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Oct
5

For work comp, Lyft and Uber aren’t the answer

Transporting work comp patients to and from medical visits, PT, IMEs, hearings and the like is a big business – big for worker’s comp that is.

At first blush, it looks like a perfect opportunity for Lyft and Uber (L/U)- they’ve got a gazillion drivers everywhere, a great service model, and they are much less expensive than the traditional work comp transportation services.

In fact, OneCall and Lyft announced a partnership over two years ago (interested to hear how that’s working out; if you know please comment below).

Here’s why I don’t think they’ll replace work comp-specific transportation companies.

  • the big one – being late for or missing an IME is really, really expensive – the payer has to pay the IME doc the $1000 – $2000 anyway, rescheduling an IME incurs more indemnity, attorney, and other expense, and it makes adjusters nuts. The same is true for PT or other medical treatment – although not quite as bad.
  • WC patients don’t all have smartphones, so figuring out which patients can access L/U is a necessary first step
  • L/U drivers wait a maximum of 5 minutes – this doesn’t work for patients:
    • with limited movement ability trying to get ready
    • who aren’t really interested in making that IME appointment
    • whose doctor appointments may run late
  • L/U drivers aren’t going to go up to the patient’s door and help them get into the vehicle
  • L/U drivers’ vehicles typically aren’t accessible for patients with limited physical ability
  • Some WC patients aren’t native English speakers, and may require drivers to speak their language
  • If you try to schedule a pickup for a time in the future, L/U typically don’t reach out to drivers until a few minutes before that pickup time – which may well not work for patients in remote areas
  • which brings us to location – L/U work really well in metro areas, and not so much in more rural/suburban settings. So, schedulers may find L/U doesn’t have available drivers
  • you can’t talk to a person at L/U – ever. Many WC transportation services involve a three-way call between the scheduler, driver, and patient; this is just not going to happen with the ride-sharing services.
  • Some states regulate transportation fees, which may not work in the L/U pricing model.
  • Finally, while the dollars are significant in WC, they really don’t amount to that much compared to other opportunities in Medicaid and Medicare. If you’re L/U, you’re going to focus on those payers and ignore WC.

This is not to say L/U won’t be part of the answer – I’m just suggesting that “part” may be pretty defined and not nearly as big as we may have thought a while back.

I’m sure there are other reasons – as well as arguments for L/U as successful disruptors. I look forward to hearing them.

What does this mean for you?

Once again, what looks simple isn’t because of the inherent complexities of work comp.


11 thoughts on “For work comp, Lyft and Uber aren’t the answer”

  1. Joe, great article and have been raising many of the points you mention, but what it really comes down to is liability and price. So many adjusters and NCM’s will pick or utilize U/L simply because it is a few pennies less per mile. They don’t understand the inherent liability of putting an already injured person who may or may not have an attorney at this point in a vehicle being driven by a non-professional driver who does not know the best routes, traffic patterns and no ongoing vehicle inspections. How bad do you think a plaintiff attorney would jump on a TPA/Insurance CO/NCM if there was an accident involving their client and they find out that you put an injured patient with a driver who was a 22yr old part time student with little driving experience? Yikes.

  2. You guys are really showing your lack of knowledge about this subject. My suggestion would be that before you write an article filled with opinions, do some research, reach out to companies like One Call to hear their take on the service. That’s just simple research before coming up with an opinion. Come to think about it, I don’t recall seeing one article about One Call that was not negative so clearly your blogs are bias.

    1. Hello Lou, and welcome to MCM.

      I spoke with several individuals in this business and this was their take. You’ll note that I asked for different perspectives, so thanks for responding. What can you tell us about the OneCall program’s operations, uptake, successes and challenges?

      Re OneCall, I call them like I see them. Always happy to hear from someone with a different perspective.

      Cheers Joe

  3. Great post Joe ! I appreciate you touching on this subject and think you’re spot on with your assessment of the WC transportation landscape. I’ve worked for a major MCO in the WC ancillary space and owned a small NEMT company and I’ve send the trend towards using TNC’s. I agree that there are certain patient care requirements that U/L are not yet able to provide for WC patients. I do believe using rideshare technology seems to be the trend going forward. I know of a few startups that are utilizing this technology in the medical transportation sector, albeit not for WC except for maybe OneCall.

  4. Joe
    Appreciate your post and perspective as always. There are some materially inaccurate comments/assumptions made that need to be addressed, my comments below. The most important thing to know is Rideshare is NOT an exclusive option, if properly implemented it is a tool within a complete transportation solution. My comments come from the perspective of the company I work for, HOMELINK, which began offering Rideshare as a solution in 2015. I look forward to your feedback.

    • The big one – being late for or missing an IME is really, really expensive – the payer has to pay the IME doc the $1000 – $2000 anyway, rescheduling an IME incurs more indemnity, attorney, and other expense, and it makes adjusters nuts. The same is true for PT or other medical treatment – although not quite as bad.
    • Rideshare programs are a great solution for just this point. The transparencies provided from real time monitoring of rides allows immediate rescheduling if an adverse issue arises.

    • WC patients don’t all have smartphones, so figuring out which patients can access L/U is a necessary first step
    • The benefit of this program is the patient does not utilize commercial applications. The coordination and monitoring of rides are done through the vendor, such as HOMELINK.

    • L/U drivers wait a maximum of 5 minutes – this doesn’t work for patients:
    • Through HOMELINK’s processes, every patient is qualified before the coordination of the ride. Patients with specific needs or limiting diagnoses are coordinated with transports meeting their exact needs.

    • L/U drivers aren’t going to go up to the patient’s door and help them get into the vehicle
    • As mentioned before, these patients would undergo our initial Rideshare assessment and coordinated with transports meeting their exact needs.

    • L/U drivers’ vehicles typically aren’t accessible for patients with limited physical ability
    • This would be vetted in the assessment process as outlined above.

    • Some WC patients aren’t native English speakers, and may require drivers to speak their language
    • This would be vetted in the assessment process as outlined above.

    • If you try to schedule a pickup for a time in the future, L/U typically don’t reach out to drivers until a few minutes before that pickup time – which may well not work for patients in remote areas
    • Since HOMELINK coordinates the referral, these necessary communications all occur within our patient care teams.

    • which brings us to location – L/U work really well in metro areas, and not so much in more rural/suburban settings. So, schedulers may find L/U doesn’t have available drivers
    • Rideshare and traditional transportation are not mutually exclusive, Rideshare is a cost savings tool to be used by payers when the situation allows. In this example, if Rideshare did not have adequate coverage a traditional transport would be coordinated.

    • you can’t talk to a person at L/U – ever. Many WC transportation services involve a three-way call between the scheduler, driver, and patient; this is just not going to happen with the ride-sharing services.
    • Our relationship and developed workflows allow our patient care coordinates to have open communications with the driver.

    • Finally, while the dollars are significant in WC, they really don’t amount to that much compared to other opportunities in Medicaid and Medicare. If you’re L/U, you’re going to focus on those payers and ignore WC.
    • If you’re looking at Rideshare organizations making a direct play with WC you are correct. However, relationships established in this space with companies such as HOMELINK have allowed for payers to capitalize on substantial savings. We have shown comparative savings (Rideshare vs. traditional transportation) approaching up to 40%. This is not an exclusive tool in a transportation portfolio, it is another innovative approach to improve patient experience and optimize savings. Since our rollout in 2015, we have seen Rideshare utilization becoming a larger percentage of our partner’s transportation mix.

  5. Hello Joe – a few notes as I see it:

    1. One Call’s partnership with Lyft is actually geared more towards non-work comp arenas, specifically providers looking to solve for higher-than-average missed appointment percentages. For work comp patients, they still want to lean on their traditional network.
    2. They’re using a concierge-style service to follow the patient real-time from pick-up to drop-off. This is meant as an interventive measure to ensure the patient makes it into the vehicle, but also to alert the provider of traffic would have the patient running 15 minutes late. There’s more there than just brokering rideshares, and goes directly to address I g your initial points on missed IMEs and PT appointments, for example. It also helps control for the limited wait time window that L/U offer, but flip that around – someone is not having to pay a transport company wait time to sit in the parking lot for the inevitable return trip home.
    3. There is the capability for them to integrate the rest of their network within an app-based solution, which would change the patient/provider relationship drastically with the simple benefits that the general population already sees using ridesharing as a means of mass transit.

    The solution is not perfect for every patient, but it does provide a very unique, very real benefit for a large cross-section of patients in need of more affordable transport. The folks at One Call are doing that with patient populations outside of work como, and it’s evident that there will be plenty of synergy to bring from success on that side of the world back over to work comp.

  6. I am uncertain how payment would occur with L/U. Would they bill the insurance company? Doubtful. Would they require the patient pay with credit card and then the patient seek re-imbursement? That would not work. Like you said, there is no one to talk to about these issues.

  7. I work for a company that utilizes Lyft for ambulatory transport nationwide for workers comp. The key to success is how the utilization is done. We concentrate on placing Lyft on transports in major services areas, and mainly on transports that do not require the driver to wait, but those assignments where the driver can drop the claimant, and the claimant can call our company for the return home. We rely on our regular medical transport network for IMEs and special request transports. So, I counter that if you use L/U correctly, they can be a true benefit to your transportation network.

    1. Hello Kevin, and thanks for the comment.

      I don’t think we are in disagreement; I believe rideshare can be useful albeit in limited circumstances. For some reason some readers have interpreted my post as “all or nothing” when that’s certainly not the case.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates

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