Introducing Uber Health, Removing Transportation as a Barrier to Care
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My cost is $20 per visit for the copay - I guess they bill the insurance company in the same way as if you'd gone into the practice.
$99 is the cost with no insurance; with insurance they bill and you pay your normal copay. $99 is probably less than their average reimbursement.
> That's cheaper than driving and a copay.
If you have really high cost of driving, have poor insurance, or are comparing it to average urgent care copays instead of primary/specialist office visits (IIRC, copays for primary average around $25 and specialist around $40; $60-75 seems improbably high transport cost for most people to drive to a doctor, even with non-free parking), sure. But unless appointment availability is really high, it's going to be higher latency, on average, than urgent care, and in any case it seems necessarily to be less well equipped than most urgent care facilities (meaning you are more likely to need to go somewhere else and be seen after your visit when using it as an urgent care.)
$24 primary, $37 specialist, though that was published last year so it may have crept up a bit (it's been trending slowly upward.) [0]
> You've just got really excellent insurance
$25 is more than my primary care copay. I know I have excellent insurance; I also don't assume everyone else's is like mine. OTOH, you apparently have really crappy insurance and are assuming everyone else does.
[0] http://time.com/money/4044394/average-health-deductible-prem...
Note that, as stated in the article you linked, the percentage of plans with deductibles has gone up significantly (67%). So your average is really a veiled figure - many people won't come close to spending as much as their deductible on healthcare in a year to ever actually pay those prices.
At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care.
That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.
Compared to an urgent care facility, they pretty clearly have to be doing that.
For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere.
It sounds to me like you may be making unjustified assumptions to get to that conclusion. Citation?
I have no horse in this race, but I found it interesting that the above was followed by four “you don’t know…” statements.
You’re making assumptions as well. The person to whom you are responding may know a great deal more than they have revealed.
Maybe the economics work somehow for others, but they didn’t for her (car + gas + parking + large drop in number of patients seen).
> given all the regulation and equipment requirements.
Um, so how does not having a facility, which is probably required to give care, all of the sudden eliminate all of the equipment and regulatory requirements? I mean, don't you think the equipment and the regulation is probably there for a reason..?
It's required for certain levels of care, but not every encounter requires those.
A home visit of a physician is hardly a new concept.
If I'm not mistaken, it's a norm in France, and I know that it functioned that way in the USSR (not sure about the modern Russia). The doctors were indeed complaining about the number of visits but somehow it functioned: while booking a specialist or finding quality equipment was an issue, there was rarely an issue to book a visit of a family doctor within a couple of days' notice, at least in a big city.
Highly dependent on the hospital and provider you have. Modern Russian does have a general government health care for most things, but you can also get private insurance. For the general care, you usually end up going to a local community clinic. For paid insurance, typically you can get a home visit within a few hours from a doctor who does the basics and writes you a doctors note for sick leave. (My experience has been that the sick leave is pretty generous; last time I had the flu I was given a week's rest, then for my follow up the doctor told me to take another 3 days)
It's not perfect for other things, but compared to the health care situation I had when still living in the US, this facet is far better. (at my last job in the US, both Insurance and my Work Place refused to approve sick leave for a summary from my in-network GP that suggested that a treatment required several days of recovery after some radiation therapy. They said I'd have to go to another clinic to have the situation reviewed; the second clinic decided I was fit to work so my choices were either burn vacation days or sign a form to accept time off without pay during recovery.)
It's not "either/or", there is no reason not to have both systems running in parallel. I would have no issue paying a doctor more for him to come visit us at home, to ensure it makes it as profitable for them to do that.
The key points are the “I need help” focus right in the name, and a triage process done by phone.
They’ll deal with sny unforseen event that needs medical attention. It can be a severe pain in the back in the middle of the night or high fever for a kid, anything that is not a regular check-up or renewing a prescription.
Then there’s pre-filtering of the calls to decide if it’s worth it to send someone, or if the patient better come to the office, or straight up call official emergency services.
Price is higher than an usual consultation but not that much, and interestingly it’s also higher than ER in a public hospital, so you have incentives to choose the right service for you.
We end up using it a lot because usually we detect our kid is sick after picking up from school or during week-ends, when normal offices are already closed and there’s no hope to get an appointment.
https://www.motherjones.com/kevin-drum/2013/11/its-doctors-w...
> So the number and composition of residencies is controlled by doctors, even as they’re subsidized by $13 billion in taxpayer money every year. And doctor pay, which almost everywhere is based on Medicare rates, is controlled by doctors. It’s doctors who are directly responsible for both their own high pay and their own low numbers.
https://washingtonmonthly.com/magazine/julyaugust-2013/first...
> The U.S. spends $13 billion a year subsidizing graduate medical education. Yet almost all of this money winds up producing the wrong kinds of doctors in the wrong places, with America’s most elite teaching hospitals being the worst offenders.
Flu is a great example (not judging you, I have no idea how bad it was!) where most people could self care.
Much better is phone doctors & good websites; the NHS have invested heavily in this. You can self-care for many minor things based on online guides, and are then directed to a phone GP for triaging if you need further help.
(example online guide; https://www.nhs.uk/conditions/flu/ what I like about it is that it gives you clear exoectations about self care and when you should feel better, plus clear (and varied) escalation paths for worsened symptoms)
The Heal service was an immense win for our family's situation.
If people paid directly for visits, there’s a built in incentive to reserve doctor visits for when they are actually necessary, rather than the British system of “free” (provided you can jump through enough hoops to actually earn an appointment.)
Using the NHS as a model of “good” health care is laughable. What’s “good” about the NHS is that it’s “free.” It isn’t actually good when it comes to access to care or advanced treatments. Compare cancer death rates of the UK vs the US, for example. The French system where you actually have to pay some money for appointments is far better — you don’t have to wait weeks to visit a GP: I can get pediatrician appointments generally same day. That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses — I am not an idiot, I know how to google. I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value.
Want to better allocate a scarce resource? Make people pay a price that reflects the available supply instead of making it “free” but with convoluted access models.
Well, no. And this is why: https://www.nhs.uk/news/medication/effectiveness-of-tamiflu-...
What I love here is that there is clear, documented information about the choices on offer - and background into why the NHS recommends paracetamol/ibuprofen on its website.
> Compare cancer death rates of the UK vs the US, for example
Okay; looks like they are nearly identical for US, UK, France (105, 107, 109 per 100,000).
> That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses
This is the thing - emotively if your kid is ill it feels like they need a doctor. But likely they just need rest and over-the-counter medications (I've always found the pharmacist to be a good port of call for the right advice here).
If you do need a GP for your kid I have never had any problems getting one; day or night.
> I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value.
In which case, great, but then I think you're not the target for these sorts of initiatives as you are using healthcare appropriately.
With regards to the US, the issue isn't the medical need to see a doctor, it's the bureaucratic need to see one, as you can't get approved for extended sick leave without it.
Such visits (and per this document [1, pg 7-8], many ER visits) are for purely bureaucratic reasons, such as no insurance or no other providers available. I interpret this as largely a workflow issue with regards to the availability of the simple care. A separate style clinic or service dedicated and allowed by Employers/Insurance which deals in low-priority cases for the purpose of documentation (e.g., flu clinics) would solve a lot of these issues, but, as I found out with my previous employer and insurance, flu clinics are "not real doctors", and as such cannot be submitted for sick leave claims.
I think we'd see the numbers for inappropriate/unnecessary visits drop rapidly if Employers/Insurance accepted such documentation more easily/readily.
It goes to show that healthcare is intrinsically linked into so many parts of our daily lives in weird ways.
There's a huge need for in-home care, especially in the aging population. For able bodied humans, going to the doctor's office is a pain but not a particular challenge. For aging, disabled, or mobility-limited individuals, it can be nearly impossible for them to get to a doctors office. Not to mention, an office is full of nasty things that can harm immuno-challenged individuals more than the office visit can benefit.
Telemedicine is a really good start, but there are huge limitations without being able to actually interact with a patient. As more of these types of services popup, it's going to be incredibly beneficial for aging and homebound or almost homebound individuals.
It really exciting to see a whole gamut of services, like Shipt and ClickList, popup. Hopefully in 10 years, aging in place will be more common until the point that individuals actually require frequent assistance or medical attention.
But a subscription service model for those that can afford the highest quality home care for the elderly. Represents a phenomenal startup growth opportunity.
It's super handy for us, having 2 people in our family with illnesses that require regular doctor visits (once or twice a month on average). If it's night time and we need the GP, we don't have to worry about waking up the baby, loading up the kids and nappy bags and everything we need into the car, etc.
We only go and visit our actual family GP if we need prescriptions renewed, or we want to talk to him about a bigger issue or general questions. Eg stuff that isn't urgent, so we don't waste the home-visit GP's time. Then again, the home-visit GPs have told us multiple times that they're happy to come out no matter how small the issue, and they prioritise/triage calls so you're never keeping a more urgent case waiting.
The stories I've seen about employees tracking individual riders lead me to view this skeptically.
There is absolutely no way I would use this service.
Edit: It should also be remembered that Uber hired this driver, the rapist, as a known rapist (a recorded criminal history of being convicted for rape). Uber hired him without caring about his background or past criminal behaviour. Uber hired him with the knowledge that he could well be a rapist, since they declined to do a simple background check, presumably because it would "take too long" and they consider the occasional rape just a part of doing business. The evil behaviour and willful disregard for the safety of their normal Uber passengers - before trying to ruin their lives with deception, theft and lies - makes it 100% impossible to trust them about anything ever again, especially personal health.
#DeleteUber.
Obviously my experience is anecdotal, so I'd be interested to see if similar patterns are true elsewhere. But when there are so few companies competing with each other it seems a lot more likely that there's some sort of regulatory burden or capture in play rather than simple greed. Capitalism might explain why a service with few competitors is expensive but it doesn't explain why there are so few competitors to begin with.
This is literally the endpoint of Capitalism without regulation to prevent monopolies and a floor of public goods. You absolutely should blame it and those who fail to either check or dismantle its power.
Throughout American history, corporations have explicitly undermined and destroyed public transportation so they can profit from it. That’s why things are so bad. First they did it to sell individual cars and now to sell taxi services. Uber’s express ambition is to become the transportation monopoly you decry.
No, they've been doing this since at least railroads, the OG monopolies
We're quickly derailing from my initial point though, that however things got here I think Ubera new service has the potential to relieve a lot of people in a market which I believe is inadequately served at the moment.
What sort of transportation? Are you talking about based on income level? Age? Could you clarify?
But I don’t think that’s what the poster was saying.
Med students get a little grey area on this because their job is to absorb as much info as possible without necessarily providing care, but even they shouldn’t venture outside the census of their supervising physician.
So if any breach occurs, access can be tracked to individuals.
In my country, one programmer who unfortunately lost his newborn daughter to sepsis decided to make a machine learning program to help doctors diagnose the infection early. The software has access to patient data and it recognizes patterns that match the development of sepsis. It decreased the number of severe sepsis cases per month from 1.5 to 0.5 and cut the waiting time before effective treatment was administered by 60%.
People have told me this sort of system would not have been impossible in the USA because of the HIPAA. Is this true?
That said, the company has to make sure that only the people that have a clinical need to access the data have access. So the developers would probably use a de-identified data set to write and test the program. Only the clinicians (care management and disease management nurses) would have access to the identified data so they can contact the patient to offer care.
that said, compliance audits are pretty strict if they are doing it correctly, and not-so-fun. It will be an interesting world when there is a medical-data-firehose pointed at an AI that is looking at all the available med records to do predictive analytics against an entire population....
We are likely a decade from that.
If a company just has data about you that is not medical data then there is no legal requirements as to who can have access to it internally. (So Joe's Sprocket's has a list of everyone who has bought sprockets and their phone numbers - anyone in the company could look at that info and there would be no legal implications)
It’s not a “delay and get people to show up to town hall” sort of issue.
Yet I’ve never heard of a major company fined or punished for HIPAA violations. Have there been any such notable incidents in the past few years?
They lose like 1000x that per year.
One can try to argue that uber is lying about its hipaa compliance efforts in order to save the few hundred thousands that they would be paying Clearwater and in dev costs, and one can counter argue that that accusation has no reliable sources to back it up and is fueled by a desire for internet karma points.
It’s not fixed.
IMHO, that couldn't have been handled better.
And Aug 30 to Nov 21 is very much “months”.
This convo sounds like when folks were jokingly asking Dara the week after he started the job if he had fixed all the problems in the company, made it profitable and ready for IPO yet.
Considering that the timeframe in question would be probationary period for a normal person in a normal job and that the guy was jumping into what was effectively a burning transcontinental train wreck, I'd say getting an investigation completed and disclosed within a few months of his job start date is actually pretty commendable. By comparison, it took like half a year for people to see anything come out of the Holden report, and timeframes for resolution for some historically big scandals in other companies have taken far longer (e.g. the Equifax one is still making news with bigger and bigger impact estimate corrections).
Also, I find it curious that you think Joe Sullivan was made a scapegoat out of convenience, since there isn't a single news article about him complaining of being fired unjustly. You'd think news orgs would be all over such a story.
It's not like Dara walked into a whiteboard in the CEO office that said "list of 2016 suckers lol" and then sat on it twiddling his thumbs for a month. My understanding of the incident is that it had been covered up by Sullivan and TK. In my mind, an investigation is precisely for figuring out what the hell happened, who was affected and to what extent.
I don't know the specific details of this investigation in particular, but for the Holden one, it involved a lot of one-on-one interviews with various employees to try to reconstruct the stories of each harassment claim so that an appropriate punishment/course of action could be determined for each case. If this investigation was conducted in a similar manner, it wouldn't surprise me that finding out the blame would occur in tandem with discovering the extent of the breach.
it's more than 1 month, but "months" is a stretch here
I don't care if they have "strong internal data access controls". They should have had that Day 1, they should never have lied or cheated and they certainly should not ever expect anyone to trust them about anything ever again.
First, I doubt that it's true that they have strong controls. I don't trust organizations that have such a long, clear and bragging history of lying.
Second, that sounds like the Titanic being unsinkable. As if I'm going to trust Uber with personal health data - they are the first group I'd suspect to try to sell that data under the table, the first group I'd expect to abuse the power, and also the first group I'd expect to suffer internal leaks or external hacks.
No way I would trust this given the very recent and abhorrent behaviour of the executives at the company.
Edit: Also this,
> and any user data access need a ticket and a justification before accessing
is not secure. Sounds to me like any user can make a ticket and create any justification they like. This is like the NSA saying "any user of our PRISM system is logged and watched" - but what happens when millions of tickets are going through? Is each one actually being carefully inspected for abuse? If Uber executives are in charge of this decision then no way do I trust it.
My intention here is not to go into details, which would not be appropriate for me as an engineer that doesn’t work on those aspects. I am only saying we care a lot about this.
There are so many alternatives to Uber that are better, safer, and even cheaper that there will never be a need to use Uber and they will never get any trust. The people up-top there have been so thoroughly evil for so long and the damage they have done so great that I have no interest trusting them ever again.
Edit: You downvoters have downvoted me so much I'm no longer allowed to reply or otherwise talk on HN. Goodbye.
There was a time when there was a lot of animosity towards Microsoft, but over the years, younger people that had not been exposed to the drama grew up with a more neutral stance, and many many years of not-really-dramatic developments means that nowadays, people only really think of Microsoft as the company behind MS Office, XBox, etc and not so much about what its ethics framework looks like. Obviously you can still see people referring to it as M$ and similar and making fun on windows users, but it certainly isn't _common_ for average people to outright _hate_ Microsoft on ethical grounds.
Uber, Microsoft, Enron, Blackwater, Comcast, Oracle, all get plenty of hate, even from non techies.
I’m sure there are people at Uber who are fascinated by seeing where celebs take ubers... and can’t blame them.
Here are some juicy stories for you to read if you want to know the details of all the kinds of stupidity and evil it takes to invade someone's privacy like that.
https://www.revealnews.org/article/uber-said-it-protects-you...
So blame was the wrong word...
HEY! In 2016, I worked on the pilot program that was the predecessor of the product. It was just me and an intern finding ways to modify Uber's core dispatch and billing workflows to make workflows like this possible.
The project started attracting interest in the company, and we handed it off to a newly-formed dedicated team for the project. They made it into a fully-fledged, HIPAA-compliant product with a great UX.
I'm absolutely ecstatic that this launched. Although I probably can't answer any questions about the project, since they probably had to rewrite all of my prototype code.
It redirects me to https://www.uber.com/de/newsroom/uber-health/ which gives a 404 error.
God, I hate geo redirects. I wish you could set some "don't do geo based redirects" option in your browser that sites would then respect.
But nah, let's be too clever and offer localized content based on IP! No localized content? Enjoy the 404!
I remember reading in the Google Forum from an American who flew to Kuwait (War contractor?) and when they loaded up Google on their laptop, it's in Arabic. They were furious...
Uber has probably already disrupted that industry in a large way. I'd be quaking in my boots right now if I made my living doing this.
I'm curious what adoption among patients will actually look like. A provider in Philadelphia tried providing their patients with free rides and found that a free ride made absolutely no difference whether patients missed their appointment.
https://www.reuters.com/article/us-health-ridesharing-missed...
https://www.cms.gov/medicare-medicaid-coordination/fraud-pre...
[1] https://www.recode.net/2017/6/7/15754316/uber-executive-indi...
https://www.buzzfeed.com/carolineodonovan/taking-uber-lyft-e...
One of my first thoughts, and one of the risks people couldn’t get over, was if a person isn’t so sick they don’t need an ambulance, why doesn’t a normal Uber work?
The natural assumption is people who have no business getting in a car with someone else would be the ones to use it the most.
- Doctors are incentivized to have fewer cancelations and help get their patients to and from appointments.
- People get to the doctor more often and have better care.
Uber is easy to hate on, but this seems like a societal net-positive. Good for them.
E.g.: http://www.sfparatransit.com/
Trained people who can handle mobility and disability needs.
It’s unclear where the gulf is between people who just book an Uber to go to the doctor (which seems to be all this is, just arranged by the provider themselves instead) and services that have trained professionals transporting people.
Why would anyone trust them in any aspect of healthcare?
If Uber Health can provide affordable transportation services for dialysis patients, it is providing a life changing service that is sorely needed. This is a great idea and I hope that the service succeeds.
Sorry, I am very skeptical when it comes to healthcare offerings.
Anyone have a good article on Uber's attempts to de-bro itself?
What else would you like me to think about with them? (Genuine question).
I'm perfectly happy with Lyft, so I'm not dying to resurrect my account. But that was my main concern as that led to a lot of the other cultural problems they had.
A handful of cities already have UberESPAÑOL. I'm not certain, but I imagine that the healthcare provider's dashboard should be able to request the product if it is available at the pickup location.
https://www.uber.com/drive/san-diego/resources/san-diego-ube...
They'd have to make sure it was free at the point of delivery to the patient. They'd have to have good governance (so, actually doing background checks) and have better training for drivers.
But a non-medical (more normal) conveyance to hospital is probably something many people want.
A whole host of potential liability issues, Uber's favorite thing to avoid.
But this service doesn't seem to be for people who need to be transported so much as for people who need transportation. That is, the target for this service isn't the person who has a medical issue that needs to be addressed in transport. It's for people who need a transport and whose destination happens to be medical in nature. That's why it seems to be marketed primarily to medical providers rather than patients, with the benefit of a reduction in missed appointments and an increase in efficiency.
If there is a new fleet, then, it's likely that the vehicles would have none of the medical equipment that ambulances do. (Though maybe they'd have more leg room, or a stool to help people in, or other minor accessibility considerations.) I'd also expect that drivers would be specially trained in HIPAA, and probably in recognizing imminent life threats so that they could call 911 in case someone was trying to use them as an ambulance.
Apropos of anything else, most if not all states require ambulances to be individually licensed as such, and have a specified minimum complement of equipment including but not limited to oxygen, defibrillators, etc.
They also require the company/agency to have a overarching license to transport patients.
Something tells me, as an EMS provider, that state Departments of Health would likely come down hard on attempts to use (or indeed advertise) this service as such.
> and probably in recognizing imminent life threats
If you're looking at that, you're probably getting to 80 hours of training (most Basic Life Support courses are around 160-200 of practical and classroom training). I can't imagine Uber doing this, or the liability nightmare that could ensue.
And very specifically, if you're talking about wanting to "recognize acute medical emergencies", the half the EMT course I'd be looking at would be exactly the opposite half you mentioned, and more things like "symptoms of acute coronary syndrome", "respiratory distress" and the like. Yes, a non-urgent transport would likely have no need of A&P, etc.
> I'd also expect that drivers would be specially trained ... in recognizing imminent life threats
And trying to consider what that might look like.
http://web1.ctaa.org/webmodules/webarticles/articlefiles/Rur...
The voucher program actually goes direct through hospitals, the hospitals negotiate with transportation providers like Uber (or local taxi companies).
Unfortunately, shit doesn't work like this anymore. Hospitals don't always dispatch transportation out to local taxi companies. For Medicaid, most states have Logisticare which is very much a rent-seeking company paid based on the number of Medicaid subscribers (not runs). This company finds local transportation providers (or ride share services) and dispatches out the patients to them. Their job is to get the taxi companies to blind bid in a race to the bottom.
How do I know this? I part-time drove a couple nights a week for a tiny family owned taxi company that sometimes did voucher runs for a local hospital. They also considered Logisticare but backed off when I told them what it would require and how they'd get pushed into accepting below their usual mileage rate.
Also, Logisticare doesn't give a shit about inspecting the transportation providers, so noncompliance is common since they'll contract with any rando that'll work for dirt. [1][2]
[1] https://www.myajc.com/news/state--regional/pressure-drivers-... [2] https://oig.hhs.gov/oas/reports/region2/21401001.asp