When Imran Cronk began his studies at the University of Pennsylvania, starting a company was the last thing on his mind. But an experience while volunteering in a North Carolina emergency department during his freshman year put a problem in his head that he just couldn’t shake. “One night, this patient was discharged into the waiting area and he told me that he didn’t know how to get home,” Cronk recalled. “He went to the nurse’s station, but they told him that the system couldn’t afford to provide a way for every patient to go home and that he’d have to figure something else out. I asked him what he was going to do and he said he was considering walking. He lived nearly nine miles away. This gentleman was 60–70 years old, off-balance and had blurry vision. No part of this sounded like a good idea.” In the end, Cronk drove the man home himself and the seed of an idea was planted.
It’s a story that emergency physicians know all too well.
“I deal with transportation issues on every shift that I work and it is not uncommon for these issues to increase length of stay up to 8,10 even 12 hours,” said Pat Sinclair, DO, an EM resident in Chicago. “One case I won’t forget was a stable patient with an ectopic pregnancy who needed to be transferred for operative management, but transport via ambulance was delayed because she had three children at bedside and no family who could take care of them.
The ambulance did not have the ability to take the children so the patient sat in the ED for roughly 12 hours while several social workers and different hospital administration got involved. Ultimately, someone from administration drove the kids in their own car to the accepting institution while the patient went in an ambulance.”
“While working at one of our community hospitals in residency, I had a patient with an NSTEMI,” recalled Jeremy Lacocque, DO. “I wanted to transfer him to a hospital about eight miles away that had interventional cardiology, but he refused. He said he would have no way to get home from the other hospital and was tired of being sent places with no way home and would rather go home to his family.” In the end, the man signed out against medical advice despite lengthy conversations with his doctors. “It felt horrible to not be able to do the right thing for him just because he was concerned about transportation,” Lacocque said.
Cronk spent the rest of college digging into the connection between health and transportation. He found that what might feel like an inconvenience during one shift is a manifestation of a deep, far-reaching health system problem. Lack of transportation to and from the hospital has become a social determinant of health, as well as a massive drain on everyone’s bottom line. By one estimate, missed healthcare appointments alone cost the United States $150 billion each year, not to mention the personal health cost of missed or delayed diagnoses and treatment.
Cronk’s curiosity continued, and upon graduation he took a leap and started a company called Ride Health. He and a small team took up residence in a shared office in Manhattan’s Chelsea neighborhood and set about the challenging work of creating a digital health platform that would offer patients free transportation to and from healthcare facilities, at the click of a button.
You’d be forgiven for calling Ride Health – which is now a fully functioning platform delivering hundreds of free rides per day – an Uber for healthcare, but given that the ride hailing behemoth rolled out its own “Uber Health” offering at HIMSS, it’s worth taking a more detailed look under the hood.
At its heart, Ride Health is more of a care coordination platform than a traditional ride hailing service. On the hospital side, the platform allows care coordinators and social workers to set up rides for their patients, regardless of insurance plan or health system. Users create patient profiles that detail where the patient lives as well as their preferred communication method. Not every elderly patient has a smartphone, so Ride Health made sure that the platform would work over a landline.
The type of vehicle needed can range from an Uber (curb-to-curb) to a BLS/ALS ambulance, depending on the patient’s level of need. This information is stored in the system as well. Ride Health communicates ride details with the patient before and after, like Uber or Lyft, but the company takes the added step of communicating with the transportation providers to ensure that patient transportation was successful.
So far so good. Who wouldn’t want to give free rides to patients being discharged from the emergency department? In fact, many hospitals have attempted to address this problem through cab voucher programs or free bus tokens. Anecdotally, these initiatives often end up getting abused by patients and then abandoned by hospital administration, leading to more physician frustration. So the natural question for Ride Health is as obvious as it is essential: How can a free program be sustainable and avoid abuse?
On the financial front, the pitch to hospitals – who end up footing the bill – is simple. By going far up the chain of complexity in the medical transport sector, Ride Health’s platform offers hospitals a way to improve workflows and facilitate all transportation.
Next, the transparency of the platform allows for more efficient care coordination, which leads to cost savings. The rides themselves result in an improved patient experience and improved follow-up attendance, which both improve the bottom line. Finally, Ride Health can show emergency departments a reduction in “left without being seen” because wait times were long and/or no beds were available.
In order to curb abuse, Ride Health developed detailed inclusion criteria. Patients are provided with transportation assistance only when the patient is established in care, has a legitimate need that cannot be fulfilled by a family member, is traveling within the OIG safe harbor guideline of 25 miles, and is not provided “luxury service.”
“Front-line staff needs to have honest conversations with patients about the appropriate use of the service and only provide transportation when all other ready options have been exhausted,” Cronk said. “The issue of going to unauthorized locations can be mitigated through the enforcement of location dictionaries (e.g. the patient can only go to a home address or another facility in the hospital’s network) and real-time GPS tracking of rides.”
Bumps in the Road
As with most startups, it hasn’t all been smooth driving for Imran and his team. There have been false assumptions that required course correction.
“We assumed that hospitals would want patients to be their own point of contact during discharge rides, which would make the activation of such rides easier because there would be no intermediary between patients and drivers,” Cronk said. “However, hospitals have wanted to maintain control over discharge for a variety of reasons — concerns about patients leaving too soon, the inability of patients to receive text messages in facilities with sparse cell coverage within the hospital walls and the general inability of some patients to manage text messaging during an already complex discharge experience.”
Those experiences prompted Ride Health to build in workflows for Clinical Contacts, who would be able to manage interactions with the driver on the patient’s behalf.
“Even though the Clinical Contact workflow is intuitive, it still adds an extra intermediary between the patient and driver that can sometimes create communication issues during the narrow window of a driver arrival and wait,” Cronk said.
Cronk’s fresh perspective – and the way he is tying a social good directly to cost savings – is resonating with the industry. To date Ride Health has deployed with health system, health plan and other healthcare organization customers in 25 states, including partnerships with the American Cancer Society, University of Pennsylvania Health System and Mission Health System.
They’ve been able to show an average no-show reduction of 35% and an average delayed discharge reduction of nine hours. Ride Health has a 95% on-time appointment arrival rate, 99% patient satisfaction and 30% cost savings on a per-ride basis.
Those are strong numbers from a company helmed by a college grad barely old enough to rent a car himself. When asked about his age, and how it’s affected his journey as an entrepreneur, Cronk is circumspect.
“We put a strong value on intellectual humility, on not assuming that we know all the answers. I spend a lot of time speaking with hospital administrators and transportation care coordinators who are 30–50 years older than me,” Cronk said. “I learn so much from them every day. I’m able to take that fresh look into the system from the outside. I listen to them, in an active and thoughtful way, and try to put things together.”
If Ride Health continues its momentum, the next time you have a patient who is struggling to get home from the emergency department, it could be a very different experience.
Imagine, as you’re discussing discharge instructions, you ask, “Do you have a way to get home tonight?”
“Actually I don’t,” the patient responds. “I got dropped off and I don’t have anyone I can call for a ride.”
You tell him not to worry, that you’ve got his transport information and address in front of you on the screen, and a car will be picking him up in 15 minutes. Oh, and by the way, here’s a number you can call if you’re going to have trouble getting a ride to your follow-up appointment. A car can pick you up for that too.
Have a nice night.
Think Ride Health is a good idea, or should be available at your hospital? Let Imran Cronk and team know by sending a note to firstname.lastname@example.org