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Tech startups can save healthcare billions by getting patients to their medical appointments

Certified drivers are needed who know how to deal with a wheelchair user or who has cognitive problems

RoundTrip staff have created an online portal that complies with federal regulations and makes it easy to find, book and track customised rides for patients. No-shows are reported to cost the healthcare industry as much as US$150 billion in lost revenue annually.

New York

AS America's baby boomers are hitting 65 at a rate of 10,000 a day, and healthier lifestyles are keeping them in their homes longer, demand is escalating for a little talked-about - yet critical - healthcare-related job: transporting people to and from non-emergency medical appointments.

"It's going to become a massive phenomena," said Ken Dychtwald, founder and chief executive of Age Wave, a consulting firm specialising in age-related issues. "This is an unmet need that's going to be in the tens of millions of people."

It is no longer enough to call a taxi or regular car service and hope that frail seniors can get in and out - or through the entrance of a doctor's office on their own as the driver speeds off.

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For people requiring oxygen tanks and wheelchairs, it is an even bigger challenge, and long waiting periods are often required to arrange for specially equipped vehicles. Those needing transportation and specialised drivers covered by their insurance often have to wade through another labyrinth of red tape. Many older people require sensitive, skilled or specially certified drivers who know how to deal with someone who is frail, uses a wheelchair or has mild cognitive problems.

"It's more than pick up and drop off," Mr Dychtwald said. As many as 30 per cent of all patients skip doctor appointments, citing transportation as a key reason, according to a report by SCI Solutions, a healthcare technology firm. The no-shows cost the healthcare industry US$150 billion in lost revenue annually, as unused time slots cost a doctor an average of US$200, the report said. Those missed appointments could cost the patient and healthcare system even more in the long term if a mild illness - left unchecked - turns into a chronic or debilitating one. "It could be the difference between catching a disease early on or too late," Jamie Gier, chief marketing officer at SCI Solutions, wrote in a commentary.

Mr Dychtwald called the need "transport care" and said that it was not limited to older people. Recovering drug addicts and cancer, dialysis, physical therapy and low-income patients are among those needing to travel to regular medical appointments.

"With people living and working longer, and advances in health care, it's a need that's not going to go away," said Tom Ailor, president of TenderCare of Virginia, a non-emergency medical transportation firm.

Several technology startups, RoundTrip, Circulation Inc and Kaizen Health, have set up shop over the past two years to address this need. Each created an online portal that complies with federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) and makes it easy to find, book and track customised rides for patients.

Each company partners with healthcare facilities and transportation companies, which match skilled drivers with patients' needs. It even handles the insurance end. Mark Switaj, who founded RoundTrip in early 2017, saw the transport care problem firsthand while working as an emergency medical technician and at other healthcare-related jobs in the mid-Atlantic region for 15 years.

He saw what he called a clunky, layered system that was inefficient and unreliable for doctors and patients. "I saw patients giving up - simply not going to their doctor anymore because they felt the ride was really a burden to them," he said. So he used his healthcare experience and business skills learnt from Boston College and Georgetown University to create RoundTrip, which is based in Philadelphia.

Now, a patient or social worker can log on to the RoundTrip portal and book a ride. The patient receives phone calls or texts, with real-time updates on the status of the ride, which can cost up to 40 per cent less than a taxi voucher, be booked in about a minute and be tracked from start to finish, said Mr Switaj.

He said that the no-show rate for medical facilities using his portal was less than 4 per cent. RoundTrip has 15 healthcare partners, many of which operate in dozens of locations, and 200 transportation organisations in its network in more than 23 states.

Circulation, based in Boston, has grown rapidly since it started in 2016. It partners with 95 healthcare providers (many of which have dozens of locations) in 45 states, up from three facilities in three states in 2016.

John Brownstein, a professor at Harvard Medical School and chief innovation officer at Boston Children's Hospital, came up with the idea for Circulation after the success of Uber Health, another program that he created in 2014.

"We put nurses into Uber vehicles and delivered flu shots to where people were," he said, and people signed up in droves - even those who had never had flu shots before. So, he decided to create a similar programme that would make it easier for people to get transportation to non-emergency medical appointments. Plans are underway to expand Circulation into transporting prescriptions, medical equipment, laboratory collections and other health-related product, he said.

Karen Frazier, 66, of Yorba Linda, California, broke her elbow in May and was unable to drive. But coordinating transportation to and from her physical therapy sessions, about 13 km from her suburban Los Angeles home, was challenging.

"In the suburbs, there is no public transportation whatsoever," she said. "When you don't have access to public transportation, and your spouse is working and your children are no longer home, it's a little difficult to get to your appointments." She now books through RoundTrip. "I'm very, very pleased with how this platform works," she said. NYT