VA tries a novel way to ensure veterans get to their medical appointments

The Veterans Health Administration has been working a deal with Uber the ride service to help rural veterans get to their appointments.

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The Veterans Health Administration has been working a deal with Uber, the ride service to help rural veterans get to their appointments. A test has been in place since July at the VA Medical Center in Memphis, Tennessee. Joining the Federal Drive with Tom Temin in studio with more on this and other initiatives she’s working on, the innovation specialist at Memphis, Dr. Indra Sandal.

Interview transcript:

Tom Temin: And you are an innovation specialist at VA and you are part of a cohort of innovation specialists. Let’s talk about that program. Because there’s lots of interesting projects going on, aren’t there?

Indra Sandal: Only 33 VA Medical Centers all across the country is  part of the VHA innovators network. What does that mean? That means that innovation, which we are doing in VA is very cutting edge technology or some new programs, which we are trying to bring it from the outside or from the inside.

Tom Temin: Let’s talk about the Uber program. What is the problem that you were trying to solve? By using Uber to get veterans to the Memphis Medical Center?

Indra Sandal: In 2021, we started working with the Uber Health. So transportation is the largest barrier to health care access to over 5 million veterans living in a rural and urban areas both. Sometimes people think it’s a problem only in the rural area. No, it’s the problem in the urban areas also. 1.8 million missed appointments, which happens every year in the VHA facilities is because of transportation. Some people cannot drive, some people have only one car. We are piloting this program, which we are calling  a VHA Uber Health Connect Initiative in both the urban and the rural areas.

Tom Temin: Right. There’s no taxi cabs in those areas. So why would there be Uber in those areas?

Indra Sandal: That’s true. More than 56% of the veterans living in rural areas are 65 or older. And only 10% has a car and I think  11% doesn’t have a driver’s license, and more than 20 or 25% rely on their family. All these things showed how they can miss that appointment. It’s like every fraction of a second they  miss their appointment. And all these missed appointments cost agency $4.4 billion every year.

Tom Temin: We’re speaking with Dr. Indra Sandal, she’s executive management fellow at the Veterans Health Administration, working out of Memphis, Tennessee. So how has the pilot with Uber Health worked? How does it work? And what have been some of the results that you’ve been able to garner so far?

Indra Sandal: Yes. It’s very, very interesting that when we started it, as you know, it’s a federal government, right, very difficult to bring any technology from the outside. So it took almost more than one year for us to collaborate with the Uber Health to collaborate with the veteran transportation program office.

Tom Temin: So is it VA drivers have the Uber app or is it private drivers? How does it work in practice?

Indra Sandal: So what we did we ask the Uber Health, we want your HIPAA compliant technology. So they integrated their technology in the transportation system, as a result of which we created the centralized dashboard. So each VA has a transportation team. So if we made that centralized dashboard, and mobility manager can schedule the ride on behalf of the veterans, they note a veteran is coming and they need the ride so they can schedule the ride on their monitor, track the ride schedule, the ride, pay the invoices, have 24/7 access for the support system.

Tom Temin: And the ride is provided, by whom? I mean, is it a VA employee driving a vehicle?

Indra Sandal: No, it’s the Uber drivers.

Tom Temin: But what about in those deep rural areas? Are there Uber drivers out there?

Indra Sandal: Yes. so when we started this pilot, we saw this challenge because in the rural area, you are not going to get it. In those areas what they are doing at this time in our nine month pilot we started in January, they do have resources for the transportation as I mentioned from the program office, so they are working very cleverly. So these mobility managers using their resources to go far away and let their buses and the van go and then pick the veterans in the rural area and use the Uber which is available for the close veterans. Uber is providing us the same pool, which you and me use for using the Uber, but the VA has their own drivers which is not related to Uber. Every VA has a budget for the buses.

Tom Temin: Can those buses use the Uber application to understand the routes and the planning to go get the people?

Indra Sandal: They have their own mapping system.

Tom Temin: So basically then, you have adopted Uber Health and made it kind of a taxi dispatch system, only that is HIPAA compliant?

Indra Sandal: HIPAA compliant and also a lot of stuff for the veteran but the other piece which you’re talking about in January, by all these lessons, which we are learning, we are also working with the Uber Health that how we can increase the people who are in that pool of the Uber drivers considering some of the third parties, because there are some third parties also there, which is Uber or Lyft. Beyond that there are people who are only driving in the rural area. Can you bring that network in the Uber network and use that network together to get the people who are in the rural population, so they are working on it. And we are hoping that by next year, we will get that system. So we will have the drivers, real Uber drivers who are only specifically assigned to pick the riders who are living in a rural population.

Tom Temin: Right. So there could be people in the rural population that may not be veterans, but they’ve got that old Chevy citation that still runs. They could monetize that old jalopy to take some veterans into Memphis.

Indra Sandal: Yes, so everything is possible. And that’s why we call this an innovation project. Because the way we are moving, it’s also making sure that during the process, we are learning, we are changing, we are making sure that everything happens. And then we are also testing because you cannot create something from the idea and then say, okay, it’s going to work. Testing and then going.

Tom Temin: And what results have you gotten so far? What is this beginning to produce for you?

Indra Sandal: Yes. And that’s the biggest thing. So we when we started this, the goal was, can we reduce the missed appointment? Can we improve the veteran experience? And can we have some cost saving for the VA hospitals. So keeping in mind those three goals. Till now in nine months in 10 VA Hospitals, we have more than 15,000 rides provided to more than 3000 unique veterans, and almost ran 200,000 miles is used ’til now. And from the missed appointment, we awarded 10,000, missed appointments. And we also saved more than 1000 bed days. And what does that mean? That it made $15 to $17 million cost saving for the VA hospital as such, but the main main thing is for the veteran. So what happened  when veteran has to get the transportation or when they will use the transportation based on their service connected disability, they get the reimbursement. So every veteran they can take their car and file for the reimbursement for their mileage, which they use,  for the gas, anything, but they will get it. So anybody who’s a beneficiary travel eligible veteran will get the money back. But for that, you have to file a claim, you have to do the reimbursement and then you get the money, which is a long process. And it takes some time, three to four months. And in this process, what we did, that veteran doesn’t have to do anything. Mobility manager is scheduling the right for that veteran, and he doesn’t have to pay upfront, you don’t have to file the claim. And you don’t have to do the reimbursement. So it’s like a valet service. And then they come sit, and you don’t need even an app. See, it’s not necessary, you need it, you get the information on your own, and then he will get it and then driver is there. He doesn’t even have to worry in the morning that I have to have the money,, I have to fill the gas or somebody I have to call to go and all the process is almost gone.

Tom Temin: And do the drivers get paid quickly? Or do they have to wait three or four months?

Indra Sandal:
No, the drivers are the Uber drivers. So Uber drivers are paid as they are paid for when they are taking us. But we pay monthly as the invoice which goes from the VA hospital. Veteran doesn’t have to be involved in any of the process. So when people say what is this all about, I say it’s more about not only the process the way we worked together, but it’s basically a value for not only for the VA, but also for the caregivers like the providers, there will be no missed appointment. And the most important thing is for the veterans, and also how we are improving their experience. And for that we also went a step ahead because in the pilot, if we will not come to know the feedback of the veterans, there is no way we can continue. We are asking a 65-year-old veteran to come and sit in the stranger car, how he  will feel secure or safe. We have to make sure about that. So we collaborated with the Veteran Experience Office and asked them to interview these veterans who took the rideshare and ask them how was your experience? And it was so amazing. That 82% said that we are really satisfied. 90% said that we are going to recommend to the other veteran and 85% veterans think if they might have not got this ride share, they might have missed that appointment.

Tom Temin: Dr. Indra Sandal is an executive management fellow with the Veterans Health Administration.


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