Healthcare providers are starting to embrace consumer technologies, and Boston has emerged as one of the hubs of experimentation.
The latest example is Circulation, a startup founded last year and partly incubated at Boston Children’s Hospital. The new venture makes software that manages non-emergency medical transportation for patients, primarily those who are elderly, disabled, or low-income. Many of these patients need help getting to and from their appointments, and are often eligible for transportation vouchers paid by Medicare and Medicaid.
Circulation today announced three pilot programs with hospitals and clinics—including Boston Children’s—as well as a partnership with Uber, whose drivers will transport patients to and from healthcare facilities. (More on how Circulation’s service works in a minute.)
The problem they’re trying to solve is this: the federal government spends about $3 billion annually subsidizing patient transportation, yet an estimated 3.6 million Americans miss medical appointments each year because of transportation issues, Circulation says. That results in significant costs for the healthcare system, in part because it increases the odds that patients will miss a crucial check-up and end up being admitted to a hospital.
“It’s not a flashy concept that comes up a ton” in discussions about improving the U.S. healthcare system, says Circulation co-founder John Brownstein, who is the chief innovation officer at Boston Children’s. “But it’s actually one that represents a huge pain point and a huge cost.”
Uber and Circulation aren’t the only companies who see an opportunity here. Lyft, one of Uber’s chief rivals, has rolled out a similar service in partnership with National MedTrans Network. A study published this month in the Journal of the American Medical Association found that the service reduced transportation wait times by 30 percent for Medicare patients at CareMore Health System in southern California, while also reducing average per-ride costs by more than 30 percent. In a press release, CareMore says it’s considering expanding the service to its facilities outside of California.
Meanwhile, Boston Children’s has in recent years put a lot of effort into adopting or helping create new digital technologies, including incubating startups and developing software for devices powered by Amazon’s Alexa voice assistant.
Brownstein is one of the people driving the hospital’s efforts in digital health, by helping revamp in-house innovation programs, striking partnerships with outside companies such as IBM and Rock Health, and launching companies. He also co-founded Epidemico, a population health data company acquired by Booz Allen Hamilton in 2014.
Brownstein is an advisor to Uber on healthcare initiatives. He helped create the UberHealth project in which nurses ride around in Uber vehicles for several hours and administer flu vaccines to interested users of the company’s app.
“That opened up my eyes to this idea that on-demand logistics, as it has taken hold in the consumer realm, really could have a place in the healthcare realm,” Brownstein says.
Circulation will further test that idea. The company’s software acts as the connector between the transportation provider and the hospital or clinic. (Right now, Uber is Circulation’s main partner, but the startup’s technology is capable of working with other transportation providers, Brownstein says.) The software accesses patient medical records and securely stores important data—contact information, health insurance, pertinent health information, and so on.
Circulation enables hospitals to schedule rides for patients as far in advance of the appointment as needed. The software books the ride for the patient, choosing the type of vehicle that best suits his or her needs, such as those that are wheelchair accessible. Circulation’s software also handles billing.
The service can automatically send ride reminders and real-time updates to both patients and their caregivers. Riders don’t need to have a smartphone to use the service, Brownstein says. Reminders and alerts—such as the driver’s estimated pickup time and the vehicle’s make and license plate number—can be relayed to them through a phone call or text message. When the medical visit ends, the patient can book a return ride by sending a text message or making a phone call and referencing a code provided by Circulation, Brownstein says.
Currently, non-emergency medical transportation voucher programs typically pay for patient rides in taxis or private shuttle services, and sometimes public buses, Brownstein says.
But he thinks Circulation’s software can improve the efficiency and reliability of non-emergency medical transportation, while providing a more convenient and higher-quality service to patients. The benefits include providing patients with a more precise estimated pickup time, and the ability for doctors and transportation coordinators to track rides in real time via a software dashboard. In the future, Circulation could also enable patients to fill out medical forms or satisfaction surveys while riding in the car, Brownstein says, helping to save time at the doctor’s office.
“We’re very concerned about patients adhering to their clinical recommendations,” Brownstein says. “The more we can make it a seamless healthcare experience for a patient, the more likely they are to adhere. The patient experience begins with the ride” to the doctor’s office, he says.
Circulation is initially being tested by Boston Children’s,
