Boston Medical Center sickle cell anemia clinic slashes no-show rate

The Pediatric Hematology Clinic at Boston Medical Center (BMC) offers state-of-the-art diagnosis and treatment of blood disorders, including genetic blood abnormalities such as sickle cell anemia.

The disease requires consistent, preventive care, including 4 or more visits to the clinic a year. For many of the young patients’ caregivers, transportation insecurity has proven to be a real challenge. As an urban safety-net hospital, BMC serves a diverse population that includes a high number of new immigrants with low income and Medicaid insurance. This at-risk population often can’t afford a car, and public transportation can prove quite arduous and time-consuming—especially when traveling with children who are susceptible to infection.

Unfortunately, lack of transportation as an obstacle to care isn’t unique to the BMC clinic and its patients. The importance of transportation is so well established that the American Academy of Pediatrics, in its position statement on managing sickle cell disease in children, recommends that providers discuss transportation with families.

While traditional forms of non-emergency medical transportation (NEMT) exist and may be reimbursable by Medicaid, in practice they can be inconsistent and cumbersome to use. They require preauthorization and booking well ahead of time.

Once the clinic staff learned that Uber Health supported their HIPAA compliance program, enabling them to provide transportation while adhering to the clinic’s strict privacy standards, they were convinced it was an alternative worth testing.

Early in 2019, the clinic rolled out Uber Health to all families currently receiving care for sickle cell disease in its Pediatric Hematology Clinic. To be eligible for the service, families had to screen positive for transportation insecurity in the lead-up to their appointment. They also needed access to a mobile phone or texting plan, as well as their own car seats when needed.

Here’s how the pilot program worked: two days ahead of the appointment, during routine reminder calls, the clinic’s administrative coordinator asked caregivers if they had a way to get to their appointment. If the answer was no, the caregiver was told about the program and given the opportunity to take part. For those interested, a ride with Uber Health was booked for the day of the appointment while the person was still on the line. The admin also entered a note into the electronic health record about whether the Uber trip was offered and accepted (or declined). Return rides were arranged at the end of the patient’s visit.

Among the key figures from the pilot program:

• BMC contacted 86 caregivers about upcoming appointments

• More than half (56%) of those who answered the phone reported transportation insecurity and were connected with Uber Health trips

• All 35 of the patients who took Uber Health showed up to their appointments, and they were more likely to be on time than patients who took other forms of transportation

• Of the patients who reported they didn’t need transportation or who weren’t reachable by phone, the no-show rates were 14% and 17%, respectively

• The average cost of a ride was $60, and the average round-trip distance was 24 miles

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Original research: HealthCity, May, 22, 2019, Our Sickle Cell Anemia Clinic Was Struggling With No-Shows. So We Called an Uber.