Uber has already disrupted transportation. Now it’s coming for healthcare.
Patient transportation has long been a pain point in the health care sector. About 3.6 million Americans miss or delay medical appointments because of difficulties arranging a ride, amounting to a cost of $150 billion per year. Hospitals traditionally have two options when it comes to arranging non-emergency medical transportation (NEMT) for patients who can’t drive themselves: provide them with taxi vouchers or encourage them to schedule rides with a contracted NEMT company.
But neither of these offers the on-demand amenities of rideshare companies like Uber or Lyft — known in the industry as Transportation Network Companies (TNCs) — including real-time ride tracking, documentation of pickup and drop-off times and locations, easily retrievable payment receipts, the convenience of short wait times amid high driver volume, and often lower costs.
In March 2018, Uber officially launched its Uber Health platform and began partnering directly with healthcare facilities to provide patient rides. Lyft also began offering a similar service via Lyft Concierge.
But their unique features also introduce new risks. To reap the benefits without falling victim to unforeseen exposures, hospital risk managers should consider the following risks and recommendations when it comes to using TNCs for patient transportation:
Using Uber Health or Lyft Concierge is not appropriate for every scenario. If a patient has been under anesthesia, for example, he or she may need a caregiver to travel with them.
“TNC platforms don’t solve for acuity. They aren’t chaperones. If patients need chaperones under traditional transportation options, they’re still going to need chaperones under this option,” said Jeff Duncan, Chief Underwriting Officer, Healthcare Practice, Liberty Mutual Insurance.
A TNC may also not be a good match for patients with mobility challenges or who use wheelchairs.
Noted Njoki Wamiti, VP & Miscellaneous Medical Facilities Product Manager, IronHealth, “There is the loading and unloading exposure since the provider would be the one assisting the patient to the vehicle and securing them in.”
Risk Management Action Items:
“Any time you get into a vehicle, no matter how good the driver is, there are thousands of other people behind the wheel who may not be as skilled,” Duncan said. “The patient is exposed to all the hazards of the road.”
Most state laws mandate that TNCs carry $1 million in auto liability limits, but in the case of a severe accident, “a hospital or other healthcare provider may be vicariously liable for the conduct of the driver because it facilitated that ride,” Wamiti said.
But a driver’s conduct extends beyond how he or she handles a vehicle. As with auto accidents, a hospital can be held vicariously liable for a driver’s hostile or inappropriate actions, such as the abuse or sexual assault of a patient. Given the high profiles of large TNCs, these types of incidents can receive significant media attention.
“Medical malpractice policies may cover claims of sexual abuse, so this is where a claimant may try to trace liability back to the healthcare provider,” Wamiti said.
Risk Management Action Items:
Healthcare-dedicated TNC platforms like Uber Health integrate with hospitals’ electronic health records, pulling patient contact information and medical history to auto-populate specific fields. This integration can create yet another access point for hackers. A breach of these records would violate HIPAA laws and likely result in not only regulatory fines, but also lawsuits claiming negligence.
“Hospitals heavily secure their data, but are they making sure their vendor partners adhere to the same standards?” asked Wamiti.
Risk Management Action Items:
Unauthorized access to medical records is not the only threat to patient privacy and HIPAA compliance. Drivers for TNC healthcare platforms should also not know anything about their passengers’ hospital visits.
“A driver doesn’t know in advance that a requested ride is for a hospital-related visit — which is a benefit, not a bug,” Duncan said. Withholding this information helps TNC platforms maintain HIPAA compliance, but an untrained employee escorting a patient to a vehicle can easily break that confidence by sharing unnecessary details with the driver.
“Mentioning to the driver that a patient was under anesthesia or will need help exiting the vehicle due to such-and-such procedure is an inappropriate disclosure of private information,” Wamiti said.
Risk Management Action Items:
As a first step, healthcare risk managers interested in using TNCs should communicate with their brokers and insurance carriers to ensure they have adequate coverage and the right risk mitigation strategies in place.
When healthcare risk managers buy commercial auto policies from Liberty Mutual and professional and cyber liability policies from Ironshore, a Liberty Mutual Company, “the programs dovetail seamlessly — as does claims management — so clients are better protected,” Wamiti said.
Says Duncan, “Liberty Mutual and Ironshore understand the dynamics of using TNCs for non-emergency medical transport and are prepared to work with risk managers to identify potential exposures so they can take advantage of this new technology.”
To learn more, visit https://lmi.co/healthcare.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.
R&I: What was your first job?
My first job out of undergrad was as an actuarial trainee at Chubb.I was a math major in school, and I think the options for a math major coming out are either a teacher or an actuary, right? Anyway, I was really happy when the opportunity at Chubb presented itself. Fantastic company. I learned a lot there.
R&I: How did you come to work in risk management?
After I went back to get my MBA, I decided I wanted to work in corporate finance. When I was interviewing, one of the opportunities was with Merck. I really liked their mission, and things worked out. Given my background, they thought a good starting job would be in Merck’s risk management group. I started there, rotated through other areas within Merck finance but ultimately came back to the Insurance & Risk Management group. I guess I’m just one of those people who enjoy this type of work.
R&I: What is risk management doing right?
I think the community is doing a good job of promoting education, sharing ideas and advancing knowledge. Opportunities like this help make us all better business partners. We can take these ideas and translate them into actionable solutions to help our companies.
R&I: What could the risk management community be doing a better job of?
I think we have made good advancements in articulating the value proposition of investing in risk management, but much more can be done. Sometimes there is such a focus on delivering immediate value, such as cost savings, that risk management does not get appropriate attention (until something happens). We need to develop better tools that can reinforce that risk management is value-creating and good for operational efficiency, customers and shareholders.
R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?
I’d actually say there hasn’t been as much change as I would have hoped. I think the industry speaks about innovation more often than it does it. To be fair, at Merck we do have key partners that are innovators, but some in the industry are less enthusiastic to consider new approaches. I think there is a real need to find new and relevant solutions for large, complex risks.
R&I: What emerging commercial risk most concerns you?
Cyber risk. While it’s not emerging anymore, it’s evolving, dynamic and deserves the attention it gets. Merck was an early adopter of risk transfer solutions for cyber risk, and we continue to see insurance as an important component of the overall cyber risk management framework. From my perspective, this risk, more than any other, demands continuous forward-thinking to ensure we evolve solutions.
R&I: What’s the biggest challenge you’ve faced in your career?
Sticking with the cyber theme, I’d say navigating through a cyber incident is right up there. In June 2017, Merck experienced a network cyber attack that led to a disruption of its worldwide operations, including manufacturing, research and sales. It was a very challenging environment. And managing the insurance claim that resulted has been extremely complex. But at the same time, I have learned a tremendous amount in terms of how to think about the risk, enterprise resiliency and how to manage through a cyber incident.
R&I: What advice might you give to students or other aspiring risk managers?
Have strong intellectual curiosity. Always be willing to listen and learn. Ask “why?” We deal with a lot of ambiguity in our business, and the more you seek to understand, the better you will be able to apply those learnings toward developing solutions that meet the evolving risk landscape and needs of the business.
R&I: What role does technology play in your company’s approach to risk management?
We’re continuing to look for ways to apply technology. For example, being able to extract and leverage data that resides in our systems to evaluate risk, drive efficiencies and make things like property-value reporting easier. We’re also looking to utilize data visualization tools to help gain insights into our risks.
R&I: What are your goals for the next five to 10 years of your career?
I think, at this time, I would like to continue to learn and grow in the type of work I do and broaden my scope of responsibilities. There are many opportunities to deliver value. I want to continue to focus on becoming a stronger business partner and help enable growth.
R&I: What is your favorite book or movie?
I’d say right now Star Wars is top on my list. It has been magical re-watching and re-living the series I watched as a kid through the eyes of my children.
R&I: What is the riskiest activity you ever engaged in? When I was about 15, I went to a New York Rangers versus Philadelphia Flyers game at the Philadelphia Spectrum. I wore my Rangers jersey. I would not do that again.
R&I: What is it about this work you find most fulfilling or rewarding?
I am passionate about Merck’s mission of saving and improving lives. “Inventing for Life” is Merck’s tagline. It’s funny, but most people don’t associate “inventing” with medicine. But Merck has been inventing medicines and vaccines for many of the world’s most challenging diseases for a long time. It’s amazing to think the products we make can help people fight terrible diseases like cancer. Whatever little bit I can do to help advance that mission is very fulfilling and rewarding.
R&I: What do your friends and family think you do?
Ha! My kids think I make medicine. I guess they think that because I work for Merck. I suppose if even in a small way I can contribute to Merck’s mission of saving and improving lives, I am good with that. &