The Health Care Journey Starts with a Ride: HealthChangers Podcast

March 27, 2018

Having access to health care is a national conversation, but one significant step that is often overlooked is the transportation to and from the doctor’s office. In this HealthChangers podcast we talk with Robin Heffernan, the Co-Founder and CEO of Circulation a digital platform that offers a straightforward and accessible solution to coordinate convenient and reliable nonemergency transportation for all areas of health care. Robin describes how Circulation was developed as a single access point for scheduling and monitoring of transportation and how its helped their consumers save money through its efficiencies. With its effectiveness and success established Circulation is now exploring making prescriptions part of their delivery system as well as medical equipment as they expand into the next phase of transforming the way people experience health care.

Join us as we learn how future trends in health care technology can start by solving the most basic logistical health problems from those needing to go to a routine health care appointment to those going through dialysis or chemotherapy, the simplest solutions can have a positive disruptive effect on the health system.

You can listen to this episode with the player above, on iTunes or on Stitcher, or read the full transcript below.

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Leslie Constans: Welcome to the HealthChangers podcast, presented by Cambia Health Solutions, where we share real stories of health care transformation from those experiencing it, and those helping to make health care more personalized.

I am your host, Leslie. So many of the conversations we've had over the last year on this podcast have touched on a key question: How do you make it easier for people to access health care? In many cases, the answer is you need to make that process more convenient for them. My guest today has been trying to improve health care access through better transportation.

Robin Heffernan is the Co-Founder and CEO of Circulation, a medical transportation platform that helps coordinate rides to and from hospitals, doctors' offices, and clinics. I'm really excited to be here today with Robin Heffernan.

Robin Heffernan: Hi Leslie. Thank you so much. I am very excited to be on your show today.

LC: How do you describe Circulation for people who don't work in health care

RH: Most of the time we just say we are a health care logistics company. We help patients get to and from their medical appointments.

LC: Got it.

RH: We work with Uber. We work with Lyft. We also work with wheelchair providers, ambulance providers, door to door service, but at a very simple level, we help patients get to and from the health care appointments that they need.

LC: What are some of the kinds of people who are using Circulation? What are their stories? What does transportation solve for them?

RH: We have a broad swath of clients right now. So, we work with some large managed care organizations and health systems. We also work with individual hospitals, dialysis clinics, oncology clinics, other outpatient clinics. We have some community health centers, all the way down to homeless shelters.

LC: What are some of the challenges people face in getting to and from appointments?

RH: The largest issues we've seen are the traditional broker model, which is still the majority of how Medicaid members access their appointments. You need to call them and request your ride 72 hours in advance. You get a pickup window that can be several hours.

LC: Oh, wow.

RH: When you're done with your appointment, you can repeat the same process. Literally, these folks can spend an entire day getting to an appointment that's 20 minutes, and they have to think about it multiple days in advance to even arrange it.

Health Care Solutions Empowered by Patients

“There are a lot more services being delivered in the home whether diagnostic services, basic daily living activities, actual full primary care visits.”

LC: Wow, that's really...that is a challenge. What about...it sounds like...did you start with patient rides first, and now you've expanded into moving products and prescriptions around. Has that kind of been the evolution, or were both kind of available from the get-go?

RH: We've seen the same trend that the health care industry has seen. There are a lot more services being delivered in the home, whether its diagnostic services, basic daily living activities, actual full primary care visits being conducted in the home. There is a lot more that's going on in the home, and so we started to see people using the platform for that. Then just recently, we've been expanding into some of those product initiatives.

LC: How does that work with prescriptions or durable medical equipment? How does a patient access those services?

RH: It's the same access point in terms of scheduling that service. For prescriptions, it's either a stop along the way at the pharmacy, or it can be a direct delivery to the hospital so you have your prescription at discharge. Or, a direct delivery to your home. For DME (durable medical equipment), it tends to be more business related right now, but getting delivery of DME equipment out to someone, at their home.

Fascinating, to me, I did not know this before I got into this stage, but there's a lot of very expensive equipment that gets delivered to patients with COPD (Chronic obstructive pulmonary disease), or some of these other chronic conditions. They test it out once. They don't like it. They throw it in the back corner, and it sits there collecting dust for three months until someone remembers to go pick it up. So, not terribly efficient. We help with both the delivery and then also the retrieval.

LC: Oh, interesting. Okay. So, in the case of COPD, that might be something like oxygen tanks and-

RH: Yeah, it's generally new breathing devices that are being tested out or other medical equipment that they might be on.

LC: I had wanted to ask you, I think you might have answered it already, how does Circulation fit into what's happening in the larger health care industry right now? You mentioned so much more is moving to the home. Are there any other bigger trends you're seeing in terms of use of technology, or convenience?

RH: We've also seen this push to get primary care into retail clinics. So, things that you might have historically gone to your primary care physician to have done, now you will go to a CVS Minute Clinic, or you will go to the clinic inside Walmart or Walgreens. We've also seen the emergence of the urgent care facilities replacing some of the unnecessary emergency department travel that used to go on, with someone that...it could just be their off-hours or it happens to be easier for them to call 911 if they have a call, rather than call someone else.

The ambulance will come and transport them to the emergency department, and the emergency department is obligated to at least assess that member. There's a whole host of inefficiencies in that process. We are seeing more of that get diverted away from the emergency department to these urgent care clinics. Certainly, most of the time, that person does not need an ambulance. They need a form of transportation for that right. On the mobile diagnostics front, we have also seen there are more connected devices that people have, whether it's monitoring them in a health care facility or at their home, and folks are starting to use data from those devices to automatically trigger events.

Relevant to us, I think at least two years ago, maybe less time than that, you would need a human to make an assessment of when does somebody really need a ride to get to an urgent care clinic, or emergency department, or primary care office. Now, there are folks starting to do that on a programmatic basis. Their heart pressure monitor, their blood pressure, their weight ... it's being monitored every single day. If trending hits a certain threshold, automatically that person gets a transportation to one of these facilities.

Ease of Transportation Creates Efficiencies and Savings

“Most of our clients have saved at least 40%...some have claimed as much as 70% in ride-cost savings the first month that they've used the service.”

LC: Can you share any stories you've heard from your clients or really the end users about how Circulation has helped?

RH: Yes, I think our clients have been religiously tracking three things. One is economic impact to them, obviously. So, most of our clients have saved at least 40%, if not much more. Some have claimed as much as 70% in ride-cost savings the first month that they've used the service. Really, that's a lot of making sure that someone goes in an appropriate vehicle, making sure that they use transportation when they should be using it. It's not rocket science. The clients spend a lot of time there.

And then starting to track what's the impact on my no-show rates? What's the impact on my bed utilization if I'm in a hospital or if I can discharge someone two hours earlier; that's very meaningful also. So, that's on one level. The patient experience and the administrator experience for booking rides has been significantly improved. I think administrators spend just over a minute with the average booking time for a ride.

Some of these folks used to spend 20 minutes going back and forth on the telephone, trying to find a provider that would actually service the ride. That is a huge improvement, particularly for social workers and discharge nurses because transportation is not their job. It's something that they are doing above and beyond their job, and so they do not have 20 minutes. They don't even have five minutes, really, to spend on that.

Then, they get peace of mind around tracking rides in real time. So, they know that someone has reached home safely. They know someone is coming in to visit them, or if they're on time, or if they're not on time: "They're almost here. I can see them coming." That has been a huge peace of mind for folks, particularly if they were giving out taxi vouchers before, and having no insight into what happened.

On the patients' side, we communicate a lot with our riders. We don’t do that in an app, instead we do that over landline phone calls, in text messages and emails. In both English and Spanish right now. They have expressed satisfaction really even from the moment of scheduling the ride because they get the confirmation notice if the rides on schedule. They automatically get the night before reminder. They have an opportunity to instantly cancel a ride and tell their provider why.

All the way to when a ride actually gets dispatched, and now they have Uber/Lyft information for every single ride category. "I know my driver," or, "I know the license plate," "I know the color of the car that's coming," "I can watch an app to coming to me." Again, not rocket science outside of health care, but very different for these patients to have that experience.

We also have a feature we call, "User Initiated Rides," where someone can set up a ride, and it will generate a five-digit code. When the person's ready to take that ride, all they do is type back five digits, or call a landline phone and give us the five digits. It makes, oftentimes, the return visit after an appointment so easy. "I get out of my appointment. I'm ready to take my ride home." It's all pre-scheduled by just initiated, then it comes and I'm off and running.

It seems small until you experience it for yourself. But, if you're in the hospital, you're going to a dialysis appointment, or an oncology visit, or even some of these quick surgeries...it's long. You're tired. You finally finish your appointment, you're ready to go home. And to have to sit a few hours and try to coordinate scheduling of that right home is the last thing you want to do. You just want to get in the car and get home and start your recovery process.

We are pleased. We collect ratings after every ride. We have, right now, 4.9 out of five stars-

LC: Oh, that's phenomenal.

Health Care Transformation Can Start with Getting a Ride

“Their ride is actually their first interaction with the health system and their last interaction with the health system.”

RH: Thank you. I think a big part of it is just making it easy for someone to get there and easy for them to get back, remembering their ride is actually their first interaction with the health system and their last interaction with the health system.

Sometimes, if those goes poorly, a hospital, they get a bad HCAP survey (Hospital Consumer Assessment of Healthcare. Providers and Systems), or they get a complaint from the person, despite the fact that it may have been an amazing experience at the health facility. So, just being able to keep the experience going before and after is a good point.

LC: It's amazing to me to hear you talk and to think that you just started this company less than two years ago. Where do you go next?

RH: This is what we ask ourselves every day. So, there is a plethora of opportunity in this space. We are doing a lot more of our core business-

LC: When you say core business, you mean the transportation piece?

RH: Correct. Yeah. Just basic logistics. Whether that's moving people or product, so a lot to do in that space.

LC: Okay.

Person-focused Care Helps Position Health Tech for Today and the Future

“I have to make sure we're well positioned for today, and we're well positioned for whatever comes next...”

RH: We also spend time thinking about, "How does someone start to access our service?" Even easier, right? Right now, I can initiate rides via taxi. I can initiate them via a landline phone call. My health care provider can do it for me. But, then you see...there are services like Amazon’s Alexa. Those are becoming more prevalent in the home, and certainly, at some point in time, it's probably very conceivable to ask Alexa to book you a ride or talk to Siri on your phone.

We're thinking through what are the right strategic integration points for us to just make it easier for someone in their normal course of business. On the flip side, we've seen a lot of new entrants in terms of Cancer Patient Partners, actually, Amazon has their own fleet, Amazon Flex. We've been thinking what are the right strategic business partnerships on our transportation network. So, I have to make sure we're well positioned for today, and we're well positioned for whatever comes next in terms of the best way to move people.

LC: Well, I know this isn't your first health care startup, but I would be interested to know how it compares to the others, and if you have any learning you would want to share or even advice?

RH: Thank you. Certainly, this is my third. The first one was a predictive risk analytic business, help to do things like predict readmission risks for patients, and also who might just enroll in my health plan in the next six years. The second business was a business looking at social media and news media to pick out early signals of public health. So, we looked at things like early signals for disease outbreaks. Actually, that product, Power WHO, and the CDC and some other groups, because it will pick out a disease-outbreak four weeks earlier than anyone else knows about.

Those two, we definitely had more of a luxury around commercial timing. We had time to craft the product, and think about the launch of it. This business, everyone does transportation. They either do it via a taxi voucher, or broker, or maybe some ad hoc way, but most people do it. This is a better way to facilitate that. So, we have been fortunate from the beginning to have a flood of inbound, but also that's different.

LC: Yeah.

RH: I think the real benefits have been our team, and we've been super fortunate, more than half of us, and we're 25 people now. More than half of us have worked together over five years. There's a lot to be said about working with folks deeply for a long period of time. Many of us have worked together for 12 years, as an example.

LC: At the other startups?

RH: Correct, yes. The other piece is I do think for health care businesses, there's an extra piece in the industry that allows people to be successful faster, or not. Health care is one of those where there is a huge regulatory...there's a whole specific language to health care, with a lot of acronyms that if you're not in health care, you won't understand.

We spent a lot of time in that, and we've also spent a lot of time specifically trying to help groups take on risks and do care better for patients that they serve, which are...inherently, those patients tend to be sicker and more complicated, and they've got a lot of logistics to fulfill. So, we've been in and around that space for a number of years, and I think that's helped.

LC: Great. Well is there anything else you would like to add that I have not asked?

RH: I think now is the time in particular where there's a lot of noise and a lot of companies. We find that when we go to sell the hospitals, clinics, you know...certainly large payer systems, they have seen hundreds of demos of new products and widgets, and platforms and exchanges, and pick your favorite buzz word. They have seen a lot of them, they're probably testing a lot of them.

My advice for not necessarily rising above that noise, but getting the foot in the door quickly, is to be able to have a product that provides value within the first month. The traditional pitch is to start using this. Maybe after six months, we've got enough data to start looking at it. Really, after 12 months, we've got some sort of ROI. I think particularly in this day today and coupled that with consumers wanting instant gratification, and the media convenience and impact, you need something that moves the needle quickly.

LC: Do you think that was one of the keys to your quick pace of growth and success in being able to provide those analytics right out of the gate, in that first month or two?

RH: I do. I think the benefit of working with Uber and Lyft and shifting a lot of the tasking volume to them, enabled some really amazing cost savings straight out of the gates. The other thing we did, which I would advocate to others, is make contracting easy. We have a very simple business model. We task through the cost of the rides, and we charge a booking fee. That's it. Contracting is hard enough with health systems, and I think a simple business model to start does help accelerate growth.

LC: Great advice. Thank you for sharing that. So, that wraps up our conversation today, Robin. I just want to thank you so much for being on the show and sharing your journey and expertise as a health care entrepreneur, that's actually changing health care. Thanks for being here with us.

RH: Thank you, Leslie. I am so glad that you have this podcast series and very fortunate to be able to be here with you on it. So, thank you.

LC: That wraps up this episode of Health Changers. You can find more information on all of our episodes at cambiahealth.com. You can also follow us on Twitter @cambia. Please subscribe to HealthChangers on iTunes or Stitcher and leave a review. Thanks for listening.