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Saul Marquez:
Hey everybody! Saul Marquez with the HLTH Matters podcast. I want to welcome you to another amazing episode with today’s most amazing health leaders straight from the show floor in Las Vegas, Nevada. This year with the HLTH event, I’ve got the amazing Caitlin Donovan with me from Uber Health. She’s the global health head of Uber Health. She joins Uber most recently from MyOrthos, an orthodontics services organization, where she served as the chief operating officer. Prior to that, Caitlin developed her knack for tackling obstacles to patient care as chief operating officer of circulation and executive vice president of Operations at LogistiCare, now ModivCare, specialty benefit managers in the non-emergency medical transport space. She also served as the Vice President of Operations at CareCentrix with a focus on home health and post-acute care. Early in her career, she worked in finance as an investor at Bain Capital and as a member of the internal consulting group at Summit Partners. She’s an incredible healthcare thought leader and the work that she’s doing to really enable Uber Health to take their business to the next level is extraordinary. So excited to dive into equity, access, and all of the amazing things that Caitlin and the team at Uber Health are up to. So, Caitlin, thank you so much for being with us.
Caitlin Donovan:
Thank you so much for having me.
Saul Marquez:
So we’ve talked a lot about social determinants of health and from food scarcity to getting to the hospital or to your appointments, and so I’m excited to speak with you more about Uber’s role in the continuum of care, but before we do, I’d love to really learn more about you. What inspires your work in healthcare?
Caitlin Donovan:
Sure! When I joined the healthcare industry as an operator for the first time, I never looked back because I think there’s so much good work to be done. So many good people that have the same mission of wanting to help patients and so many inefficiencies in the system. So being in an industry where you can help people and solve really complex and highly regulated problems is where I want to be and really specifically have consistently chosen companies, including Uber Health, that address the needs of both individual patients, but really think about how to use technology process systems to make the work that we’re doing scalable and embedded into the overall ecosystem.
Saul Marquez:
That’s great, thank you for that, Caitlin. And you know, all of us know Uber, we’ve all used Uber, but maybe you haven’t had a chance to think about Uber as part of the entire health system in how we deliver care, so this is a great opportunity to level-set, although many folks that are listening already know. But hey, whether you know or don’t know, today is a great opportunity to dive into what Uber is doing in healthcare. So, Caitlin, talk to us about how Uber is adding value to the healthcare ecosystem.
Caitlin Donovan:
I’m so glad that you said that most of our listeners know and use Uber, I hope the same thing. But like you said, Uber Health is a little bit different. Intended to build on the core competencies of Uber, our marketplace technology that connects you to independent earners that can bring you places or deliver things to you, but apply that to healthcare. And what’s really different about Uber Health is we’re not an app on your phone in your pocket, we’re purposely built as a web-based tool or an API with a care coordinator in mind. And the reason for that is we’re really trying to tackle the needs of a vulnerable population that cannot, won’t, or doesn’t know how to navigate that ecosystem themselves. And we think the best way to do that is to use that provider touchpoint, whether it’s a call center to health plan, a case manager, a discharge planner, a provider’s office, we want to enable those that are in contact with the patients most in need to connect them to care.
Saul Marquez:
I think that’s fantastic. Thank you for clarifying. It’s good to differentiate right between the Uber that we all know in our pocket versus the more integrated provider-facing tool that we’re talking about here. So really globally recognized name, what is the population that the product is appropriate for?
Caitlin Donovan:
We tend to serve a Medicaid population, as you’d expect. Medicaid has had transportation as a covered benefit since 1966. You tend to see relatively high and growing utilization just given the underlying social and economic factors that drive that population. Increasingly, we’re seeing use in the Medicare Advantage population as well. If you think about caring for seniors, aging at home, especially those with complex chronic conditions, you need a lot of logistics, right? You need to bring folks to their appointments to deliver things, whether that’s food or prescriptions, or over-the-counter medications to them. And we’re finding that more and more health plans are looking to enable that with their portfolio of ancillary benefits that they offer. And I think it’s also important to note that while Medicaid and Medicare may seem like the obvious populations to serve, we’re increasingly finding that commercial populations, and especially self-insured employer populations, really should think about addressing these needs as well. A recent study of 5.1 million commercial members found that what we might think of them as stable in their jobs, having access to care, not having the underlying social determinants of health that you see in a traditional Medicaid or Medicare population, they did. 27% lived at 200% of the poverty line or below, that population used preventative services 50% less and saw four times more avoidable admissions. And so we think it’s really important to, yes, play in the well-established Medicaid and Medicare benefits, but also to start thinking about this from a self-insured employer perspective as well.
Saul Marquez:
That’s great, thanks for that invitation, Caitlin. And folks, something to think about, right? As you’re thinking about the plan that you currently deliver to your employees or the members of your organization, it’s worth tapping into options like Uber to deliver some of these things and to deliver patients to their appointments. I think it’s great that you mentioned both taking patients to their appointments but also delivering much-needed medications. Can you give us some examples? Just be great to hear about some of the things that you guys are delivering.
Caitlin Donovan:
Sure, so we have a very flexible platform and bring in partners that allow us to be more specialized in what we do. I think the vast majority of what we do today is on the transportation side and have some wonderful results to share there where, we partnered with Surgo Ventures, for example, in Washington, DC, to run a Rides for Moms program, where we brought patients to their prenatal appointments. And what’s really interesting here is this population had a transportation benefit, they were Medicaid members, but it was really hard for them to access that benefit in the way that it was currently administered. So just by embedding Uber Health at the provider’s office at two federally qualified health centers, we found that 76% reported they wouldn’t have been able to attend their appointment without Uber Health.
Saul Marquez:
Amazing.
Caitlin Donovan:
And if they use it once, they use it 66% of the time, intended to attend one more appointment in the episode of care, which is pretty meaningful in an episode of Care, that’s 7 to 10 appointments long. When we think about what’s next to your point on the delivery side, starting to do very similar work in the maternal health space, when you think about a WIC program. To register for WIC, you have to go in person to an office and then you can get your groceries delivered, right? So thinking about how to make it really easy for a patient who has other things to do, rather than figure out all of the various places they need to go to navigate care, giving them that central hub, that central touchpoint we think is so critically important.
Saul Marquez:
Love that, thank you, Caitlin. So we’re really kind of as an industry all familiar with the way social determinants of health affect access to care. What’s Uber Health’s strategy for addressing social determinants of health and overcoming barriers to care?
Caitlin Donovan:
Great question. I think it’s really easy to hone in on what happens at the individual level, and that’s really important, right? You as a patient know how critically important and candidly scary it is if you don’t know how to get to your care. But what we’ve been thinking about is how do you meet the needs of the individual but make that inherently scalable, and so we’ve been thinking a lot about, how do you design benefits at the health plan level so that our work gets embedded into the ecosystem? And maybe to talk about what we’re doing, it’s helpful to hear an example of where the ecosystem goes wrong today. You know, thinking about social determinants of health, what patients need, I think we all come back to those three words, value-based care that we think solve everything. And what I’ve found in real-life examples is that value-based care alone does not completely align incentives. So to give a concrete example, we were contracted with the care coordinator that was on a value-based care plan. They had that upside-downside risk, were fully incentivized to do the right thing for the patient, not just because it was the right thing to do, but because they were financially incentivized to do so. This particular patient was a dual eligible patient, meaning they were on Medicaid and Medicare and they needed to get to an acute appointment. They had to cross state lines so Medicaid wouldn’t pay for it, this had happened so many times that Medicare wouldn’t pay for it because they’d exhausted their benefit. And so this customer called us and said, what should we do? And we said, well, this is why you’re contracted with us, where your catch-all solution here so that you can get the patient to the care they need. And they said, you know what? We’re not going to do it. The benefit’s exhausted, I bet the health plan will be mad. And so what happened was that patient did have the acute event, they had to call an ambulance. So what would have been a $40 ride, now cost thousands of dollars, not an inpatient stay, right? Wrong thing to do for the patient, wrong thing to do for the system, and value-based care designs alone don’t solve it. We have to think about the benefit structure and preplanning for extensions of benefits to make this scalable.
Saul Marquez:
Yeah, you know, I’m glad that you went there, Caitlin, because it is required, right? All of these things are stitched together. It’s a domino effect, and if we’re not incorporating the benefits part of this, it could be a big miss, like in this example that you mentioned. And even like in California, for example, like this could happen at the county level.
Caitlin Donovan:
Yes, that’s right, that’s right, and honestly, that’s why we think it’s so important to have this provider-facing tool but structure these contracts with payers so that we can design the benefits appropriately, give the right messages to providers, and align the incentives all the way across the ecosystem.
Saul Marquez:
I love it. I love the way you guys are thinking about this. Today, you shared more about Uber Health’s Employer Solutions during the HLTH announcement. Can you share more about how Uber Health is facilitating access to care through these employer solutions?
Caitlin Donovan:
I think it’s really important to borrow what we’ve learned from Medicaid and Medicare. We typically run three distinct programs for care coordinators. One is simple benefit administration, how do you access benefits that your health plan filed? Second is gapping care closures, thinking about how do you if you were discharged from the hospital, get to your seven-day follow-up? How do you go to your breast cancer screening annually? You find that most star measures mean you have to go someplace or get somewhere, which we can be really helpful with. And the third is effective network design. I think most of us have heard at this HLTH conference the value of telehealth, which I completely subscribe to, and we try to make that more valuable by making sure patients can get to their labs in advance to make better use of a telehealth appointment and avoid a potentially duplicative appointment just because their lab results weren’t there. So how does that apply to employers? You know, I used to run call centers and we did not think about the incentives of our employees. We graded them based on their attendance, we didn’t give enough vacation days, and so why would they take a precious vacation day or risk getting a bad grade on their attendance to go to a doctor’s appointment? So, again, using those same lessons, those preventative care programs that benefit design, that effective network design that prioritizes telehealth over a three-hour visit, I think is really critical to addressing those underlying inefficiencies at the employer level.
Saul Marquez:
Yeah, you know, and Caitlin, I’m glad we’re going there because you always have to peel it back a few more layers, right, and understand the why and people’s behaviors. And I think you’re getting to something really important that we all need to be thinking about. It goes beyond just the logistics.
Caitlin Donovan:
I think that’s right. I think that’s right because logistics alone doesn’t solve the problem if you don’t think about the underlying incentives that stitch the system together.
Saul Marquez:
Well, that’s fantastic, and I hope today, folks, in your mind, you’re starting to think about Uber as more than just logistics and transportation. This is a healthcare team that is thinking about the continuum of care, the ins and outs, the benefits. So I want to thank you, Caitlin, for helping ground us in the advancements that you guys have made. Caitlin, as we approach 2024, benefit year, what are Uber Health’s plans for ensuring that people access all of their benefits, not just traditional medical service benefits?
Caitlin Donovan:
I’m so glad that you said that. I think planning ahead matters, especially because most of our customers are already planning for their 2024 benefit year. I think it’s really important to think about the patient holistically. Like we talked about benefit design and the way you administer that really matters when it comes to outcomes, and especially on the Medicare Advantage side, when you think about the changes in star ratings and the high correlation between offering a great food and over the counter medication benefit and its impact on stars, we’re offering the wrong transportation benefit and it’s drag on stars. Thinking about how to address those problems in the right way, from design to administration to patient satisfaction score, will really have an impact both on outcomes and stars for 2024.
Saul Marquez:
Amazing, thank you for rounding out our time together with that. You’ve given us a lot to think about, Caitlin, and folks, I want to make sure you remember that in the show notes of this podcast, you’ll find links to all of the resources and things that we’ve discussed with Caitlin. And with that in mind, Caitlin, I want to welcome you to share a closing thought with the listeners.
Caitlin Donovan:
That’s a great question. There’s too many closing thoughts, but the one I’ll leave you with is, I think, the value of technology embedded in the healthcare ecosystem is you can really have that hyper-specific patient focus and local nuance that you need to address the needs of the individual, which is the backbone of our healthcare system, but make the process scalable and make it work for an entire population versus one-on-one.
Saul Marquez:
Love it, great takeaway there. And the best place that listeners could learn more about you and the business?
Caitlin Donovan:
Come join us at UberHealth.com.
Saul Marquez:
I love it. Thank you, Caitlin, I appreciate your time.
Caitlin Donovan:
Thanks so much.
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