. Uber Health has been automatically scheduling drop offs and pick ups for patients, removing the need for patients to schedule their own transport. And, to make it more accessible and convenient, they are sending either text or phone reminders to patients, thus removing as many barriers as possible for individuals.  

A third discovery I’ll share in this brief is the mission-driven focus Uber Health is placing on health equity.  By removing the need to have a smartphone, internet connectivity, the ability to download apps and even texting capabilities, Uber is democratizing transportation and access to healthcare.  By automatically scheduling transport for patients and including reminders, they are making it possible for low income and technologically-challenged individuals to obtain care.  

One example of their health equity focus is the Rise for Moms program piloted in Washington DC. In this program, Uber offered transportation to low-income, pregnant women who were obtaining care at two federally qualified health centers. About 60% of these women were high-risk pregnancies and most had to spend 30 to 60 minutes in public transport getting to their healthcare centers. 68% of these women reported major challenges in finding transportation to their appointments. 76% said it would have been far more difficult to make their appointments had they not had Uber. The results of this pilot demonstrated a marked decrease in no-shows. The implications here are profound in terms of reducing healthcare disparities and reducing the human and financial costs of high risk pregnancies. As we all know, the maternal/fetal rate for black women and their infants in the US is significantly higher than for white women – a shameful national statistic that has to be remedied. Imagine how many lives and how much cost would be saved if the Rise for Moms program was deployed at a national scale!  

Never before in my career would I have thought to be so enthusiastic about the possibility of a transportation platform solving some of the core challenges in American healthcare. This speaks to the point that health care is much larger than the traditional health care we have all been trained to believe in. It speaks to the point that the transformation of American healthcare will require the integration of numerous disciplines and industries, as well as social and political sectors that have not been considered a formal part of our healthcare system.  It speaks to the fundamental point that we will not solve the American healthcare dilemma unless we allow ourselves to be open to reframing healthcare.

Until next time, be well.

Zeev Neuwirth, MD