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The company plans to expand beyond rides to and from the doctor to into in-home care services
What we think of as health and healthcare has expanded rapidly in just the last few years. No longer is it just the 15 minute face-to-face visit with a doctor, but all the things we do in our lives, from what we eat to how we sleep to our social interactions.
One of the most important of these so-called social determinants of health is transportation, or the ability to actually get to and from the doctor; if people miss their appointments, or put off getting treated, it can lead to worse health outcomes and more expensive care. Luckily, insurance companies have started to actually offer transportation as a benefit. Unfortunately, that system still doesn't work so well, with massive inefficiencies and long wait times.
That's what Joshua Itano saw while working at Alignment Healthcare and it's what led him to found CareCar, a company that uses a marketplace mode to provide healthcare transportation. On Thursday, the company announced a $3 million seed funding round led by Kapor Capital and Impact America Fund, with Concrete Rose participating as a co-investor.
"We were creating these transportation benefits for our patients, because transportation is a real barrier to care for our patient population, especially those in Medicare and Medicaid. We had the solution, we had the benefit, but our partners just really weren't keeping up with how we wanted that experience to work from a patient perspective," he said.
"So, for example, if you’re a patient enrolled in a Medicare plan, you have this benefit, you have to request three days in advance or else you're not going to get service or transport. But sometimes things come up right, you need to see your primary care physician today, you need to go to urgent care, and you have to see a specialists, and that was a no-go with the status quo."
In addition, many existing providers didn't use technology, and there wasn't a lot of oversight and management into what was going on, leading to stories about patients who would sometimes have to wait literally hours to go home from an appointment.
CareCar's solution to these problems is to use a market platform approach, where the company onboards independent nursing assistants and medical assistants, and people with that kind of background, to transport patients to and from the doctor using their own vehicles. The company calls these caregivers its "care partners," and there are 400 of them on the platform right now, who are vetted, not only with standard background checks, but to understand if they have the temperament for this type of work.
"We know that they can provide a really good patient experience, and understand the patients from a holistic healthcare perspective. Those individuals represent the core of our network on our platform because they are the ones encountering these patients day to day," said Itano.
On the patient side, CareCar deals mostly with Medicare and Medicaid patients who have transportation barriers to their care, which are usually due to physiological or socioeconomic issues. That's why the company partners with health plans, who create these benefits and subsidize the cost of these transports, so patients don't have to pay.
Typically patients will make appoints through phone calls, though they can also book through the company's website, where they will connect with a care coordinator who will walk them through what's going to happen. As soon as the request gets into the CareCar system, it is pushed out to the network, whether that’s the same day or the next day, and a caregiver will accept that, and then they'll go to the patient's house to pick them up. They will help them in and out of the residence, that caregiver will also take them to their appointment, and then actually escort them into her physician's office just to make sure that they actually got there okay. When the appointment is done, the patient will either call or send CareCar a text message that they're ready to go home.
In addition the company also has local partners who are fleet owners, such as ambulance companies, who use its software as well, and then it also has integrations into the rideshare partners, like Lyft and Uber. The company will determine if a particular patient needs a care partner, or if they can take a rideshare, depending on their specific needs.
CareCar currently manages supplemental benefits for approximately 150,000 patients in California and North Carolina. The value to them, Itano explained, is they get someone who is reliable and can appropriately take care of their needs.
"Having that market network platform delivery model, we can guarantee that reliability and appropriateness. The ROI for the patient is they can have reliable access, transportation is no longer a barrier, because their health plan decided to contract with CareCar," he said.
Ultimately, though, CareCar's customer is the health plan, as they're the ones who are paying for the services, and part of the company's value is helping capture data that not only helps the patient, but also helps the health plan manage risk better.
For example, there are situations where hospitals will discharge someone who is bedbound, but who doesn't have a caregiver at home. In that situation, CareCar will reach out to the case management team at the health plan so they can coordinate long term care going forward and get help them get in-home support. By getting that patient to long term care, that likely avoids a readmission to the hospital, which can cost anywhere from $3,500 to $4,500 a day.
Another example was a dialysis patient who told CareCar they didn't feel like going in one day. When that became two days, the company let the health plan know, and got someone to do home dialysis with that member over the weekend, which avoided a hospitalization.
"Those are real costs. You can imagine if we do two or three of those a month, the service is almost paying for itself. That's in addition to the fact that the more people who have access to regular care are also going to use less critical high cost services," said Itano.
"Behind the scenes, when the patient is requesting services, we're constantly looking at the data and trying to determine, can we improve a person's health through this data in partnership with the health plan."
CareCar plans to use the funds to grow out the number of Care Partners on the platform; by the end of the year the company plans have close to 750, and roughly 1,000 in the next 12 months. It is also looking into new markets; right now, the service is available in California and North Carolina and the company looking at 13 potential new states to launch in, specifically, Florida, Arizona, and Texas, as those are states with growing senior populations, and high Medicare Advantage penetration.
The company is also planning on expanding its services in the senior homecare sector, and that's a preview of CareCar's long term plan of growing beyond only offering transportation services, but using its Care Partners for in-home care as well.
"When we built our models, we just wanted to over architect the hell out of transportation. That's why we targeted caregivers to be the actual folks delivering those services. After a while, these caregivers, because their natural environment is to do home care, to take care of patients, it just started happening, it was a network effect in and of itself. And we realized we have all these caregivers on our platform, we need to be doing more with them, and they're already doing it by capturing the data that we deliver. What else can we do?" Itano said.
The company realized, through the interactions with the Care Partners and their patients, that there are a lot of gaps in senior care, as they have limitations that prevent them from performing everyday activities such as bathing, self care, making making food for themselves, going grocery shopping. CareCar plans to use its network to help deliver these services efficiently, much like it does now for transportation.
Care Partners can go into the home of these patients and help them for one or two hours a day, which will also assist with the patients who have social isolation. The Care Partners can also check the home for safety issues and they can coordinate some home modification, for example.
The ultimate goal with CareCar, Itano said, is to make sure that every single senior in the US has access to these service through CareCar.
"Any of these things that are non-clinical, that are ancillary to their health, all of those kinds of things I would like CareCar to be there for so that we are the inclusive access to care and support for all these patients."
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