Patient Transportation: The Hidden Barrier to Care

Here is one social determinant of health you might not have thought of: patient transportation. A patient’s ability to get a ride to the hospital could be the difference between getting treatment and not. The barrier to transportation not only hinders wellness, but it affects all sides of healthcare. Arranging for transportation is a major pain point for care coordinators and high no-show rates hurt hospitals. Just how far-reaching is the issue?

How big is the Patient Transportation Gap?

“3.6 million people every year miss medical appointments because of the transportation barrier,” says Ankit Mathur, CTO at Roundtrip.

Roundtrip is a digital health company that rose to the challenge of patient transportation by creating a space for medical rideshare. They’ve pioneered a digital transportation marketplace that serves the healthcare sector by making non-emergency medical transportation services more accessible and affordable. Our head of marketing, Kurt Schiller, and Ankit Mathur will discuss the issues facing patients with a lack of transportation, the burden on healthcare workers, and how Roundtrip has become part of the solution.

The podcast will focus on these major questions:

• What is the patient transportation problem and how is Roundtrip helping to solve it?
• What does the Roundtrip experience look like from both the clinical and patient perspective?
• What burden does patient transportation have on healthcare workers?
• How does the platform help to reduce hospital costs?
• How can Roundtrip’s technology improve clinical health outcomes and patient experience?
• How has Covid-19 affected patient transportation?

This episode of Product Hacker continues the theme of Engineering Health by focusing on a major obstacle in healthcare: patient transportation. We’re joined by Ankit Mathur, the Chief Technology Officer at Roundtrip, a healthcare transportation company. This week, we’ll be discussing why access to transportation is a major social determinant of health and how digital health can be of service. Could medical rideshare be the remedy?

Kurt Schiller [00:00:00]:  Hello, and welcome to Product Hacker.  I’m your host, Kurt Schiller, and today we are going to be talking about transportation as an impact on patient experience. Access to transportation has one of the biggest and clearest impacts on patient experience, as well as far-reaching implications as a social determinant of health. Some studies have found that nearly half of all doctors’ appointments result in no-shows and lack of transportation is a leading cause of missed appointments, along with factors like child care and the ability to take time off of work. Today, we’re joined by Ankit Mathur, co-founder and Chief Technology Officer at Roundtrip, a healthcare technology company that’s focused on removing transportation as a barrier to care. Ankit, welcome to the show. 

Ankit Mathur [00:00:39]: Great to be here. 

Kurt Schiller [00:00:40]: So I’m excited to talk about transportation in general, but first, I wanted to give everyone a better idea of what Roundtrip does, since I think not everyone is maybe familiar with the idea of non-emergency medical transport. 

How is Roundtrip Solving the Patient Transportation Issue?

Ankit Mathur [00:00:51]: Roundtrip really partners with hospitals, health systems, health plans even to essentially remove transportation as a barrier to care. Health systems in general have a large initiative every single year to solve transportation for their patient population. Nationally, about 18 percent of patients experience a no-show rate which is no-shows to medical appointments. 3.6 million people every year miss medical appointments because of the transportation barrier. That’s ten thousand people today. That’s 10,000 people tomorrow that are going to miss or delay that care simply because they don’t have access to transportation. So that’s why we created Roundtrip. The simplest way to coordinate transportation digitally. 

Kurt Schiller [00:01:34]: I think a lot of people in health care are probably used to hearing about missed appointments due to maybe the financial or the resource impact on providers. Approaching this maybe for someone who’s less familiar with transportation as the social determinant, what are some of the impacts to the patient population of not having access to transportation, like how does that play out? 

Ankit Mathur [00:01:53]: So the primary use cases obviously are getting people to their medical appointments, right? So it’s routine doctors’ appointments, physicals, et cetera, et cetera. Right. There’s, I would say, a primary need to make sure that people get to those appointments for the well-being of the patient, the well-being of the facility as well. Right. You know, making sure that the facility is running properly, that’s one side. The other side of the health care story is discharges, getting people out of the hospital after a routine surgery or an admission for any kind of treatment. Then there’s the routine appointments, such as dialysis, chemotherapy, et cetera, et cetera. And then we start talking about social determinants of health. 

Ankit Mathur [00:02:33]: So when we talk about social determinants, it’s not just getting people to their medical appointments, getting them out of the hospital in a timely manner. It’s about getting people to food banks, getting people to temporary housing, getting people to work if they are disabled or they may not have adequate transportation. That’s when we start talking about social determinants of health and the reason why it’s qualified under health, even though it’s not really when you think about going to the grocery store, that’s not really going to a medical appointment. But really, when people don’t have access to certain things such as grocery stores, when you’re living in food deserts, those types of things amount to the overall quality of life and the overall health of that individual. And so Roundtrip is focused on all of those things, not just getting people to their medical appointment. 

Kurt Schiller [00:03:21]: I feel like companies like this always have kind of like a personal angle. I think when we were talking before the podcast, I mentioned that I had a personal experience with losing access temporarily to my own transportation, having to go to the hospital. I was privileged enough that I have access to something like Uber. I could just get, you know, and like take an Uber. You know, first of all, when I got to the hospital, the providers there were extremely displeased with me for having taken an Uber. But then obviously, you know, a lot of people don’t have access to a service like that or don’t have the means to take advantage of it. How is this something that Roundtrip as a company came across? Is there a story that brought you to this particular challenge? 

Ankit Mathur [00:04:02]: It’s interesting because say over the past five to seven years, our world has kind of been changed with the advent of rideshare. When you mention rideshare, that is a big part of transportation. And so we need to incorporate that into the work that we’re doing. But rideshare can’t solve all the problems. And that’s really why we built Roundtrip. So we really got started because I was introduced to our co-founder, Mark Switaj, who comes from the world of medical transportation, he was an EMT, sat on an ambulance, cared for thousands of patients during his time as an EMT, as he was looking around at the ambulance industry in general. He realized that there were a lot of inefficiencies related to medical transportation. You saw that on the demand side, there were medical patients that were waiting sometimes hours just to be picked up to make it to a medical appointment or even waiting to be discharged out of a hospital. But on the supply side, you had ambulance companies that had excess capacity at times, so it didn’t really make a lot of sense. And so what we really set out to do was create one comprehensive platform that accompanies all types of medical transportation. Anything as simple as a medical sedan all the way to a wheelchair van and then various levels of ambulance transports and a non-emergency level. So no lights, no sirens, but just making sure that the whole system runs a lot more efficiently. 

Ankit Mathur [00:05:30]: And so when you know, when I was introduced to Mark and we had a really incredible I would say two, three-hour long conversation about what medical transportation is. And as somebody that really had no idea about the industry to begin with, I immediately was enthralled by a lot of inefficiencies, both on the healthcare side and on the medical transportation side and how we could potentially make it better. So we met, had a whole bunch of whiteboarding sessions, really got down into the details and as my eyes opened up and to what an opportunity it was to solve such a big problem in health care, we knew immediately that we had something that we could solve. 

Kurt Schiller [00:06:07]: What does the typical roundtrip experience look like both from the clinical side and from the patient side?

What is the full Roundtrip experience?

Ankit Mathur [00:06:13]: So from the clinical side, we primarily work with our hospital partners to provide a one-stop-shop for access to any type of transportation for their patients. So typically what we call care coordinators, care managers, social workers, discharge nurses, anybody at the health system that is responsible for or has a responsibility for coordinating transportation for that patient is able to very quickly access Roundtrip– our software application. Enter in a small number of details about the patient that is needed based on the level of transportation that they are trying to request. That request goes into our marketplace of hundreds of transportation companies all over the country based on the location of where the patient needs to be picked up amongst various other attributes about the ride. We then have access to that– our marketplace of medical transportation companies– that claim those rides. Those rides are then communicated to the patient, to the care coordinator about the status of the ride. Real-time status is available for all levels of transports and then that patient is picked up and in some cases, insurance even will cover the costs of those rides. 

Kurt Schiller [00:07:27]: You mentioned a couple of different things that I want to touch on there. One of them, as you mentioned, care coordinators. And I thought it was really interesting that you mentioned that. I’ve mentioned before in the podcast that I have some experience working in the Medicaid managed care industry. And I know that one of the challenges that we always had was the fact that transportation was kind of set aside as its own thing and there wasn’t always communication between the transportation companies and the providers and the care coordinators. So you might have a scenario where transportation would be– would be coming to pick up someone for a pre-scheduled appointment. And the patient wasn’t there because they had been transferred into a long-term care facility and nobody had communicated it back. And transportation was operating almost like a completely different system, totally outside of the patient or clinical experience. I think it’s really interesting that you specifically mentioned care coordinators. Does that– is that something that I guess forms a big part of the Roundtrip model is working with people like that?

What is the Burden of Patient Transportation on Care Coordinators?

Ankit Mathur [00:08:31]: Absolutely. There is– I would say that care coordinators have my utmost respect and admiration. I think the work of a care coordinator is so difficult and so important in the healthcare workflow. You know, when we launched Roundtrip, we spoke to dozens of care coordinators and really saw how transportation was affecting their everyday workflow. We had some care coordinators that would spend almost four hours of their day on the phone calling around to all the medical transportation companies, either requesting a ride or even potentially getting the status of a ride. These are people that got into the business to take care of a patient, not to coordinate transportation. We saw that an average of about 20 to 30 minutes was spent scheduling one transport for one patient. 90 percent or more of the rides that come through the Roundtrip platform require less than two minutes of that staff time. So we’ve been able to drastically reduce how long it takes to book the ride. We also now can provide real-time status updates of rides as they’re booked on our platform. That is just from a time perspective, we really sought out to allow these care coordinators to operate at the top of their license instead of doing administrative work such as coordinating transportation.  

Kurt Schiller [00:09:50]: Use cases like this are a really interesting way of kind of spotlighting the way that technology can be augmentative– or our previous guest used the term force multiplier on the human resources that go into providing a good patient experience. So like, you know, you mentioned reducing the amount of time that it takes a care co-ordinator to schedule transportation for one patient. Obviously, you know, if it goes from 30 minutes to 2 minutes, that’s 28 minutes that they can spend working with other patients. 

Kurt Schiller [00:10:22]: And there’s this multiplicative effect that rolls out. That’s one of the things that makes technology so exciting in patient experience is you know, you can look at it on the one hand as oh well we’re taking people out of healthcare. But on the other hand, you can look at it as well we are enabling the human effort– the human element in healthcare to spend more time being human and spend less time trying to function like a very slow version of technology.

How is Roundtrip Reducing the Cost of Transportation?

Ankit Mathur [00:10:49]: You know, there are soft costs, obviously, to the work that we do, right. I mentioned the reduction of time it takes simply to book the ride and some of our larger healthcare partners. We’ve seen a 40 percent reduction in calls for care coordinators. But I think there’s also– and its important highlight that there’s a business case to it as well. You know, we reduce patient no-show rates in some places as much as five times what their original no-show rate was. You know, we reduced the overall cost of transportation at a facility that we do cancer rides for. You know, we reduced the average costs of a ride from about two dollars and fifty cents a mile down to 90 cents a mile. So there are tangible benefits to Roundtrip as well as some of the soft costs that are associated with saving time and effort.

How does Roundtrip Improve Clinical Health Outcomes and Focus on Patient Experience?

Kurt Schiller [00:11:39]: One of the things that I think is most advantageous is kind of like the removal of friction from the patient experience and transportation is such a big part of that. People don’t think about, you know, if you have some kind of a long-term condition that requires you to take three or four trips each month. And you have a car, maybe it’s not a big deal if you don’t have access to a car, you know, not only is there a burden that’s being placed on, you know, the care coordinator, the provider, whoever is helping the patient get there. There’s also a burden of, you know, worrying about, am I going to have transportation? I need to get to this place. I need to be ready at this time. And making that easier means that fewer people fall out of the process. If you can improve the experience, especially around something is as integral as transportation, it may be hard to directly trace it through like this person had a good clinical outcome because of a good transportation experience. But when you look at it from a population health level, talking about, you know, social determinants, again. It absolutely winds up having this rollover effects on, you know, better patient outcomes. I think it’s again, it’s a really interesting use of technology. 

Ankit Mathur [00:12:51]: You know, it’s also important to know that not everybody reacts to the treatment that they receive even on the healthcare side equally. So you may even have access to transportation or you may even have a car that you can take to an appointment. But if you’re receiving dialysis or chemotherapy or something that drains your body after the treatment– you know, it may not be safe for you to operate that vehicle after the fact and drive 20 or 30 minutes home in rush hour traffic, whatever it may be. So, you know, it’s really important to understand that people are people and we all react differently to certain different things. Transportation, even though you may have access to a vehicle, doesn’t always mean you have access to care. And that’s something that’s really important to highlight. 

Ankit Mathur [00:13:35]: When you talk about social determinants and you talk about access to transportation for social determinants. There’s a whole other level of healthcare that happens, right. So your mindset starts to shift instead of worrying about how you’re going to get to the food bank, whatever it may be. You now know, okay, I know exactly when I’m gonna go to receive that service in order to pick up the goods that I need to bring them and support my family or go to work every day. And that’s just one less thing to worry about, in which case. Now the overall mindset shift starts to change. And all of that is part of well-being. All that’s part of social determinants. And so when you talk about overall health equity within a community, within a county or a city, these types of things are really important to think about. And that’s really what’s so of determinants is to answer it. 

Kurt Schiller [00:14:26]: How do you approach, I guess, your role in the patient experience? Like how do you ensure that round-trip is able to provide a good patient experience to the actual end-user of the transportation? 

Ankit Mathur [00:14:40]: There’s a lot of things that we do. We do believe that we are an integral part to play when it comes to the overall patient experience at the beginning of the trip journey. Before that even happens, we send trip reminders, we make sure that patients have all the information that they need prior to getting into that vehicle. So there’s less apprehension about it. They know that their ride is scheduled. They know the time that ride will be arriving in front of their home or wherever they’re being picked up from. During the transport, right before the transport. We send additional notifications. We meet patients where they are. We also support multiple languages to make sure that we’re supporting the patient population that we’re serving and you know, ensure that the patient actually does connect with the vehicle and the driver that they need to connect with. We also offer real-time ride monitoring both to the patient and also to the care managers. Now we have complete transparency as to what’s going on with that ride. And then after the fact, we also collect patient satisfaction scores and we’re able to provide back to health plans, back to health systems so that we understand. How satisfied are these rides? Are they going OK? What’s happening during the transport? All of that stuff is really important throughout the patient experience. And that information is then extremely valuable to our health systems and also our health plan partners that use it for a variety of different things later on down the road. 

Kurt Schiller [00:16:03]: Do you think there is that there’s one thing that has been a particular ongoing challenge in areas where the healthcare system is as complex or operates other than you might expect. Is there any one factor that you think you have had to grapple with that makes this a unique challenge? 

Ankit Mathur [00:16:20]: We talk about challenges in healthcare. I think there’s a lot of challenges and in many urban areas that we operate, but we also operate in a lot of rural areas as well. There’s a much deeper problem in healthcare when it comes to rural patient populations. We talked about food deserts earlier. We said to our primary care desert. Seventy-seven percent I believe of rural counties are considered primary care deserts. That’s a large amount. Almost 10 percent of those have almost no physicians at all. There’s a big problem to solve there. And then there’s you know, where we’re Roundtrip can come in is really provide access to those patients that live in those rural areas and making sure that there’s adequate transportation in those areas to serve those patients and make sure that the transportation is able to transport them from where they live to the care that they need. Yeah, we think when you talk about challenges, I think rural healthcare is a challenge for this entire country. 

Kurt Schiller [00:17:21]: Our last guest, Dr. Mike Consuelos we were specifically talking about delivering behavioral health in rural America. And he mentioned a lot of the same factors that you just pointed out, that, you know, there is a lack of primary care providers, both because, you know, fewer people are going into primary care and also because the people who do go into primary care tend to remain near where they went to school. And that tends to be where they start practicing. And so there has been this general erosion of the landscape of care. Well, one of the things that we always try to talk about when we talk about social determinants is you did a good job of bringing this up earlier. The way that they interact. 

Kurt Schiller [00:18:02]: So it’s not just that they don’t have transportation. It’s someone doesn’t have transportation. They’re also living in an area where there isn’t good access to primary care. They probably also– they may have been moved between different payers. They may have been moved between different services. This is something that I was really surprised to learn, is how many people have both a primary and a secondary form of coverage and even just figuring out whether you’re a provider or the patient. Which one is getting billed is the right one getting billed. All these factors like come together and form this big tangled confusing knot that like when you start looking at that, it’s like, well, no wonder patient experience itself is such a big challenge for people. 

Ankit Mathur [00:18:45]: And frankly, where does transportation fit into all of that all over the place? Talk about behavioral health. You talk about just simply getting people to their medical appointments or discharges out of the hospital when you live a hundred miles away or 50 miles away. That’s all transportation. You know, there’s no wonder why. I think the American Hospital Association said that transportation is the leading cause of patient shows. It absolutely makes a lot of sense. And that’s the problem that we’re trying to solve. 

Kurt Schiller [00:19:11]: Is there a use case that you think people might not be aware of falls under non-medical transport? You mentioned access to food banks or to groceries. In one of the programs that I worked with, they did like quality of life, transportation as well, which I thought was really interesting for people who are doing in-home long term care. That’s probably not exactly the correct terminology where they would do like quality of life trips or it’s like, okay, you need to go shopping, we’ll arrange transportation to the store and assistance so that you can shop and maintain some level of independence. I kind of talked over the question, but is there any particular use case that you think people might not be aware of? 

Ankit Mathur [00:19:49]: Well, I think you nailed it from that perspective. I think, you know, the other area that we really focus on is our paratransit partners. So paratransit is a unique vertical that we serve, which essentially is the individuals that qualify under the Americans with Disabilities Act that live in a particular county. Those individuals may not have access to transportation either, but these individuals have a job. They go to work every single day. They get hungry like all of us. They need to go grocery shopping. They want to go to a restaurant and eat. They simply just don’t have adequate access to transportation. In many of these counties. The city or the county government has set up what’s called paratransit, which is a program that usually has small buses or vans that are very costly, I think, to the county to operate. We flip that model a little on its head and we do on-demand transports for these populations in a subsidized model. So, you know, again, talking about non-emergent medical transportation. But still, people that are in wheelchairs or may have visual impairment or hearing impairment or any other type of disability are still able to use the Roundtrip platform in a subsidized way to access transportation to go almost anywhere that they want.

What Effect has the COVID-19 Pandemic had on Patient Transportation?

Kurt Schiller [00:21:07]: Kind of wrapping up, I think I would be remiss to not ask. We are in the middle of an event that has wide-ranging impacts on the way that healthcare is delivered. What sort of impact on transportation have you seen as a result of the Covid-19 pandemic? 

Ankit Mathur [00:21:23]: I think there’s– there’s been quite a bit. Roundtrip has seen quite a bit change, I think in a very short amount of time, as really the whole world has. You know, we’ve seen routine appointments get delayed, which we will likely see a huge impact of what that is. Probably, you know, as health care starts to reopen and you start getting some of those elective surgeries and also non-urgent surgeries rescheduled. So we’ve seen– certainly seen a decrease in those types of rides. Where we’ve seen an increase in our rights to food banks, grocery deliveries that we’re doing to people so they can stay home and stay in quarantine safely. And we’ve also been transporting COVID patients. So we’ve– very quickly our product team pivoted to add functionality directly to our application to identify these patients that are either testing positive for COVID or have potential symptoms of COVID. We are now able to track– those patients who were able to track that usage at the health system level, at the transportation system level, and then provide that valuable data back to those health systems so they know exactly how transportation is affecting them. Not all medical transportation providers are supporting transport to the transportation of COVID patients. And so we’re really working closely with those medical transportation providers to make sure that the right patient is getting into the right vehicle. 

Kurt Schiller [00:22:50]: Well, thanks so much for joining us today, Ankit. Is there anything that you want to shout out or where can people go to learn more about roundtrip? 

Ankit Mathur [00:22:58]: Well, I mean, first and foremost, the entire round trip team has been phenomenal, especially during the past two months as we navigate through uncertain times here. Please feel free to visit our www.roundtriphealth.com or send us an email at hello@roundtriphealth.com and we’d love to talk to anybody that’s interested. 

Kurt Schiller [00:23:18]: Well, thank you again for joining us today, Ankit. And thanks, everyone, for listening to Product Hacker. Talk to you again soon. Cheers.