Lyft hires VP of healthcare, solidifying its foray into the industry

https://www.fiercehealthcare.com/hospitals-health-systems/healthcare-roundup-lyft-hires-vp-healthcare-advocate-aurora-health-to?mkt_tok=eyJpIjoiTVdGaU5XVmlZelZsTVRNMSIsInQiOiI4Umh2ZWxjOExQVFBIM1RxT2RuRHM5RUFBOGhmUjVncU0zTitQUGtYVjhzd2ltZkpYT05Zd1plUElBNlh5OXlwYWpLeXViM2pxWHJJMVpQbEo5aGpNdklNVFdzaFJLa1B3XC9pejgxTVJGNUJjRng3cHlYUzBiMERDNnE5ODRTXC96In0%3D&mrkid=959610

Lyft car

Ride-hailing service Lyft has hired an executive to lead its expansion into healthcare.

Megan Callahan will join the company as vice president of healthcare, Lyft announced. Callahan, who served most recently as chief strategy officer at Change Healthcare, will lead the strategic direction and growth of Lyft’s healthcare business.

Lyft currently partners with nine health systems and offers healthcare rides in all 50 states and the District of Columbia.

Lyft’s main competitor, Uber, has also launched healthcare-focused initiatives. (Announcement)

Ride-hailing company Uber’s healthcare platform is seeking supporters within the industry to help it expand its reach.

Uber launched the Uber Health dashboard in March, which allows providers to schedule rides for patients and is compliant with the Health Insurance Portability and Accountability Act (HIPAA). The concept was born from the company’s idea to use Uber’s growing influence to improve quality of life beyond commuting to work, said Lauren Steingold, head of strategy at Uber Health.

She said that Uber believes it can play a role in healthcare’s growing interest in home healthcare—helping providers offer more visits in a day—and could supplement nutrition services by delivering food.

More than 100 providers signed on to Uber Health at launch, and the program can be rolled out at any healthcare facility operating in regions where Uber provides its typical services. Steingold said that Uber Health’s growth will rely strongly on word-of-mouth marketing.

“For us, we just need one champion and an organization that gets it,” she said. “If someone believes in what we’re doing, they can champion it and get us over the line.”

Steingold was one of dozens of speakers at U.S. News & World Report’s Healthcare of Tomorrow conference in Washington, D.C., this week.

The healthcare industry is slow to take on new or innovative technology, but having the support of a clinician or a prominent voice within a hospital is what’s driving interest in their platform, she said.

Uber Health allows providers to schedule transportation 30 days in advance and will bill for all rides on a monthly basis. Patients are not billed directly for the rides, and any trips booked through the healthcare dashboard are not linked to that patient’s personal Uber account, if they have one. 

Uber Health is also working to address access gaps that can arise for patients who may not have a cellphone. At present, the dashboard will send a text message to the patient when a ride is booked, providing the driver’s license plate number and car model, along with the time and other meetup information.

For patients who may not have a mobile phone, the providers themselves have to call them and offer those details. That hiccup is something Uber is working to address, Steingold said.

She said the company is also looking to expand its reach into underserved, rural areas, which may lack the public transportation alternatives to help patients get to appointments. Drivers are more likely to make themselves available for rides to and from the doctors’ office as more providers embrace Uber’s tools, as visits are often in the mid-day lull for ride-sharing.

Uber is also working with payers, both public and private, to address coverage concerns. Commercial payers have expressed interest in the dashboard, Steingold said, but regulations governing public programs were written long before Uber was conceieved—and are far harder to navigate.

But ride-sharing is finding its place in the healthcare system, she said. 

“It’s just a matter of time,” Steingold said. 

 

 

New healthcare fraud trends managed care organizations need to watch

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/new-healthcare-fraud-trends-managed-care-organizations-need-watch?GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=17112017

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Even traditional fraud schemes can be difficult to detect, and new methods will only make things more difficult for security teams watching healthcare dollars, says Shimon R. Richmond, special agent in charge at the Miami Regional Office in the Office of Investigations for the Office of the Attorney General.

Richmond gave a presentation on healthcare fraud trends on November 16 at the annual National Healthcare Anti-Fraud Association conference in Orlando, and says hypervigilance is key because obvious red flags are rare.

Where fraud is most prevalent

Richmond says these methods are often based in home health care, personal services, community-based services, and hospice care.

“We see a lot of unnecessary services and billing for services not provided. In the personal care services arena there are a lot of incestuous relationships in terms of who’s providing the care, who’s receiving the care, and who’s billing,” Richmond says. “One really kind of significant theme is pervasive and that’s the overwhelming influence of kickbacks in every area of fraud that we’re seeing.”

Kickbacks can be difficult to detect because this type of fraud often occurs outside of medical systems, he says. Data analytics systems can help, particularly if a system can recognize spikes in billing patterns or from certain providers.

“That’s a red flag. There are those anomalies that we can identify in a proactive manner. But the outside financial arrangements are really something that law enforcement is really only able to get into once we delve into an investigation,” Richmond says.

New fraud trends  

Emerging fraud trends are another challenge when counteracting fraud. It’s difficult to get in front of a new problem that hasn’t been seen before, and the game is always changing, Richmond says.

Recently, Richmond says he has seen an uptick in inappropriate prescriptions for  SUBSYS (fentanyl sublingual spray), which is meant to be prescribed to treat breakthrough pain in cancer patients.

“We’ve seen a huge issue lately where it is being marketed and prescribed to noncancer patients,” Richmond says. “Huge amounts of this drug are being prescribed, but the prescriber is not an oncologist.”

Pharmacies can also be involved in fraudulent activities by searching patient insurance plans to find high-cost prescriptions that can be filled and paid for. The pharmacies then target those consumers to push medications they don’t need, or bill for prescriptions that are never filled.

“A lot of times it’s a bait-and-switch type situation where they’ll do some kind of advertising for a knee brace or some other kind of thing just to get patients to call a number,” Richmond says. Once patients call, they are told the product they were interested in is not available but are offered a more expensive substitute. “There are a lot of marketing companies out there that are acting as lead generators where they are essentially selling to patients the idea of trying out these pains creams or scar creams.”

Hospitals and provider groups in financial distress are also becoming involved in fraud schemes, setting up in-house labs or working with outside labs to generate claims, often for fraudulent genetic testing or urine/drug screens. They may bill for unneeded tests with a kickback, or collect samples that never get tested but are still billed, he says.

Cyber threats and identity theft also continue to be a problem, Richmond says, with a huge spike in the area of telemedicine.

New fraudsters enter the arena

“We are seeing bulk cash transfers, weapons caches, and drug organizations migrating in as they develop their technological abilities and acumen in how to exploit electronic health records,” Richmond says. “This is kind of an evolving threat, and unfortunately, so much of the information is obtainable either online or through an employee that compromises the organization and practice.”

Security teams have to focus on trending information from data on encounters and billing practices, and analyze patterns just to try and keep up.

“I can’t emphasize enough the value of the investments in the analytics and proactive monitoring. That is crucial. Being in the law enforcement arena, a lot of our proactive efforts involve a combination of those analytics and looking for those outliers, or those parts that don’t make sense,” Richmond says. “At the end of the day, it’s all about hypervigilance.