More Programs Offering Low-Cost, Reliable Transportation for Health Care Visits
The Nation's Health
June 2024
In 2017, executives at Denver Health were tracking a troubling trend. No-show rates were climbing and wait times for Medicaid-brokered cab rides were at times inching toward the two-hour mark. The final straw came when an elderly woman waited nearly seven hours in the hospital’s lobby for a taxi to take her home.
“That’s when I knew we needed to do something different,” said Amy Friedman, MA, chief experience officer at Denver Health, which is Colorado’s primary safety-net institution.
A patient survey found that the missed appointments were largely due to a lack of transportation, which in turn was driving the growing demand and longer wait times for Medicaid and Medicare-funded rides. Many of Denver Health’s patients depend on Medicaid or Medicare, or have no insurance at all, Friedman said, noting that some live in hard-to-navigate housing areas and homeless shelters, and speak languages other than English. Some patients reported having to take four different buses to get to Denver Health for an appointment.
Determined to solve the problem, Friedman reached out to Lyft for assistance. Eager to help, the ride hailing company immediately went to work to develop what is widely praised as the nation’s first platform enabling a hospital system to order rides for patients in need of transportation services.
The safe, affordable and reliable program was an instant hit, with hundreds of rides booked in just the first month. Patients can arrange rides in a variety of ways, such as during discharge planning or simply by telling a nurse or doctor that they do not have anyone to pick them up or take them to an appointment.
Patient assisters arrange rides through the hospital’s proprietary Lyft platform. The cost of rides is completely covered through the Denver Health Foundation, and like most ride hailing programs, drivers typically arrive within five minutes. Many requests come on weekends during pre-dawn hours, when buses are not running.
Across the nation, transportation barriers such as those identified by Denver Health continue to be a leading social determinant of health, impacting everything from access to health care to getting good jobs and obtaining healthy food. Research has shown transportation barriers — including lack of a car or driver and insufficient access to buses and other public transportation — are harmful for both communities and individuals.
A report published in January by the Centers for Disease Control and Prevention showed that nearly 6% of adults in the 2022 National Health Interview Survey lacked reliable transportation for activities associated with daily living, including getting to work, school and health care appointments, and shopping for groceries. The survey showed that people of color, people with low economic status, people with disabilities and people with less than a high school education were disproportionately affected.
Similarly, a 2023 Urban Institute survey found that more than 1 in 5 adults without access to a vehicle and with limited access to public transit were significantly more likely to skip needed care.
Aiming to remove barriers to public transit among low-income residents, Kansas City, Missouri, in 2020 became the first major American city to completely eliminate bus fares. Due to funding concerns, city officials are now considering reinstating fares, but public health researchers at the University of Missouri-Kansas City have asked them to hold off because preliminary data suggest that the absence of fares can improve social determinants of health.
With a grant from the National Institutes of Health, researchers are studying the zero-fare policy’s impact on health, including access to healthy foods and health services.
“We’ve had a lot of transportation policies historically that have harmed people’s health, especially in low-income communities — things like gentrification, bulldozing communities to build highways and things like that,” said Jordan Carlson, PhD, director of community-engaged health research at Children’s Mercy Kansas City. “In this case, we are excited that it’s a policy that has the potential to benefit health.”
Preliminary findings are largely in the form of testimonials from users praising the zero-fare program’s impact on their ability to take their children to doctors or shop for healthy groceries at stores outside of their food deserts, Carlson told The Nation’s Health.
Recognizing that a lack of safe and reliable transportation hinders the ability of people to thrive in their communities, numerous innovative transportation initiatives have emerged in recent years as nonprofit organizations, local and state governments, faith-based organizations and other community partners have entered into partnerships with ride hailing companies such as Lyft and Uber to close transportation gaps.
Public health leaders say the entry of Lyft and Uber into the medical transportation arena has the potential to revolutionize health care by providing a cost-effective alternative.
Even small nonprofits are seeing the benefits of partnering with the ride hailing companies. For example, the Brem Foundation in Silver Spring, Maryland, has gained national recognition for its innovative work to provide under-resourced women with access to quality breast care. Through its Wheels for Women program, Brem partners with Lyft to provide free transportation to and from breast screening and diagnostic exams, ensuring that women have access to vital breast care.
“By targeting transportation barriers, Wheels for Women directly chips away at a significant obstacle to quality breast care for so many in our community who operate without a safety net,” Julia Kepniss, the Brem Foundation’s director of strategy and programming, told The Nation’s Health. “Our partners report that these rides are an important factor, and often the determining factor, in the patient receiving an essential breast exam.”
On a national scale, United Way Worldwide is leveraging the strengths of local United Way agencies across the country, along with its nationwide 211 call centers, to offer Ride United. Launched in 2018, the program, funded primarily through Lyft, provides free Lyft rides to medical services and, in some cases, jobs and schools.
“Unfortunately, despite demand, there is a severe undersupply of accessible and affordable transportation that we know is critically needed to do things like buy healthy food, get to medical appointments, pick up prescriptions and get to work,” said Nicole Cooper, DrPH, MPH, executive vice president and chief strategy and innovation officer at United Way Worldwide.
Ride United is currently available in about 30 states and has provided more than 413,000 rides. In some cases, newly employed people can obtain free rides to work for the first month or so of the job. Like Denver’s program, the drivers are compensated through Lyft for their work and are unaware that they are providing a service to a United Way customer.
“Second to housing and utilities needs, transportation is one of the top unmet needs for 211 clients nationwide,” Cooper told The Nation’s Health. “And that’s very concerning to us. We know that getting to and from various places where you access critical services is not only connected to, but is really vital to, your social and economic well-being.”
[CALL OUT BOX] “We know that getting to and from various places where you access critical services is not only connected to, but is really vital to, your social and economic well-being.”— Nicole Cooper
Similarly, Uber — through its Uber Health initiative — has also grown to become a major provider of free transportation to health care for people in need. Through its network and partnerships, Uber Health aims to empower organizations to reduce health care costs by enabling access to preventive appointments and improving operational efficiencies.
Uber now provides transportation services to more than 3,000 health care customers, including the Mississippi State Department of Health, which is nearing the end of a demonstration phase with Uber Health but plans to procure a long-term contract with the company in July.
Launched in September, the Mississippi State Department of Health’s Transportation to Health program aims to make access to care and prevention services easier for people that need it most by providing free rides to appointments at any of its county health departments.
“All of us who work in health and human services in state government run into the barrier of transportation so very frequently,” said State Health Officer Daniel Edney, MD.
When he stepped into the top leadership role 18 months ago, Edney quickly became concerned over no-show rates, which at one county health department had reached 50%, which meant people were missing health services they needed.
“It was pretty clear very fast that access to transportation for the population we serve in our county heath departments was a huge factor,” Edney told The Nation’s Health.
Edney credits his department’s health equity team for working with Uber to design and implement the popular program, which is currently funded in part by a CDC health equity grant. The need is huge and the program is affordable and sustainable, Edney said, so the department has a plan to continue to fund it even if federal money run out.
“We will handle the money,” he said. “It does no good to provide community-level public health services that people can’t get to.”