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Lyft’s Role in Eliminating Barriers to Care for Patients with Cancer
Prepared for National Cancer Policy ForumSeptember 21, 2021
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Jennifer Sisto Gall, MPHHead of Government Business Development, Healthcare, Lyft
Jennifer has spent 12 years in the healthcare industry at the intersection of business strategy, health policy, and technology. She currently leads Business Development for Lyft’s Healthcare business in government markets, focusing on non-emergency medical transportation (NEMT) and transportation as a social determinant of health.
Prior to Lyft, Jennifer worked with Evidation Health to launch digital biomarker research with clients to understand how everyday behavior and health interact. She also worked at Change Healthcare where she led Enterprise Strategy initiatives across the $3B portfolio, focused on software and services for health systems and health plans. She completed a post-graduate Rotational Program with RelayHealth, a division of McKesson, where she drove the go-to-market launch of a clinical and claims data platform with a focus on quality measures. Jennifer started her career as a consultant with Accenture within both the public and private sector Healthcare consulting practices, including with HHS/ONC and CMS on the Healthcare.gov recovery effort.
Jennifer has her Master of Public Health in Health Policy and Management from the University of California, Berkeley School of Public Health. She received her BS from the McKelvey School of Engineering at Washington University in St. Louis in Systems Science and Mathematics, with a second major in Healthcare Management from Olin School of Business.
Why is Lyft here today?
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Our mission is to improve people’s lives with the world’s best transportation.
Transportation & Wellbeing: An Opportunity to Connect the Dots
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Lyft in HealthcareA business-to-business platform for sending and scheduling rides for members and patients.
Partnerships with thousands of healthcare organizations and community organizations, including top health systems and top health plans.
Driving access to care at scale
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Lyft Healthcare is one of the largest providers of non-emergency medical transportation (NEMT) services in the United States, ensuring access to reliable rides for millions of eligible patients who lack transportation.
Lyft’s has driven authorization for rideshare in Medicaid NEMT across the country. Medicaid NEMT is the largest program for transportation insecure patients.
40%decrease in
emergency room utilization
73%decrease in no-shows
for primary care appointments
90%of seniors who use Lyft report improved
quality of life
Sources: AmeriHealth Caritas DC ,Alameda Health System, USC/AARP/UnitedHealthcare
Prevention
Detection
Diagnosis
Treatment
Survivorship
Food, Jobs, Elder Mobility Access programs Lyft has provided over tens of thousands of discounted rides across 25+ cities to help people access grocery stores. We’ve focused on nonprofit partners operating under the Produce Prescription (ProduceRX) model.
SDOH screeningLyft participates in the Gravity Project to support standards for transportation insecurity screening.
Access to cancer screeningsLyft facilities Medicaid and Medicare Advantage NEMT to and from doctor’s appointments for screening.
Lyft has had partnerships with the Brem Foundation, Rush University Medical Center, Memorial Sloan Kettering Cancer Center to provide cost effective transportation to and from cancer screening appointments with a focus on breast cancer awareness.
Transportation for donorsLyft and Be the Match partnered toprovide convenient transportation tobone marrow donor appointments
Transportation for clinical trialsTrips for pharma or CROs
Opportunity for Lyft to provide rides to support racially, ethnically inclusive clinical trial participation if included as an endpoint in state Medicaid NEMT coverage
Lyft’s Role Across the Cancer Care Continuum
Access to care for patientsLyft facilities Medicaid and Medicare Advantage NEMT to and from appointments for treatments.
Lyft previously partnered with the American Cancer Society to provide rides for thousands of patients across 10 cities to access high quality cancer treatment
What have we learned in this space?
Currently there is no standard method used to assess transportation as a barrier to accessing health care.
The following are commonly used factors across current methods:
• Time spent traveling to a health care provider• Distance between patients and available health care facilities• Existing Transportation Infrastructure (Personal & Public) • Cost of Transportation Services • Knowledge Perception and Use of available transportation services• Appropriateness of Transportation Mode
Defining Transportation Barriers
The Gravity Project is focused on developing comprehensive coding standards for SDOH data capture, exchange, and use across the variety of systems and settings of care and social services.
With funding from the Robert Wood Johnson Foundation, UCSF’s Social Interventions Research and Evaluation Network (SIREN) launched the Gravity Project in 2019.
Based on rigorous research, transportation access was chosen as one the primary domains of focus.
TrackStandardize Study
Currently, most health systems aren’t tracking SDOH data and there’s a lack of standardization across the data that is collected.
Lyft is proud to help steer consensus-driven standards that integrate SDOH data into digital infrastructure and address social care in clinical settings.
While SDOH medical codes exist, research shows that many of them are used in less than 2% of patient interactions.
The Gravity Project: Transportation Insecurity Screening Approaches
Screening Tool Description Source(s)
2018 National Health Interview Survey
The National Health Interview Survey (NHIS) is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS).
Access to health care and non emergency medical transportation: two missing links. Transportation research record 2005;1924(01):76-84. https://www.cdc.gov/nchs/nhis/1997-2018.htm#2002
Accountable Health Communities (AHC)- HRSN
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) have made the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool to use in the AHC Model.
https://innovation.cms.gov/Files/worksheets/ahcm-screeningtool.pdf
American Academy of Family Physicians (AAFP) Social Needs Screening tool (Long)
This is tool is part of the EveryONE Project toolkit. The EveryONE Project offers a collection of tools and resources to use at the point of care to tackle your patients' social determinants of health.
A Practical Approach to screening for social determinants of health. Fam pract Manag. 2018 May-June; 25(3):7-12. http://www.nachc.org/research-and-data/ prapare/toolkit/
American Academy of Family Physicians (AAFP) Social Needs Screening tool (Short)
This is tool is part of the EveryONE Project toolkit. The EveryONE Project offers a collection of tools and resources to use at the point of care to tackle your patients' social determinants of health.
A Practical Approach to screening for social determinants of health. Fam pract Manag. 2018 May-June; 25(3):7-12. https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/patient-long-print.pdf
HealthLeads The Health Leads Social Needs Screening Toolkit is a comprehensive blueprint for health systems seeking to identify and screen patients for adverse social determinants of health.
https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/
PRAPARE The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) is a national effort to help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health.
http://www.nachc.org/wp-content/uploads/2018/05/PRAPARE_One_Pager_Sept_2016.pdf
PROMIS This toolkit is meant to provide researchers with the information they need to understand how the health center model can support their research initiatives. It is intended to depict how health centers operate, their research interests, their research experience, and their research needs.
http://www.nachc.org/wp-content/uploads/2015/06/WANTK.pdf
https://confluence.hl7.org/display/GRAV/Transportation+Insecurity
Who funds NEMT today?
Transportation x Health: Core Programs (Slide 1/2)Program Description No. of Beneficiaries Funding source
Medicaid non-emergency medical transportation (NEMT)
● Rides to medical appts for Medicaid beneficiaries who are eligible, given they do not have another mode of transportation available or meet or criteria
● Each state administers NEMT differently -- vendors, screening/eligibility, prior authorization
75.4M individuals were enrolled in Medicaid as of April 2021 (CMS)1
Subset of population is eligible (Dependent on state)
Federal (CMS) + State
~$5B total in 2019, ~$3B federal and ~$2B state2
Medicaid Waiver transportation: ex: Home and Community Based Services (HCBS)
● Medicaid Waiver beneficiaries often have more expansive transportation benefits to non-medical destinations to promote independence, self-determination for seniors and people with disabilities and chronic conditions3
Enrollment: 81K individuals receiving Section 1915(i) state plan services, 1.8M individuals receiving Section 1915 (c) waiver services3
Federal (CMS) + State
Medicaid MCO value-added transportation
● Medicaid contracted health plans, Managed Care Organizations (MCOs), may provide value-added transportation for beneficiaries, subject to state reqts
Dependent on state programs Health plan
Medicare Advantage Supplemental Benefits (Medicaid Part C)
● Medicare Advantage plans can offer transportation to medical appointments, as well as “wellness” or social needs rides
● Some tailoring of the benefits are allowed across MA population based on chronic conditions, SNPs
5.6M MA enrollees have some transportation benefit in 2020 out of 25.3M MA enrollees as of Sept ‘204, 5
2021 CMS MA data available 10/1
Federal (CMS)
No benefit - Medicare Parts A & B ● N/A44.6M Medicare + Med Sup enrollees w/o non-ambulance trans benefit5 Federal (CMS)
Other Health plan transportation ● Commercial or exchange business transportation benefits Dependent on private carrier benefits Health plan
1. CMS Medicaid April 2021 total enrollment: https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html2. Medicaid NEMT spend: https://azdot.gov/sites/default/files/2019/09/NEMT-Opportunities-for-Coordination-with-Other-Transportation-Services-in-Arizona.pdf 3. HCBS enrollment: https://www.kff.org/report-section/medicaid-home-and-community-based-services-enrollment-and-spending-issue-brief/ 4. MA transportation beneficiaries:https://paretointel.com/insight/2020-medicare-advantage-annual-enrollment-period-supplemental-benefits-analysis/ 5. MA and Medicare Sept 2020 enrollment https://www.cms.gov/research-statistics-data-and-systemsstatistics-trends-and-reportsmcradvpartdenroldatama-state-county/ma-statecounty-penetration-2020-09 : Assumption: Programs for dual (Medicaid/Medicare) eligibles assumed to be included
Transportation x Health: Core Programs (Slide 2/2)Program Description No. of Beneficiaries Funding source
Veterans Administration beneficiary travel
● Beneficiary Travel program pays Veterans back for mileage and other travel expenses for approved health care appts
● General healthcare travel: This benefit covers regular transportation, like car, plane, train, bus, taxi, or light rail.
● Special mode transportation: This benefit includes special types of transportation, like an ambulance, ambulette, or wheelchair van.1
9M Veterans in VA system (VA.gov)2
Subset of population is eligible
Federal (VA)
$1B in 20213
Healthcare delivery funded transportation
Often inpatient and emergency room discharge rides for:● Health systems (hospitals, IDNs, health systems)
Other relevant trips for:● Outpatient/ancillary providers (surg, PCP, IPA)● Long-term Post Acute Care (LTPAC) (SNF, Home, Rehab)
Dependent on healthcare organization funding, policies
Healthcare delivery organization
Community Transportation ● General mobility - can provide access to health care and SDOH Destinations
According to APTA, 55% of Americans have access to Public Transportation 4
Federal (FTA), State DOTs, and local match
Paratransit ● General mobility - can provide access to health care and SDOH Destinations
A subset of general population is eligible (Determined by the local transit system)
Transit Agencies
Not for profit organizations funded transportation
● Beneficiary transportation, for ex: United Way “Ride United”, American Cancer Society, Be the Match
Dependent on relevant programsGrants, fundraising, philanthropy
1. VA benefits: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/ 2. VA enrollees: https://www.va.gov/health/aboutvha.asp 3. VA spend: https://www.va.gov/budget/docs/summary/fy2022VAbudgetVolumeIImedicalProgramsAndInformationTechnology.pdf 4. APTA Transit Accessibility :https://www.apta.com/news-publications/public-transportation-facts/
More research is needed
Spur innovationUnderstand barriers to care Raise awarenessResearch can identify
populations that are affected by transportation insecurity as
well as where and in what forms barriers to access exist.
Research can show us what works and facilitate innovation as well as faster uptake of best
practices.
Research can raise the visibility of the issue of transportation
insecurity, helping policymakers and other stakeholders make
informed decisions.
Lyft Sees Research as a Key Priority
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Cost Saving
AsthmaCongestive Heart
Failure
Prenatal Care Diabetes
1. Source: “Cost Benefit Analysis of Providing Non-Emergency Medical Transportation.” The National Academies of Sciences, Engineering, and Medicine. 2005. DOI: 10.17226/22055
A 2005 systematic review by the National Academies of Sciences, found the use of NEMT services for chronic disease management and preventive services to be either cost effective or lead to lower spending1
Influenza Vaccinations
Breast Cancer Screening
Colorectal Cancer Screening
Dental Care
COPD Hypertension
Depression / Mental Health*
ESRD
Cost Effective
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Limitations and Gaps in NEMT Research
● Limited research connecting transportation access to clinical health outcomes (focus is largely on utilization)
● Limited research on value of disease-specific NEMT coverage, such as cancer, specific types and treatment approaches
● Primarily an individual-level focus; little mention of social return on investment (e.g. impacts to family, productivity)
● Study design concerns, including small sample size, lack of control groups, overly broad inclusion criteria
● Limited research on rideshare as a mode of NEMT transportation● Data on customer experience is short-term and often uses small samples
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CONFIDENTIAL NOT FOR DISTRIBUTION
Transportation Insecurity persists
Lyft x Evidation Transportation Insecurity Survey (Dec 2020)
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Go-forward Opportunities
Innovation Integration Investigation
● Re-inventing current workflows using HIT to improve member or patient experience, oriented around the user
● Adding new transportation modalities to NEMT programs and code sets (rideshare, for example)
● Increasing awareness of the NEMT benefit where it exists
● Create the data foundation for new research to understand how transportation interventions impact downstream total cost of care and health outcomes
● Better understand the intersection between cancer and transportation access
● Research to support ongoing optimal intervention design, NEMT program funding for those who need it
● Adding an ICD z-code for transportation insecurity status to be used by providers and payers (pending submission via The Gravity Project)
● Connecting transportation services to those who need it across the cancer continuum of care
● Bridging gaps for non-medical transportation (social needs) into current NEMT funding models
Jennifer Sisto Gall, MPHHead of Government Business Development, Healthcare, Lyft
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Questions?
