There’s growing recognition that non-medical factors, such as housing, safety, access to food, and transportation, have a significant impact on medical outcomes.
Providers must collaborate with partners outside of the clinical setting to improve the health and wellbeing of people with complex health and social needs. The Camden Coalition’s recent collaboration with Roundtrip, an organization that coordinates rides for patients with services like Lyft, is our latest attempt to address the transportation gap our patients experience.
Many of the people we serve meet several providers across multiple systems (medical, behavioral health, and social services) to address their complex needs. Each appointment requires transportation, but many of our patients don’t have access to a personal vehicle. While developing our care model, we learned that when our staff coordinated transportation, patients were less likely to miss appointments. However, coordinating rides isn’t always simple and our care team spends a significant amount of time scheduling transportation that could be used on more essential activities, like coordinating medical appointments, providing home visits, and building trust with patients.
In July, we started partnering with Roundtrip to reduce the burden of scheduling complications for our care team.
Our initial goals were to shift the time staff spent coordinating transportation and billing to other activities that would have a higher value for the patient and to lower overall coordination costs. While these goals still remains a high priority, our staff have also recognized additional areas where our partnership with Roundtrip could improve care for our patients.
How Roundtrip works
Roundtrip coordinates rides for our patients to save time for our care team. They schedule, dispatch, and monitor non-emergency medical transportation for our patients with Lyft, Five Star Cab Service, Logisticare, or Medical Sedans — centered on the patient’s abilities and needs. Roundtrip’s website boasts that their partners report no-show rates of less than 4%, in comparison to an industry average of over 20%, and that patients arrive on time 99% of the time. Roundtrip estimates that they save partners 40% in costs, compared to organizations scheduling rides for patients on their own.
Challenges for the system: Getting patients on the map
The potential for cost and time savings is huge, but our partnership with Roundtrip faced some unique challenges getting started in Camden.
When people discuss non-medical barriers to health for our patient population, the standard topics are repeated: housing, safety, education, literacy, income, discrimination, access to food, and transportation. When we began coordinating with Roundtrip, we found an unexpected problem: city mapping.
“Lyft rides showing up at the wrong address have been the biggest barrier to a smooth start. Patients end up waiting well after the set arrival time, only to feel abandoned. It furthers their distrust in a broken system. The drivers record this interaction as a ‘no-show’, but in reality, what’s happening is that many of the properties in Camden are poorly mapped,” reported Amadly Cruz, our Program Manager for Care Management Initiatives.
Every day, our patients face countless barriers to care and something as small as a pinpoint on a map can affect not only whether they get to a medical appointment, but can also influence their medical provider’s perception of them: “unreliable,” “a no-show,” or “non-compliant.” “We see a real inequity here because the world for these patients isn’t mapped properly,” said Natasha Dravid, head of Camden Coalition’s Clinical Redesign program.
To address this issue, Amadly takes screenshots of Google Maps, zooms in, and circles the actual locations using Microsoft Paint. She then sends that map back to Roundtrip, who sends the update to Lyft. Lyft then updates its system to reflect the actual address location. It’s a strange game of “telephone” using an assortment of technology that only works if all the people involved are accurately listening and relaying information.
The data Amadly provides on the ground could impact thousands of people over time. One of the buildings Amadly has consistently provided feedback on an apartment building that houses over a hundred of people in Camden.
While it hasn’t been ideal, Natasha sees value in our staff temporarily putting in the extra work to help with mapping issues. “Everything we do is about solving problems on a hyper-local level that can have a systems-wide impact. This mapping is no different,” said Natasha. Long term, we are looking to shift this burden from our care team to a more suitable partner such as Hopeworks or Datakind.
Natasha and Amadly both agree that Roundtrip has been extremely accommodating of our unexpected challenges and eager to listen to feedback. Originally, RoundTrip did not coordinate with Five Star Cab Service, but when the mapping issue seemed to be a recurring factor, Amadly and her team worked with RoundTrip’s CEO Mark Switaj to add mapping corrections into the mix. Five Star Cab Service has been serving Camden for years and many of the drivers are familiar with the streets.
“Being adaptable and listening to feedback has been a key to our success when partnering with organizations like the Camden Coalition,” said Mark Switaj.
Future potential of rideshare services
As the Camden Coalition’s relationship with Roundtrip develops, we are open to exploring more innovations that could address the social needs of our clients. Natasha and Amadly hope that the next iteration of the service will include training Roundtrip drivers to ask patients appropriate questions in order to coordinate pharmacy trips, grocery shopping, rides to the bank, and social service access.
“It’s not just hard for our patients to find the time and money to travel to doctor appointments. It’s hard for them to get prescriptions at those visits or health foods recommended by their providers,” said Amadly.