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Rideshares Meet Healthcare: 4 Critical Risks to Manage

From HIPAA compliance to cyber breaches and driver screenings, here's what hospital risk managers need to know.
By: | September 27, 2018 • 6 min read

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:

Risk #1: TNCs Aren’t Right for Every Patient

Jeff Duncan, Chief Underwriting Officer, Healthcare Practice, Liberty Mutual Insurance

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:

  • Set internal guidelines dictating when use of a TNC is safe and appropriate.
  • Check professional liability policies for explicit coverage for loading/unloading exposure.

Risk #2: You Can’t Control Driver Skill and Behavior

“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:

  • Ask the TNC how thoroughly and frequently it conducts driver background checks and how it follows up on reports of misconduct.
  • Confirm the TNC has adequate auto liability limits and transfer the risk via a formal contract.
  • Consider buying sexual abuse and molestation coverage.

Risk #3: New Platforms Open Other Access Points for Hackers

Njoki Wamiti, VP & Miscellaneous Medical Facilities Product Manager, IronHealth

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:

  • Verify the TNC’s security and privacy protections and the amount of cyber insurance coverage it carries.
  • Establish a HIPAA-business associate agreement with the TNC.
  • Review your own cyber policy for both first- and third-party coverage.

Risk #4: HIPAA Compliance Gets Harder

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:

  • Use a TNC’s specific healthcare platform if there is one. Regular personal or even business accounts don’t guarantee HIPAA compliance.
  • Train employees to not divulge details of patients’ visits to drivers.

Making it Work with Seamless Coverage and Expert Advice

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.

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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.




Liberty Mutual Insurance offers a wide range of insurance products and services, including general liability, property, commercial automobile, excess casualty and workers compensation.

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]