That’s when company leaders decided to take a look at health care.

“That’s when Lyft started to realize health care is not a $4 trillion monolith,” Poropatich, head of Lyft Health Care, told Home Health Care News. “It is hundreds and thousands of billion dollar industries — one of which is non–emergency medical transportation.”

Lyft’s health care strategy puts the company squarely within home-based care. It has been partnering in the space for years, with companies such as Right at Home, Comfort Keepers and Humana Inc. (NYSE: HUM).

The company’s objective in the space is not to disrupt it, but to find a specific niche within it.

Poropatich cited a recent study from the Robert Wood Johnson Foundation that found 5% of American adults reported forgoing health care in 2022 due to transportation barriers.

“That means for 10 million Americans, health care is either inaccessible at its worst and inconvenient at best,” Poropatich said. “There was just a very natural and obvious fit for Lyft, where we can leverage automated transportation to get people to the care that they want. Since then, frankly, it’s been kind of a rocketship of growth and opportunity.”

Lyft’s health care leaders also recognized that more health care would be provided in the home in the future, Poropatich said.

Originally, the company thought it had a three- to five-year window to capitalize on that momentum. Because of the COVID-19 pandemic, it became a three- to five-week sprint instead.

“Everything needed to get to the home, inclusive of care,” Poropatich said. “For us, all of a sudden new data points showed up for where things were going, where people were headed, new buying profiles, new drop-offs and destinations. Care was actually in the home.”

Poropatich believes Lyft can help patients get to health care appointments that are outside of their homes. At the same time, he believes it can help get caregivers and clinicians to those at-home visits, while also reducing windshield time for them.

One of the keys to the company’s success in health care is self-awareness, Poropatich said. He and the rest of the team know that ride-sharing is not for every at-home care worker or patient.

Understanding which lanes Lyft can fill, however, is the priority.

“The analogy we give is that we look at ourselves as urgent care,” he said. “Urgent care, from a delivery perspective, brought in cost, accessibility and convenience. That’s how we see Lyft.”

Lyft’s penetration in the market could also help health care professionals operate at the top of their licenses.

“We want the rideshare appropriate, ambulatory, fully cognizant person in a Lyft so that the people who are truly specialized in health care transportation can operate at the top of their license,” Poropatich said. “We want them to serve the population where wheelchair-accessible vehicles are needed. Not the other 40% of riders who are going to a wellness visit.”

Ultimately, Lyft wants to reduce costs, improve convenience and enhance accessibility for patients and its partners.

“We’re not a fully comprehensive solution,” Poropatich said. “This is not a threat to the academic medical center. It is a collaboration and an orchestration, and we work within the ecosystem and with the partners we have to make sure that we’re appropriately leveraged. And, when we can, bring an incredible member experience.”

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Founded in 1995, Hackensack, New Jersey-based CareFinders provides in-home care services to more than 8,500 patients throughout New Jersey, Pennsylvania and Connecticut. It has 26 offices in total.

Meanwhile, LogistiCare is one of the largest managers of non-emergency medical transportation programs for state government agencies and managed care organizations. The company’s service lines include call center management, transportation provider network development, ride management and credentialing.

Under the partnership, CareFinders’ caregivers can request Lyft rides through LogistiCare.

The services offered through the partnership are a response to the public transportation challenges that stem from the COVID-19 emergency. The aim is to make sure that caregivers have safe and reliable access to transportation, according to Care Finders leadership.

“As the largest home care services provider in the state of New Jersey, transportation is always top of mind for us,” Martha Stuart Williams, chief operating officer of CareFinders, told Home Health Care News in an email. “LogistiCare and Lyft brought a technology-centric and patient-centric solution for what is a persistent issue for many home care providers, particularly during a time as challenging as the pandemic.”  

The partnership has its roots in a contract between LogistiCare and the New Jersey Department of Human Services.

“This partnership began when LogistiCare started delivering food to those in need during the pandemic,” Kenneth Wilson, chief operating officer at LogistiCare, told HHCN. “This was in addition to our New Jersey state contract to provide non-emergency transportation for Medicaid patients to their medical appointments.”

LogistiCare learned about CareFinders’ transportation needs via conversations with New Jersey’s Medicaid director, Wilson noted.

“We reached out to CareFinders, and they expressed an interest in working together, so we agreed to create and launch a pilot program, which has been very successful,” he said.

For CareFinders, LogistiCare’s willingness to work with front-line care teams in communities hardest hit by COVID-19 made the company an attractive partner, according to Williams.

“They stepped up as a willing partner, providing reliable transportation for some of our most vulnerable caregivers in the midst of the COVID-19 shutdown,” she said. “That’s super important to us, because Total Care at CareFinders is about supporting our caregivers first and foremost so they can care for our clients.”

Overall, Williams believes that the partnership between LogistiCare, Lyft and CareFinders has allowed them to provide consistent care services. 

“At the end of the day, this partnership allows us to provide care to patients who otherwise might have been unable to receive care,” she said. “As a company dedicated to changing lives day in and day out, this partnership has become a tremendous asset for us.”

Additionally, LogistiCare is in talks with other home care providers about potential partnerships.

On its end, Lyft has increasingly gotten involved in the health care space, especially around home-based care. Many home-based care agencies use Lyft to coordinate transportation services for both caregivers and clients.

In total, CareFinders employs more than 7,.600 certified home health aides, plus more than 180 RNs and LPNs.

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And believe it or not, driverless cars — or autonomous vehicles — will make their mark on the home-based care space, just as they’ll affect shipping, retail and most other industries. As the unavoidable issues that come with a rapidly aging population continue to arise, future-facing technology companies will be waiting in line for their shot at solving them.

Ride-hailing giants Uber (NYSE: UBER) and Lyft (Nasdaq: LYFT) formed their own health care branches and have already entered into the home-based care market through partnerships with 24 Hour Home Care, Right At Home, Homewatch CareGivers, among others. They did so because they specifically recognized the growing opportunity within home-based care.

Uber and Lyft just so happen to be two of the companies in the driverless-cars arms race that’s now fully underway.

Nuro, a Santa Clara, California-based robotics company, recently made national news when it received clearance from the federal government to deploy no more than 5,000 of its R2 vehicles on U.S. public roadways. One of the exemptions afforded to Nuro was new: The federal government allowed the company to do away with requirements that did not make sense for a driverless vehicle, such as side-view mirrors and a windshield.

Nuro’s vehicles won’t be toting passengers, but they will be interacting with consumers. The company will be making mostly food deliveries in the immediate future, with current partners that include grocery chain Kroger, retail powerhouse Walmart (NYSE: WMT) and pizza franchise Domino’s.

Finding creative ways to enter the health care space is something Nuro is actively considering, Dan Mitchell, the company’s head of product operations and community engagement, told Home Health Care News.

“A huge area that we hope to grow into is delivery of medication, whether it’s prescription or just over the counter,” Mitchell said. “We are exploring partnerships with a number of providers that could provide that type of service in the near future.”

That’s just one potential health care application for Nuro. Even so, it’s easy to imagine how that could be of use to a home health provider or home care agency.

In some ways, autonomous vehicles are already here, at least from a supplies perspective. In terms of vehicles that will actually ride with passengers, those aren’t far away either, Dr. Kara Kockelman, an expert in the field, told HHCN.

“It depends on which road you’re talking about — is it a low speed road, is it a high speed road? Is it in Mountain View, California or Waco, Texas?” said Kockelman, a professor of transportation engineering at the University of Texas. “You might get picked up by one in San Francisco in five years … .[Otherwise], it’ll probably be 10 years before a lot of major U.S. cities have some in the fleet.”

The home care connection

24 Hour Home Care was one of the first home care companies to pair with Lyft, recognizing early on how such a partnership could be beneficial. As others began doing the same, providers started seeing two clear benefits.

Working with Lyft and Uber give providers more insight regarding when and where their clients are picked up or dropped off. In addition, being able to coordinate rides for caregivers means less liability and fewer hassles.

Los Angeles-based 24 Hour Home Care — formerly branded as 24Hr HomeCare — provides professional caregiving services to older adults and individuals with developmental disabilities. The company, which serves parts of California, Texas and Arizona, delivered over 4.1 million hours of care in 2019.

While it hasn’t dedicated efforts to driverless cars yet, it is on the company’s radar, Gavin Ward, 24 Hour Home Care’s regional director of strategy and partnerships, told HHCN.

The autonomous-vehicles phenomenon may seem like a far-fetched science-fiction concept, but there’s a legitimate chance of it impacting providers sooner rather than later, Ward said.

“What I think it’s going to help with is two-fold — and I think one’s going to be faster than the other,” Ward said. “Getting the buy-in of the older adult, getting the buy-in of billion-dollar health systems is going to be slow for that piece of what we do … . I think the initial adoption is going to come with our workforce and companies using autonomous vehicles for their workforce before their actual clientele.”

In other words, adoption from older adults receiving in-home care may be more gradual. But for agency workers, a lot of whom have already adopted Uber or Lyft to expedite their rides, the driverless cars could be an even safer and more efficient way of commuting to and from work sites.

Another perk: having a driverless car frees up caregivers to spend transportation time reviewing care plans and preparing for their next visit.

“Home care companies will adopt it,” Ward said.

The issue will be getting all of the accompanying parties on board.

Health systems have started to come around on Uber and Lyft as pickup options. Despite the advantages of those models, top-down adoption can sometimes be a long process.

“We have prospective hospital partners whose case management and social work teams are eager to use our program,” Ward said. “But they still have legal teams and leadership who would rather use a taxi. It’s the bureaucracy of the health care system, and the risk that’s involved with the new technology that’s going to be slow to adopt. That’s my belief.”

The benefits that home care agencies could gain from access to autonomous vehicles, however, is undeniable.

“The caregiver workforce — based on their wages — don’t always have their own reliable vehicle at all times,” Ward said. “Oftentimes in our industry, clients are demanding that a caregiver have a vehicle to take them around or to take groceries. What happens with home care agencies is they’re not always able to staff the best fit to a client. Because the best caregiver fit may not have that vehicle at all times, and so instead the caregiving agency will staff a caregiver that maybe is not the best fit but has [the ability to get there].”

Mobilizing the elderly

One of the alleged perks that driverless car advocates have long been teasing is their potential to further liberate the elderly. Nuro has already seen anecdotal evidence of its vehicles keeping the right people behind the wheel — and the wrong people away from it.

“I do think it will unlock a lot of additional activity for [elderly people],” Kockelman said. “But a lot of activity for them might be two more rides per week or something, and it’s not going to cripple the road network.”

Unlocking that ability will also be good for entire neighborhoods in the end.

“Older people can be a risk for themselves, [but also for] other road users or even just pedestrians in the community,” Mitchell said. “We saw that people were really appreciative of the delivery service because they knew that older person down the street probably shouldn’t be driving anymore, but they needed to get out to get their groceries on a weekly basis. With the application of autonomous technology as well as the electric vehicle that we’re using, we can really lower the cost of deliveries to a much more affordable level.”

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Growth-equity firm Montlake Capital has announced it will fuel Fedelta Home Care’s growth efforts.

Founded in 2004, Seattle-based Fedelta provides both home care and home health care services in the Puget Sound region. As a provider, Fedelta provides in-home care services to individuals of all ages, offering both short-term care and long-term support.

Montlake Capital principally targets Pacific Northwest businesses with $5 million to $50 million of revenue and $1 million to $10 million of EBITDA. Moving forward, Montlake Capital will contribute a growth-equity investment in Fedelta, which the provider will use to help the company retain and attract a skilled workforce, according to Fedelta CEO Steve Meyer.

“I believe we have found the best partner for our company,” Meyer said in a statement. “I have maintained a relationship with the Montlake team for more than 10 years and believe they are uniquely qualified to help us build Fedelta into the leading independent home care and home health company in the region. Montlake will add both capital and expertise, and I appreciate their success and understanding of health care services and experience building leading businesses in and around Puget Sound.”

Montlake Capital’s investment in Fedelta reflects the growing interest in home-based care companies among PE groups and growth equity firms. Similar investments will likely be common throughout 2020, especially as PE firms sit on an estimated $1.5 trillion in unspent capital.

Humana invests in social determinants of health

Humana Inc.’s (NYSE: HUM) philanthropic arm, the Humana Foundation, plans to invest a total of $1 million in two New Orleans organizations to address social determinants of health. The investment is part of a broader effort to invest $7.6 million in eight communities overall.

Humana is one of the largest health companies in the U.S. — a mix of both payer and in-home care provider. The Louisville, Kentucky-based company, which includes in-home care entities Kindred at Home and Humana At Home, covers roughly 20 million lives.

The Humana Foundation’s Strategic Community Investment Program partners with community organizations to tackle social determinants of health, such as employment, social connectedness, financial asset security and food security.

In the past few years, social determinants of health have gained wider recognition within the U.S. health care system due to the ways socioeconomic and environmental factors impact differences in health status.

The Humana Foundation will invest $416,480 in Kingsley House’s Career Pathways, an employment program that aims to help families that face generational poverty.

Additionally, the foundation will invest $613,620 in Growing Local Food Collaborative, an organization that plans to bring fresh food into food deserts and works to build an employment pipeline for local youth.

Other investments as part of the $7.6 million initiative are focused on seniors.

“We believe this approach will positively impact health outcomes in our target communities, which our first year results confirm,” Walter D. Woods, CEO of The Humana Foundation, said in a statement. “Consequently, we are creating new investments in New Orleans and continuing our investments in other locations.”

PACE enrollment sees growth

Programs for All-Inclusive Care for the Elderly (PACE) has reached an enrollment milestone, hitting 10,000 members in California.

Enrollment in the program jumped from 3,100 in 2011 to roughly 10,000 in 2020, according to new data from CalPACE.

PACE is a Medicare and Medicaid program that aims to keep people in their communities and out of nursing homes. Among the services that PACE programs provide are adult day, home care and various types of therapy. PACE often operates with the support of in-home care providers and their staff.

“PACE provides improvements in health and quality of life for frail seniors and reduces family and caregiver burnout by offering a proven, cost-effective and high-quality alternative to nursing home placement,” Linda Trowbridge, CEO of Center for Elders’ Independence, said in a statement. “It’s no surprise that enrollment in the program is growing rapidly.”

Last year, nonprofit West PACE launched with $11 million in philanthropic funding.

CommonSpirit Health, Lyft, LogistiCare form partnership

CommonSpirit Health, Lyft Inc. (Nasdaq: LYFT) and LogistiCare have teamed up to improve care access by providing non-emergency medical transportation.

Chicago-based CommonSpirit operates across 142 hospitals and more than 700 care sites in 21 states.

Meanwhile, LogistiCare is a manager of non-emergency medical transportation programs for state governments and managed care organizations.

Under the partnership, CommonSpirit’s patients will receive access to transportation — a common social determinant of health barrier.

“When our patients aren’t feeling well, the entirety of their interaction with our system – from their provider visit to discharge to their door – affects their experience,” Christine Brocato, system vice president for strategic innovation at CommonSpirit Health, said in a statement. “By giving our caregivers access to LogistiCare’s ride-ordering platform, we can help our patients get rides within minutes and help give staff the peace of mind that their patient is getting a reliable ride so they can continue to devote their time to providing compassionate care.”

Additionally, CommonSpirit and Lyft plan to create an innovation task force that focuses on transportation challenges.

This isn’t the first time Lyft has attempted to address transportation barriers. The ride-hailing company also recently formed a partnership with nonprofit health system Sutter Health, for example.

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With Lyft as a resource, Sutter — a big home health organization in its own right — can likely rid itself of certain liability burdens that come with allowing workers to travel to and from case assignments in their personal vehicles. Additionally, with arranged travel, employees can strip themselves of the stress and excess time that previously went into finding their own way to a patient’s home.

Sutter serves more than 3 million northern Californians and employs 60,000 people. The health system makes over 200,000 home health visits per year across more than two dozen California counties, largely operating through its Sutter Care at Home service line.

The Sutter and Lyft partnership had been a work in progress, leaders from both sides told Home Health Care News. The two organizations had collaborated on a pilot project over the past few years, and that collaboration led them to think deeper about how ride-hailing services could benefit a health system that makes hundreds of thousands of in-home visits per year.

Sutter’s home health workers often tend to patients in need of wound care, physical therapy or nutritional support.

“Maximizing the time of those clinicians as they go about their day — either to allow them to prepare for the next visit or to document a visit that they’ve just left … is a huge benefit,” Megan Callahan, the VP of Lyft Healthcare, told HHCN.

For Sutter, Lyft controlling its employee transportation led to other ancillary benefits, too. For example, it leads to a safer visit process, Sutter’s chief innovation officer, Chris Waugh, told HHCN.

“That’s a bit of a breakthrough use case that we found,” Waugh said. “Our home health employees, if they are getting in their cars, they have to find a place to park. They have to make sure they’re at the right address … Sometimes, those environments aren’t safe. We’re finding with the Lyft partnership that those employees can get some of their time back — or at least have a less stressful ride to the next visit.”

After Lyft drops Sutter employees off at a patient home, it will also be there to pick them back up. So far, the only downside of the partnership is that employees have had to adjust to not leaving their lunches in the car, Waugh remarked.

One of the first times Lyft and Sutter worked together was in reaction to a fire in the northern California area a few years back. Within a day, an affected region was geo-fenced, and employees and patients within those boundaries were given access to rides, whether it was for work, an appointment or to get to the grocery store.

The innovative and curious nature of the partnership that sparked geo-fencing also provided them an ability to look deeper into the transportation problem in home health care.

“[The partnership] allows the clinicians to maximize their time and work at the top of their license,” Callahan said. “I think it’s a testament to Sutter’s dedication to make things easier for their staff, to then provide excellent care to their patients.”

Lyft is deeply embedded in the health care sector. Currently, it partners with nine out of the 10 largest health systems in the United States, according to Callahan.

In terms of home-based care, Lyft has been partnering with a myriad of companies over the past few years. 24 Hour Home Care, CareLinx and Comfort Keepers are just a few relationships Lyft has forged.

“Transportation is critical for all individuals, especially those who have mobility challenges, to stay in their homes as they age without being stuck at home because of a lack of options that meet their physical needs or budget,” Sherwin Sheik, founder of CareLinx, said in December 2016. “Our partnership with Lyft makes it easier for family members to organize transportation while supporting individuals with the caregiving they need to remain independent and still affordably get to where they need to go.”

Providing transportation services to seniors — specifically those who are Medicare Advantage beneficiaries — will be a driving force in Lyft’s health care business moving forward, Callahan said in August.

Lyft isn’t alone in its efforts to build out a health care department, as major competitor Uber Technologies Inc. (NYSE: UBER) has also actively targeted in-home care agencies with transportation, isolation and social determinants of health in mind.

Lyft had a natural advantage for connecting with Sutter, however.

“Lyft is literally down the street from us and there’s a lot of overlap between our interests,” Waugh said. “We weren’t limited to the obvious use case of [giving patients a ride home]. We started exploring other possibilities like the staff … we might have different demands at our surgery sites on any particular day, and an employee can walk out of their home, get a Lyft, and the Lyft will take them to wherever they’re needed that day with zero stress on the employee’s part.”

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Founded in 2014, Honor partners with home care agencies and other senior care providers by taking over caregiver recruiting, onboarding and training responsibilities while also handling back-office tasks such as scheduling and billing. Under that co-branded structure, Honor then receives a pre-negotiated portion of an agency’s revenue.

Publicly, Honor has touted partnerships with roughly two dozen home care agencies. Overall, the Andreessen Horowitz-backed company — which has raised $115 million since launching — says its services are available across more than 800 cities and towns in six states.

While growing its business, the recruitment, retention and general experience of caregivers has risen to a core tenet for Honor. As part of that focus, the company brought in Lyft veteran Dave Mayer earlier this year to serve as its senior vice president of operations.

So far, Mayer says he sees certain similarities between Honor and Lyft Inc. (Nasdaq: LYFT).

“At Lyft, our product was the people — the drivers,” Mayer told Home Health Care News. “If you have a great driver at Lyft, that makes all the difference, and it’s the same thing [with caregivers] here at Honor.”

During his four years at Lyft, Mayer served as general manager for the ride-hailing company’s San Francisco footprint, then later as its point person for the entire West Coast. By the end of his Lyft tour, Mayer was responsible for over $1 billion in revenue, 800 employees and 50% of the company’s entire business.

He moved to Honor after hearing a podcast about the company and its mission to modernize home care.

“I was fascinated by the business,” Mayer said.

In particular, Mayer said he was fascinated with Honor because he saw areas where he could apply his operations experience from Lyft, helping Honor achieve its mission of creating compelling experiences for its caregivers — and positive experiences for the customer.

Although there are similarities between Honor and Lyft’s commitment to workers, Mayer pointed out that the business models themselves are substantially different, with Lyft being much more “transactional” than home care.

Lessons learned

When Mayer started with Lyft, the company had about 300 employees; it now has more than 4,500. Honor is also currently around the 300-employee mark, he said, with a 30-member team specifically dedicated to its ongoing workforce efforts.

Since joining Honor, Mayer has gleaned several insights into what job applicants and caregivers — or “Care Pros,” as the startup calls them — want. They’re insights that all home care agencies can learn from.

On the recruiting side, for example, Mayer has learned there’s a strong correlation between the time it takes agencies to follow up with potential new hires and when their initial applications were submitted.

“Track the [recruitment funnel] really closely,” he said. “What we’ve found is that after you get an application, the longer it takes you to respond and [connect with potential new hires], the lower the conversion rate for those applicants. We encourage people to reach out immediately, do a short phone screen and then get those applicants in the door.”

Recently, Honor made “a pretty sizable investment in online advertising,” Mayer said.

Additionally, Honor sets a relatively high bar for its caregiver teams, incorporating strict quality standards and criteria into the hiring process. Honor’s applicant-to-hire rate over the last 12 months is just 5%, according to company statistics shared with HHCN.

Once a home care agency does hire a caregiver, it’s critical to assign that new employee regular work right away. That’s especially true for experienced caregivers, Mayer noted.

“We’ve found that if you give a caregiver work within the first two weeks, they’re much more likely to stay on … for a long time,” he said. “One of the biggest correlations [to] churn is hours worked.”

Industry-wide, the home care turnover — or churn — rate checked in at an all-time high of 82% in 2018, according to Home Care Pulse. Honor’s internal mark with partner agencies is around 45%, a figure that has steadily fallen over the past few years.

At 36%, Honor’s churn rate is even lower for “optimized” caregivers, or individuals who feel like they’re respect and hours needs are being fully met.

Another lesson: More than regular hours or flexible pay, caregivers desire respect.

“Respect can manifest itself in a number of different ways,” Mayer said. “I talk to a lot of Care Pros about what respect means. They say things like, ‘Every time I called, I was able to get somebody on the phone.’ Little things matter.”

Expansion news

Honor announced expansions into Ohio and Michigan in October.

In Cleveland, the company has teamed up with Bridgewater Senior Home Care. Meanwhile, Affordable Home Care and Bridgeway Senior Services — both based in Detroit — also joined the Honor network.

Ohio and Michigan are each among the oldest states in the U.S.

In Michigan, another 30,000 personal care aides will be needed by 2020 to provide care for the state’s aging population, according to New York-based direct-care worker advocacy organization PHI. In Ohio, a survey conducted by fellow advocacy organization LeadingAge reported 57% of respondents having fewer aides than planned.

“Our biggest struggle was finding and retaining enough quality caregivers to keep up with increasing demand,” Molly Koenig, owner of Bridgewater Senior Home Care, said in a statement. “I’m always looking for new ways of thinking and doing things … .”

Prior to Ohio and Michigan, Honor entered into the Arizona market in April, thanks partly to a partnership with Cypress HomeCare Solutions. HHCN recently caught up with Cypress Managing Partner Bob Roth at the National Association for Home Care & Hospice (NAHC) 2019 conference in Seattle.

“2019 was a big year for us,” Roth told HHCN. “It was a year of change.”

Broadly, converting Cypress to the Honor network has allowed Roth to spend more time with clients and tackle big-picture issues shaping the home care industry, he said. A couple of those issues are immigration reform and the Credit for Caring Act.

“I see a world in the future where the home is really the center for care,” Roth said. “So I’m trying to do everything I can to help make that happen.”

While there were several reasons Roth decided to partner with Honor, it’s the increased ability to recruit and retain caregivers that was most appealing.

“I didn’t want to be here in 2022, scratching my head and saying, ‘What the heck! Where are these caregivers?” Roth said.

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Despite being a popular talking point and area of focus for home care agencies, many hospitals and physician practices aren’t screening for SDoH barriers. In fact, only 24% of hospitals and 16% of physician practices screen for recommended social determinants of health, according to a recent JAMA study.

“Despite the spotlight on the importance of social needs, there is little consensus about responsibility for addressing social needs or the best approaches to the problem,” researchers from Dartmouth University wrote in the study, published last month.

Broadly, social determinants of health are socioeconomic and environmental factors that impact differences in health status. They include, for example, housing instability, food insecurity and access to transportation.

As the U.S. health care system began putting a greater emphasis on value-based care, hospitals and physicians began focusing more on population health, whole-person health and addressing needs that fall outside of traditional clinical care.

Additionally, government policymakers and private payers began creating programs that attempted to integrate social services into clinical care, such as the Centers for Medicare & Medicaid Services’ (CMS’s) Accountable Health Community model.

One company that has prioritized social determinants of health is Denver-based startup DispatchHealth.

“I think we have realized how much social issues impact our overall health and, in turn, the cost of care,” Dr. Mark Prather, founder and CEO of DispatchHealth, told Home Health Care News.

DispatchHealth was founded in 2013 and works alongside in-home nursing care providers, offering mobile high-acuity services and urgent care in 16 markets across the U.S.

Even though experts say there is an increased awareness about the ways that socioeconomic and environmental factors influence health outcomes, only a small percentage of physician practices and hospitals are screening for all the ones recommended by the federal government.

One of the main reasons for this is oftentimes clinicians lack the resources to address social needs once they’ve been discovered, according to Dr. Prather.

For example: not being able to address the needs of patients who have transportation challenges, he said.

Another reason is that physician practices may not have the financial or staffing resources to

routinely screen for social determinants of health in the course of clinical care, according to the JAMA study.

The providers that are the exception when it comes to low screening rates are Medicaid accountable care organizations (ACOs), physician practices in Medicaid expansion states, federally qualified health centers, academic health centers, bundled payment participants and primary care improvement programs.

“The clinicians that are involved in value-based care reform are screening more,” Dr. Prather said. “That’s not a surprise to me, in that the totality of the cost of that care flows to those groups of providers, so they are much more interested in addressing those social needs because they understand how much that impacts cost of care. Until we get larger payment reform and value-based care reform, I worry that we won’t see an uptick in the screening.”

In general, the in-home care industry has taken an active role in addressing social determinants of health.

On the home care side, the broadened scope of the Medicare Advantage (MA) program has helped to bolster these efforts.

In April 2018, CMS first expanded the MA program, making way for home care providers to offer non-medical benefits and become partners in MA contracts.

Overall, MA beneficiaries are often affected by socioeconomic factors that have an impact on health. About 50% of dual-eligible patients reside in neighborhoods where the median income is lower than $30,000.

Further compounding matters, dual-eligibles are more likely to live in neighborhoods with higher rates of poverty and with less education, according to Avalere Health.

In June, Envoy America and HomeThrive partnered to create a program that offers transportation-plus-assistance and companionship services to older adults.

“Transportation is one of the biggest challenges that family members have,” Dave Jacobs, co-founder and managing director of HomeThrive, previously told HHCN. “So finding a great provider and partner in that was critical for us. Transportation is such a lynchpin to a lot of other social determinants.”

On the private-pay side, Alliance Homecare recently began offering food delivery through its partnership with Epicured, a subscription meal-delivery service.

“I know that food is medicine,” Greg Solometo, CEO and co-founder of Alliance, previously told HHCN. “There are absolutely ways that providing a better nutrition [experience] to our clients is going to yield better [health care] results.

New York-based Alliance provides short-term personal care, home health care and care management services in support of hospital or skilled nursing facility (SNF) discharges. The company also provides concierge services, which include long-term support, weekly care management, meal preparation, social engagement and more.
Meanwhile, major companies such as, Lyft, Uber and Ford have moved forward in setting up services and partnerships that address social need.

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Plans’ newfound ability to offer supplemental benefits such as home care and transportation for certain beneficiaries is drawing a number of new players into the space, many of whom are poised to create disruption.

In fact, there have been at least 16 new MA plan entrants this Annual Election Period (AEP), according to Patrick Phillips, CEO of Cavulus. 

Hilton Head, South Carolina-based Cavulus is a technology firm that caters specifically to the Medicare Advantage industry, providing plans solutions for marketing, sales, compliance and more.

More so than traditional payers like Humana, Aetna and others, MA startups are able to take risks in the home care realm, going after innovative offerings for beneficiaries and partnerships with providers. That’s one reason the startups are on track to revolutionize the industry, Phillips said. 

HHCN recently connected with Phillips to get his take on disruption in MA and where home-based care fits into the picture. 

You can find the rest of HHCN’s conversation with Phillips below, edited for length and clarity.

HHCN: Can you give me a little background on how Cavulus got started and what it’s goals are?

Phillips: I stood up the company following the Medicare Modernization Act back in 2004, when reimbursement rates hit a point that Medicare Advantage became profitable for the private health plan industry.

There was a lot of growth in Medicare Advantage plans being stood up and, obviously, enrollment coming into those plans. With that came a heightened level of regulation.

I really focused our technology and our research and development on ensuring protection for the senior population on how they were being sold and marketed to coming into Medicare Advantage plans.

That was an easy sell into the health plan vertical. [Plans] wanted to make sure they were operating in a compliant fashion so they didn’t receive stiff penalties and fines related to unethical sales tactics. 

Cavulus technology provides transparency in the field. That’s done in a real-time fashion and reported back to regulators and the compliance division within health plans so they know exactly what was communicated to beneficiaries. 

Everything is documented, from the first piece of marking they receive to what they inquired about to make sure [seniors] weren’t sold into the idea that a certain [benefit] was covered or a certain physician was in the PCP network — so there is an ease of enrollment and also [a record] for rapid disenrollment.

We [also] built a conduit to allow for member services to have full visibility on all the marketing an individual receives.

We’re touching about 25% of the lives in Medicare Advantage currently.

Talk about what you’ve seen in the past year since CMS first allowed MA plans to offer these in-home supplemental benefits, which previously weren’t covered.   

There are a number of new startup plans coming into the space. I’ve interacted with just about every one of them at this point. They really are poised to disrupt what has been going on with incumbent players — a lot of the existing health plans that had been in the space.

MA was never the golden, profitable aspect of their organizations, and that’s kind of [changed] over the past three or four years. MA is now one of the most profitable aspects of what insurers are offering.

New permitted benefit designs are really opening up doors for plans that are creative enough to leverage some of these new regulations in their benefit design. That’s what we’re seeing a lot of the new start ups grab hold of. 

There’s a handful of plans that have made news, especially financial news with the valuations they’ve been given and the money they’ve raised. That’s namely Devoted Health, Oscar Health and Clover Health. Oscar and Clover are backed by the Alphabet, the parent company of Google.

[They] really are technology-focused health plans. They all started out focused on the Affordable Care Act, but as that lost political support with the current administration, they really refocused on Medicare Advantage. And they are expanding their service areas pretty dramatically. 

Solace Health is another startup that’s very well funded and nimble in that they don’t have a health plan culture established yet, which is typically very bureaucratic and slow moving.

These plans can position themselves to be member-centric from the start and leverage technology to allow more direct interactions under a variety of different sales, marketing and enrollment channels — and also in designing their benefits in a more creative way.

Ride sharing companies [like] Lyft are now permitted to be baked into a Medicare Advantage benefit design. Mobile nursing units, in home visits and virtual monitoring — these are [also] things that are now being packaged and offered in.

These new plans are very well positioned to capitalize on this and leverage those new aspects of what CMS is permitting. 

How do you think these tech-focused startups will disrupt the MA industry?

Right out of the gates, I think it will be like with any other industry: Customer service for seniors when they inquire with some of the newer players will be vastly different than some of the experiences they have with incumbents.

We’re seeing more growth in the MA space with startups than we are with service area expansions among some of the larger players.

I know there are 16 new entrants this Annual Election Period (AEP).

Do new in-home benefits play an important role in this increased interested in the MA space? 

Oh, absolutely. First and foremost, utilization of benefits will increase dramatically when you have in-home monitoring and in-home nurse visits.

When you have an incapacitated beneficiary who has no way of really getting to a doctor’s office or the pharmacy … they’re often reluctant to get things filled or go to the doctor. 

What advice would you have for home-based care companies hoping to get involved with an MA plan?

It’s not unlike how we view winning relationships with Medicare Advantage plans.

It’s those that have a focus on adopting newer technologies to deliver care. Plans need to be willing to make that investment and make sure their members have adequate access to either a computer or an iPad or a cell phone that’s capable of providing some of these in-home monitoring technologies. 

One great thing about MA plans is that they all need to file their plan designs in the middle of the summer. There’s some level of visibility on exactly what these plans are doing and where they’re making their investments.

[Find] the plans that are more innovative in what they’re offering and [are] making some level of technological investment.  

With the telemedicine movement, we’re at the tip of the iceberg with that right now. That’s a huge disruptor in Medicare Advantage because we’re talking about a population that is not as mobile in getting around anymore.

The sky is the limit on how disruptive that can be in the future.

One thing that we’ve heard from bigger players is that it’s hard to offer a slew of new in-home benefits because there’s no additional money to make it happen. Is that less of a problem for these newer startups because they’re starting from scratch?  

Of course.

[Traditional MA plans] have baked in a lot of nonsensical benefits that their populations are accustomed to, even if there’s zero utilization of those benefits. Taking benefits away that the member population is accustomed to seeing can be detrimental.

These larger, incumbent plans are often stuck in the mud with things they’ve piecemealed on over the years.

One big movement is Silver Sneakers, or any gym membership that MA covers. The utilization of those benefits is miniscule but they’re already baked into a lot of these plans.

The other thing is a lot of these larger plans suffer from a culture that doesn’t allow them to move very quickly. The redesign of a benefit program is a Herculean effort for the actuaries and underwriters of a health plan.

Starting from scratch every year to do what’s most attractive to the market is an exercise that’s not always done from a standing start. It’s often templated year after year.

These new plans can read the tea leaves and create a benefit design that strikes a chord with those that are shopping this year.

The post At-Home Care Fueling Disruptive Medicare Advantage Startups appeared first on Home Health Care News.

In our latest episode of Disrupt, Home Health Care News talked to a man who helped develop them both: Dan Trigub. The current head of Uber Health came to the San Francisco-based company last year following a two-year stint at Lyft.

Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.

Today, Trigub — who himself has a background in the home-based care world — says home care is one of his division’s fastest growing verticals.

It’s anyone’s guess where that growth will take the $70 billion publicly traded company in the years to come. But when it comes to the health division, Trigub has his sights set on at least two areas in particular: Medicare Advantage (MA) meal delivery and driving partnerships for caregivers.

You can find Trigub’s conversation with HHCN below, edited for length and clarity.

HHCN: I want to start my diving into your background. This isn’t your first foray into home care — or in combining it with ride-hailing, for that matter. Tell me a little bit about how you got to where you are today.

Trigub: Home care is an area that’s very close to my heart.

My entire family immigrated to the U.S. from the former Soviet Union. My grandmother came here, and she was in her 90s — very ambulatory, in good health for the most part. And I was certainly a caregiver for her, along with my father.

She lived in New York City by herself when she came to the U.S., and she would never, ever leave her apartment, until maybe about once a week or so when my father and I would come visit her from New Jersey.

I always saw how transportation [and] mobility were so important to her well-being and independence — and the power that transportation could have in that equation.

Additionally, my wife’s family has been in the home care business for over 15 years here in the Bay Area. I always saw that industry from afar. I was very entrenched and got to learn a lot about it through [my father-in-law’s] experiences. Because of those experiences, I actually started my own startup in the senior care space.

I had the opportunity to join Lyft about three years ago to help grow and scale their health care operations, with a focus on elder care. Since then, I came here to Uber, where I lead Uber Health.

Since you joined Uber Health, how has that division of the business changed — whether it’s in terms of growth, focus, strategy, going public or anything else?

Even three years ago when I first started at the intersection of ride-hailing and health care, the question was: “What the heck is a ride-share company doing in health care? You’re just taking a millenial to a bar on a Friday night, and that’s what you’re used for.”

But that couldn’t be further from the truth. What Uber Health can do for our aging, low-income, at-risk population is tremendous. Care begins with getting to the care.

When we look at social determinants of health and, now, health plans [doing] everything from meal delivery to grocery delivery to even paying for somebody to go to church or to a social activity, transportation is at the core of all of that.

We really approached this by saying, “What does a $70 billion public technology company need to do to be able to build a health care organization within its structure?”

That came down to making sure we built it right from day one.We had to make sure not only that it was compliant, but that it met the needs of our partners, and I think we’ve done a lot of that.

Uber Health has now been live for over a year. It’s been in development for over two years, and it’s an exciting time for us to continue to grow and scale our business.

You’ve said that Uber has more than 1,000 partners in the health space. Can you tell me how many of those are home-based care providers and where they fit into the equation?

We don’t break down our revenue by any specific segment.

Today … we have many home care partners who see benefits to their day-to-day operations by having us as a solution for them. This certainly is a growing area of focus and a growing vertical within our overall business.

We want good partners. As long as they’re a good standing business, we want to work with them.

Can you highlight any home-based care relationships that you’re especially excited about?

One I love talking about … is an organization called 123 Home Care. 123 Home Care has really leaned into their relationship with Uber Health. They’ve actually created a solution that they call 123 Easy Rides. They have their own website and platform where their customers can go to learn more.

At the core of it, 123 Home Care is not a transportation company. That’s not their core offering, but they’ve seen and embraced how transportation is so important to their customers and their clients.

Another example is 24 Hour Home Care. They’ve really leaned into providing higher levels of service, higher quality care to their customers and leveraging transportation and Uber Health to empower their customers to be more independent … [and] to go where and when they need.

God forbid a caregiver uses their own vehicle [and] gets into an accident. There’s certain insurance they’re required to have, [but] many of them don’t have it. Now they can lean in and leverage Uber Health to allow their caregivers to provide transportation in an Uber vehicle.

Now what about results? Some people doubt that ride-share can make a meaningful impact on addressing social determinants of health like missed medical appointments. For example, a study that came out of Penn Medicine found that ridesharing partnerships didn’t really change the rate of missed medical appointments.

Let’s not forget about caregivers. Caregivers call all the time: “My car broke down. I can’t get to my appointment. I’ve got to cancel. What do I do?”

Now [home-based care providers] can leverage this to help their caregivers be more efficient, be more productive [and] get to their appointments.

The other thing is we’ve seen caregivers can do a much better job. They can sit in the back seat, attend to their client, focus on them and not have to focus on all the headaches that come with vehicle ownership.

That’s just on the caregiver side.

On the flipside with clients, there was just recently a study published by Boston Medical Center, one of our large health system partners. We reduced costs for the hospital and their operations. We reduced no-shows and missed appointments, and we ultimately increased patient satisfaction.

There was that one study that you allude to … but I think it was one small sample, one small data set [and] a population where it might not have made as much sense for them.

But certainly, for our elderly, low-income, at-risk populations I feel confident that transportation is critical.

We’ve talked before about Medicare Advantage and how that’s an area of interest for your team. In fact, you have a dedicated team talking to payers and looking to build partnerships. Can you give us any updates on how developing those partnerships is going?

There’s been a lot of growth and a lot of excitement on the Medicare Advantage side. We haven’t publicly announced any direct partnerships there, but stay tuned.

We’re really excited by MA plans and guidance from CMS pushing for transportation and being able to cover non-emergency medical transportation.

Many MA plans have guidance from CMS around being able to cover grocery and meal delivery, as well. Uber today has the largest meal-delivery platform in the world outside of China with Uber Eats.

We think getting a hot, healthy meal to someone in a food dessert is an area we can lean into with MA plans — as well as commercial payers, where there’s a lot of appetite there as well.

If you had to make a bold prediction for Uber Health a year from now, where will it be?

The possibilities are endless.

We can lean into this platform for health: that includes meal delivery, pharmaceutical delivery and durable medical equipment delivery. Just like Amazon first started with books but now does quite a breadth of services, we started as a ride service but the future is endless.

In the home care vertical specifically, it’s really: How do we also embed those products and services for our home care agencies? They may be interested in looking at things like meal delivery. We’ve seen that.

Then also helping provide better solutions for their caregivers and staff. Caregivers are typically hourly employees who are overworked and underpaid, [so] looking at extra sources of income is really important to them. Are there opportunities to help them become even driver partners on the Uber network? We’ve seen some interest there from our home care partners and network.

The post Uber Health Eyes Meal Delivery, Caregiver-Driving Partnerships appeared first on Home Health Care News.

It’s a point several home care providers are actively tackling through ride-hailing partnerships, especially as potential hospital and health system referral sources prioritize social determinants of health — often the root cause of seniors’ chronic illnesses. Comfort Keepers, 24 Hour Home Care and Right at Home, for example, are among the many industry pioneers that have carved out relationships with Lyft Inc. (Nasdaq: LYFT) and Uber Technologies Inc. (NYSE: UBER).

“For me, there are two big components [to offering transportation], with one being the medical piece and allowing people to access health care and appointments in a much easier way — typically at a lower cost than a taxi or other means of transportation,” Ward, 24 Hour Home Care’s regional director of strategy and partnerships, previously told Home Health Care News. “The second piece is geared toward socialization, helping clients get to religious functions or meet up with friends.”

A new study backed by a handful of well-known organizations is now highlighting just how impactful ride-hailing partnerships can be for home care providers — and the seniors they serve.

Published Monday in the Journal of mHealth, the study was led by USC Center for Body Computing researchers, with involvement from AARP Foundation, UnitedHealthcare and Lyft.

The study’s main goal: to test whether cost-free, on-demand rides truly reduce social isolation and improve medical access for seniors. 

“Older adults with chronic disease lack access to reliable transportation and turn to time-consuming, costly, or high-burden solutions such as relying on family members or government-subsidized shuttle programs, which are often ineffective and unreliable,” Dr. Leslie Saxon, director of the USC Center for Body Computing and principal investor of the study, told HHCN in an email. “Not only is access to medical centers essential, but it is well known that social isolation and other factors impact overall health.”

In total, about 150 English-speaking adults 60 and older from the Los Angeles area participated in the study, using Lyft to schedule rides through both its mobile app and a special call-in feature.

An AARP grant provided three months’ worth of unlimited rides for participants, who also wore wrist-worn activity trackers to monitor daily activity. Researchers additionally asked participants to complete pre- and post-study surveys to help gauge satisfaction, well-being and other characteristics.

Of the 150 or so older adults who participated in the study, 93% used Lyft, with the vast majority doing so through the mobile app, dispelling popularly held beliefs about seniors’ willingness to adopt certain technologies. 

“Participants are willing to adopt novel technology solutions if the benefit is there. This is especially resonant given the subjects were novice app users, previously only using their smartphones for email and web browsing,” Lyft VP of Health Care Megan Callahan told HHCN in an email. “This demonstrates that older populations are willing and capable of adopting new technologies — and Lyft in particular. This is a key finding as Medicare Advantage (MA) plans and [senior care providers] expand their use of Lyft for older adults.”

About 12% of destinations scheduled through Lyft were for medical appointments, with the remainder for errands, entertainment, fitness classes and social visits.

On average, participants scheduled about 70 rides during the study, with the average ride costing about $20.

Difficulty with transportation is linked to as many as 30% of seniors missing doctor appointments, a big factor in U.S. health care economics.

In fact, absenteeism costs the health care industry as much as $150 billion in lost revenue annually, according to previous research from health care technology firm SCI Solutions.

About 90% of study participants reported heightened quality-of-life thanks to increased access to transportation; about two-thirds reported an increase in social visits.

“Access to transportation can be a key factor for people keeping up with medical appointments and social engagements, both of which can be beneficial to overall health as we age,” Steve Warner, UnitedHealthcare’s Medicare Advantage product lead, told HHCN in an email. “That’s one of the reasons we are proud to support this research and also currently offer no-cost transportation options for health care needs through select Medicare Advantage plans.”

Providing transportation services to seniors — specifically those who are MA beneficiaries — will be a driving force in Lyft’s health care business in 2020 and beyond, Callahan reaffirmed.

Lyft currently has MA partnerships with insurers such as Humana Inc. (NYSE: HUNM), Blue Cross Blue Shield and Cigna.

“In addition to partnering with [senior care] providers across the country, as well as technology solutions for older adults like GogoGrandparent, we’re also focused on working with Medicare Advantage plans, including select Blue Cross Blue Shield plans, and Humana MA plans through LogistiCare,” she said. “We actually plan to partner with the majority of MA plans by 2020.”

While the Journal of mHealth study suggests transportation can be a game-changer for seniors’ health and quality of life, others have somewhat dampened expectations.

A 2018 study from Penn Medicine researchers published in JAMA Internal Medicine found that offering a free Lyft ride to Medicaid patients for an upcoming medical appointment did not reduce the rate of missed appointments.

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