In health care, innovation has transformed so much that was once a painful, protracted experience. Brain surgery can now be done with beams of radiation instead of knives. Some colonoscopies with the swallow of a vitamin-size, camera-enhanced capsule. Knee replacement without slicing the quadriceps muscle.
But what often remains tortuous, time-consuming, and far from reliable is patient transportation for the underprivileged and the elderly.
For many, getting to a chemotherapy treatment or an appointment with a cardiologist or wound specialist, for instance, is out of their control. They are often dependent on a Medicaid-brokered ride, SEPTA's CCT Connect, or a lift from a relative, friend, or volunteer from a group such as the American Cancer Society. Sometimes, the ride never comes. In all, an estimated 3.6 million Americans miss medical appointments each year because of transportation problems, according to the Community Transportation Association.
On the medical provider's end, it's frustrating or disruptive, especially for hospital social workers, whose mountain of responsibilities include patient transportation. For some, that might mean arranging a dozen or more rides a day, a process that involves many minutes on the phone, often on hold. It also requires tracking down patients who don't arrive, attempting to find out when they might, trying to rearrange physicians' schedules to accommodate them when they finally make it in, and then getting them home. That's in between arranging for hospice care, advanced directives, and other patient needs.
In this cauldron of inefficiency and ineffectiveness, Mark Switaj saw "opportunity to really advance the industry to the 21st century." Given this digitally addicted age, it should come as little surprise that his answer was an app.
The former emergency medical technician has founded RoundTrip, a Philadelphia-based start-up, to "rewrite the playbook" on patient transportation. Its solution after "many months and multiple iterations" is a web-based application by which rides – by sedan, wheelchair van, or nonemergency ambulance – can be scheduled in advance or requested on-demand and tracked.
When first launched in 2016, RoundTrip was a portal that allowed a nurse, social worker, or care manager to log in and order a ride. Last May, at the request of hospitals interested in rideshare options, RoundTrip integrated with the Lyft system, enabling "a different user experience" from one made through the Lyft app that the general population uses.
"That driver [secured through RoundTrip] may need to provide a little more TLC or assistance to that rider, that driver may need to wait a little bit longer in order to get to that patient who's maybe frail or elderly," Switaj said, adding that Lyft now accounts for about 50 percent of RoundTrip rides.
The collaboration is "really important for us as a business. We want to make health care more accessible … want to drive down health-care costs," said Andrew Woolf, general manager of Lyft in Pennsylvania. Although the company has so-called nonemergency medical transportation relationships with many providers, insurers, and transportation brokers nationwide, including Blue Cross Blue Shield, RoundTrip is Lyft's first such partner in Philadelphia.
"This is an area of transportation innovation that is going to continue to grow," Woolf said.
Hospitals played a big part in the design of RoundTrip, said Switaj, the company's chief executive, as did his personal experience as an EMT and director of sales with American Medical Response, a national ambulance-services company based in Colorado.
"The coolest experience I think in this whole project was building something with hospitals that would provide real value to them and then turning those hospitals into our first clients," Switaj said.
Locally, those who have signed on are Nemours Alfred I. duPont Hospital for Children in Wilmington, MD Anderson Cancer Center at Cooper in Camden, Jefferson University Sidney Kimmel Cancer Center in Philadelphia, and Crozer-Keystone Health Systems, based in Chester. Nationally, RoundTrip is doing business in 12 states.
On track to reach $1 million in revenue this year, the company of 24 full-time equivalents expects to be profitable by late 2019 and be "coast-to-coast" by 2020, Switaj said. RoundTrip makes money by charging a booking fee for every ride arranged through its app.
Although he would not provide specific ride data, Switaj said volume is growing by 30 percent to 40 percent month-over-month. By the end of March, more trips will have been completed this year than in all of last year, he said.
"That's really encouraging for us," Switaj said.
So is the $1.9 million raised in a recently completed seed round, including an undisclosed amount from Johns Hopkins University and $250,000 from Ben Franklin Technology Partners of Southeastern Pennsylvania. There, Switaj found an informed and empathetic audience in Jennifer Hartt, Ben Franklin's director of investments for health and digital health. She is a former EMT with considerable experience with nonemergency patient transportation.
"There is a lot of inefficiency in the system," Hartt said in a recent interview. "I firsthand saw it for 10 years."
She called RoundTrip "an elegant solution … tapping into an area no one is serving" well. Ben Franklin's support, she said, is the result of a shift from investing in life sciences to health and digital health, made about three years ago.
"It was really out of true need and the desire to have social impact and health-care economic impact," Hartt said.
Lisa McLaughlin, an oncology social worker at MD Anderson Cancer Center at Cooper, credits RoundTrip with her professional survival and her sanity, enabling her to schedule 100 patient transport rides one recent month when the hospital was down one social worker.
"Trying to do that [the old telephone-based way] would have been absolutely impossible," McLaughlin said, and an obstacle to everything else she's supposed to do in her job. "I'm not the transportation lady, I'm the social worker."
The first question all entrepreneurs are urged to ask themselves before they go out and start a business is, "Is there a market for the product or service you have in mind?"
The answer is a resounding yes, Switaj said, citing estimates of $8 billion to $13 billion for the medical transportation industry. There's also lots of competition, including Uber Health, a dashboard launched last month that lets providers schedule rides for patients.
"Frankly, there's a lot of opportunity out there for us and others," he said. "I want to try and capture as much of it as quickly as possible. … I think we're tapping into it at the right time."
The average rate of transportation-related missed appointments is 17 percent, Switaj said. With RoundTrip, it's under 4 percent, he said.
"We have, through a level of coordination and the use of technology, been able to improve the number of connections between a rider and the driver and thus, by getting those folks to the vehicle, they're getting to their appointment, getting to betterment of health," Switaj said. "From an outcomes basis, they're not going to an emergency department."
Talks are underway for health plans to cover rides for their insureds, Switaj said.
For now, at least, competition is not other companies offering a similar service, he said.
"Our biggest competition," Switaj said, "is the telephone."