Two years ago, John Brownstein, PhD, a Professor at Harvard Medical School and member of the Research Faculty at Boston Children’s Hospital, had an idea to encourage more people to get vaccinated, so he reached out to Uber. After all, the rideshare service was already revolutionizing how people get around, so why not help deliver on-demand flu shots?
In 2014, Uber launched a one-day initiative in four cities called Uber Health in which people could open their Uber app, pick a location, and get a flu shot. The next year, the one-day initiative was done in more than 40 cities. Now, Dr. Brownstein, who continues to serve as healthcare advisor to Uber, has taken the initial kernel of this idea and spun it into its own company—along with the help of three others (see sidebar below). Circulation, which launched in late 2016, is Uber’s preferred healthcare platform partner and is using Uber’s drivers to help people get to any kind of medical appointment. PM360 spoke with Dr. Brownstein about why he started this company and his plans for its future.
PM360: How did this company evolve from your original idea for Uber Health?
Dr. John Brownstein: Uber Health was just one example of the many opportunities in which you can integrate on-demand into healthcare. But it showed that people were more willing to get that intervention, in this case a flu shot, and repeat care if it was super convenient.
That led us to thinking about the broader opportunities in healthcare, and specifically the idea that millions of patients miss their appointments each year due to lack of transportation. So we started building this platform called Circulation, which is essentially an integration of on-demand—like Uber—into health systems and hospitals. It manages the transportation needs of patients to help seamlessly get them to and from their appointments by handling all the ride logistics, including scheduling, messaging to patients and drivers, appropriate eligibility checks and consents, and all backend billing and utilization monitoring. It really improves efficiency and reduces friction for patients.
Can patients schedule rides or are they only made through the hospital’s staff?
The first version of the platform is driven by the health system’s administration, whether it is someone in scheduling, the admin staff, a nurse, or whoever would normally coordinate transportation for patients. Of course, a patient can call to schedule and modify an appointment, and eventually we will have a more patient-facing version, but right now we’re focused on fitting into current workflows.
How does this work on the patient’s end?
From the patient’s perspective, they get confirmation and information about the driver all via text message or voice call. It doesn’t require a smartphone, because half of the patients we’re dealing with don’t necessarily have a smartphone or just are not necessarily technologically advanced. For instance, once the appointment is done and they are ready to be taken home, they just need to enter a code—either via text message or by calling it in—and Uber will already know where to pick them up and drop them off.
You have already completed pilots at Boston Children’s Hospital, Mercy Health System, and Nemours Children’s Health System. Have you learned anything from these pilots about how you may need to adjust the platform?
We’re iterating as we go based on feedback and analytics just like with any software project. But overall, the first statistics coming in show transportation costs dropping dramatically, and very high patient satisfaction. We are also seeing reduced wait times for appointments and a reduction in no show rates.
Are you doing anything with that data separately to help make hospitals or other healthcare companies more efficient?
We’re definitely feeding that information back. Our main mission is to help patients get to their critical appointments, so from a public health perspective we plan to make data available to support the value of this whole on-demand economy and where it fits into healthcare.
On your website, you estimate that 3.6 million patients across the U.S. miss at least one appointment, which equates to millions of dollars lost. How much do you think this platform could help save the healthcare industry?
It’s hard to quantify because of different levels of savings. In terms of just strict transportation costs, you could save about 40% to 50% off the bat. But if you start to reduce no show rates and help get patients to their clinical appointments, then you are potentially helping to reduce the risk of more complicated outcomes for those patients and associated avoidable downstream costs. You can start to see this snowball effect of the different types of outcomes that you can gain by creating more efficiency. Ultimately, billions of dollars could be saved.
Do you have any future aspirations for how this platform can improve healthcare?
One thing I didn’t mention was the discharge component. Some patients are often unnecessarily staying in a hospital for hours and even days beyond what they need because of the difficulty in coordinating rides. Even an hour’s worth of reduced length of hospital stay is helpful to the patient, but it also can save big dollars for hospitals as they try to manage their capacity issues.
John Brownstein didn’t launch Circulation alone. He had help from these three accomplished individuals.
Robin Heffernan, PhD, is VP of Booz Allen Hamilton, who helps lead their commercial health practice. Prior to Booz Allen Hamilton, Robin was CEO of Epidemico (another Robin and John startup focused on population health informatics, which was acquired by Booz) and Co-founder of Predilytics—a predictive health analytics startup recently acquired by Welltok. According to Brownstein, Robin has been “a phenomenal driving force in leading the strategy and operations as Circulation grows.”
Jared Hawkins, PhD, MMSc, is on the Faculty at Boston Children’s Hospital and is Director of its Informatics Innovation Program. Brownstein says, “He is instrumental in driving the technology platform and product development for Circulation.”
Leerom Segal is CEO and Co-founder of Klick Health and “…is a pioneer in digital health who provided the ability to accelerate this from an idea to reality,” says Brownstein.