EPISODE 436

Uber’s Growing Role in Healthcare - Dr. Mike Cantor, Chief Medical Officer of Uber Health

12-06-2023

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Derek Apanovitch: Hi, I am Derek Apanovitch welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. It's safe to say that the majority of people listening to this podcast have used Uber as a ride service, and many have also tapped Uber Eats for food delivery. What you might be less familiar with is the Uber Health platform that enables healthcare organizations to arrange rides and services on behalf of patients using a centralized dashboard or an API. Health plans and providers can also use the Uber Health platform to coordinate deliveries of prescriptions, groceries, and over-the-counter items to patient homes.

 

We're going to learn all about Uber Health today and discuss the related issues of social determinants of health, value-based care, and the use of technology in healthcare with my guest, Dr. Mike Cantor, it's chief medical officer. Dr. Cantor is a geriatrician and attorney who has extensive experience designing and implementing value-based care, quality improvement and care management programs for healthcare providers and health plans. He's also CEO of the Cantor Group and consults with value-based care organizations and digital health companies on product strategy, business development and thought leadership. 

Thanks so much for being with us today, Dr. Cantor.

Dr. Mike Cantor: My pleasure, Derek. Thanks for having me.

Derek: Great. Well, I'd like to start with learning more about you and what first got you interested in medicine and specifically geriatrics.

Dr. Cantor: Sure. I grew up in a medical family. My father was a primary care physician, and so I think it's like 10% of physicians have parents who are physicians, which obviously is way more than the average. I grew up at the dinner table hearing about the challenges of taking care of patients from my father's perspective. He had his own solo practice, just him. He was an osteopathic physician, so he also used osteo manipulative therapy, helped people with moving their bones and adjusting their spines and all of that, as well as using more traditional allopathic remedies, medications, tests, and so on.

My mom worked in the office with him, helped to run the office. It's kind of your typical small practice in suburban St. Louis where I grew up. They faced headwinds and barriers, which unfortunately all these years later we're still facing very similar headwinds and barriers in terms of how do you provide the highest quality of care? How do you understand what your patients need? How do you work in a system where the health plans at times don't always seem as supportive of the patients and their families or the providers, physicians and nurses and so on as other parts as they could be. So really, I was hearing about the need for advocacy to improve the healthcare system and the quality of care.

I grew up kind of learning that by osmosis, to turn a phrase, and very much wanted to have an impact in healthcare that was anchored in clinical care, but also allowed me to have a broader perspective and a broader impact. As a primary care physician, my father took care of all kinds of patients. As a family doctor, he would see the kids, the parents, the grandparents, all on the same visit. When I was a medical student, I used to go see patients with him from time to time in his clinic and it was amazing. That model of the typical small practice working in a community, really being part of that community, getting to know the people of that community really impressed me as well as the opportunities to advocate on behalf of patients and families and clinicians when faced with challenges due to the struggles within the healthcare system.

Derek: I guess the focus on geriatrics...everybody has to choose something coming out of medical school. How did you choose that specialty?

Dr. Cantor: I took sort of an unusual path in that I didn't go to medical school alone. I went to a program at the University of Illinois that offered MD plus whatever advanced degree the university offered at the time. I got an MD JD, so I'm a lawyer as well as a physician. When I started my training, I did primary care internal medicine residency at Beth Israel Hospital here in Boston where I am, and then went on to do geriatrics fellowship at Beth Israel and Harvard Medical School. When I started my training, serendipitously, my first attending was Dr. Lewis Lipsitz, who was the head of geriatrics for Beth Israel and also played a very prominent role in the Harvard Division on Aging.

He noticed that I really enjoyed working with older people. He said older people have a lot of problems with decision making -- which was an area where law and medicine intersects that I had been interested in for a long time -- such as advanced care planning and understanding how people make medical decisions. He said from a policy perspective, more generally, the problems of older adults are going to be some of the most important problems facing the healthcare system in the future. So, if you're interested in taking on sort of a generalist field where you can have a broad impact and potentially bring together your medical and legal interests to think about how do we improve decision-making communication coordination, geriatrics is definitely the place you should be.

I listened to him and agreed with him. I did like taking care of older patients. I love the fact that geriatrics, like primary care, is a very holistically-focused specialty. It isn't only about making a diagnosis and treating that diagnosis. It's about understanding the totality of that person's circumstances. Where do they live? Who helps them if they need help? What do they eat? What kinds of exercise do they do? Psychologically are they healthy? It's really not just about ‘diagnose and treat.’ A much broader understanding of health and functional status is really at the core of geriatrics. 

As I went through my three years of internal medicine training, I also had the opportunity in my last year to work with a geriatrician who was studying home health in countries around the world. My father actually had been someone who made house calls, loved making house calls, had to give it up because the insurance companies were paying more for his nurse to make the house call than for him to do it. He had a black bag, which I still carry when I make house calls, and I still do that actually from time to time. So, I really believed that based on my work with Dr. Knight Steele, who was studying home care internationally, that there's an opportunity to learn from other countries and then to take those lessons and imply them to what's happening here in the US.

I spent a year as a geriatrics fellow traveling around the world looking how other countries take care of older adults in the community, so I was focused not on hospitals or nursing homes, but really where do people live and age in place. I was very lucky to meet with a lot of great people around the world and to see different health systems. Again, the core ideas and things I learned at the dining room table were always true. It's always about the patients. It's always about their family and the caregivers. To really understand them, you have to know about their community. A lot of what older adults need isn't so much the complicated technology, but it's really focusing on their values, how they make decisions, and using those medical technologies when necessary to support them in accomplishing their goals for a successful aging.

Derek: Well, fantastic. I appreciate that overview. You've applied all these different skills as a doctor, a geriatrician, legal skills in different environments, different healthcare environments. Maybe talk a little bit about that and then we'll get to Uber Health and how you ended up there.

Dr. Cantor: Yeah, absolutely. The beautiful thing about what I learned at home and what I learned in general internal medicine and geriatrics is that I'm a generalist at heart. I really enjoy studying lots of different things. Obviously, you wouldn't be both physician and lawyer if you didn't like stretching your brain and learning totally different things and holding them in your mind at the same time. I see a lot of what I did as being a translator -- translating from medical into legal, legal into medical -- and more importantly as a clinician, translating for the patients, translating for the family, taking complicated medical ideas and making them understandable, explaining to people what the challenges were that they're facing, what is it that certain diagnosis means, and then collaborating, communicating with them to help make them successful, however they chose to define it.

And so the roles that I took on after I finished my geriatrics training...I worked for a big nursing home here in Boston. We were starting a new health plan, so even as a first year attending, I was part-time medical director. I had a unit of long-term care residents, forty nursing home residents. I was making house calls, I was working in outpatient clinics, so I was lucky to do all these different things. Then I went to work at the VA writing ethics policies for the VA system where the medical legal stuff really came together nicely... informed consent, and Do Not Resuscitate, all of that. Then I worked for a couple of organizations both back here at the Boston Geriatric Research Education and Clinical Center at the VA, setting up a new program of home-based primary care. So, making house calls again, working with remote patient monitoring, comprehensive geriatric assessment clinics, palliative and end-of-life care.

I really learned there how much I enjoyed innovation and the use of technology, actually to drive and support healthcare teams and more importantly, support and help patients. Remote patient monitoring, for example, is someone with heart failure steps on a scale every day and how their weight goes up or down tells you whether or not their heart failure is under control. That can be monitored remotely. We're still using the same technology twenty years later, still trying to figure out how to pay for them. That's the other thing I learned through all of this is it's not enough necessarily to have a good idea. It's not enough to have a great technology. You have to be able to figure out who's going to pay for it, and how are they going to pay for it.

Innovation itself is very exciting to me. Technology is exciting to me, but putting that together and making sure it's clinically relevant and using data to prove its value, that's amazing, especially if there's a business model that will support that technology, that innovation. I've worked for health plans. I've worked for physician organizations. I was chief medical officer for the Physician Network for Tufts Medical Center in Boston. We had 150,000 managed care lives across Medicare and Medicaid. These are programs that pay for insurance for older adults, for people who are less wealthy, for people who are with commercial insurance, who are working people who get their healthcare through their employer, all trying to accomplish higher quality, lower cost, better patient experience. The so-called Triple Aim goals.

I learned about management as someone who had a team with nurses, medical directors, pharmacists, social workers, analysts, quality improvement experts, all of that together. During my time there, we did better and better in our performance, in our contracts. Then I realized that here in Boston we have a stronger tradition of managed care and value-based care, but across the country, it's highly variable. I went to work for a company that focused on managing home health benefits for health plans and learned a lot there and saw how other markets work across the country and got to know people, different health plans around the country. I left there and became the chief medical Officer for Bright Health Plan, which is a new health plan that was focusing on managing the patients by collaborating really closely with the healthcare providers. That was a fantastic experience. 

Since that time, I've been working as a part-time chief Medical Officer for different companies -- Uber Health is obviously one of my main clients -- but really figuring out how to help companies get their clinical services right, what's their clinical strategy, support them with business development, and also support them with activities like this with webinars and podcasts and conferences and panels and blogs and all of that, too.

Derek: Okay. Well, fantastic. Appreciate the context. Of course, most of us know Uber as one of the great technology innovators.

Dr. Cantor: Yes.

Derek: If you're interested in having an impact at scale, there's few organizations that are more scalable, bigger, than Uber these days. It seems like your background's almost perfect for this opportunity in terms of knowing about home health, knowing about health plans. I assume many of your customers at Uber Health may be a little bit more advanced in their years as well in terms of getting transportation. So, it seems like you really bring a lot to the table. What opportunity did you see there when you decided, "I want to check this out," and maybe what's a little different after you've come on board -- either better or maybe tougher -- than you thought it would be?

Dr. Cantor: I had worked with our general manager, Caitlin Donovan, when I was at CareCentrix, a company that manages home health benefits for senior health plans. She's fantastic. The team she's assembled is great. When we started talking and she said, "Oh, I might have an opportunity for a chief medical officer," I thought, fantastic, because as you said, Uber is technologically-driven. Everyone I know, including myself, uses Uber all the time or has used it at least a couple of times. Uber is international, so they're truly a global transportation company. And actually, I would say they're a global logistics company that moves people and they move things.

The people are obvious. You and I get a ride to the airport or to our neighbor’s, to our friend's house, whatever, and they also move things. Uber Eats, which is moving food, whether it's groceries or meals or both from place to place, there's a courier system. Uber actually is already scaled, to your point, has a great technology. As you've noted, lots of older people would benefit from using Uber. Some of them can't drive themselves anymore, but have a hard time using public transportation. Some of them just don't have a car in the first place, never learned how to drive. There are opportunities to think about, are there populations where Uber transportation can make a difference or rideshare could really make a difference? And of course there are.

Turned out Uber is now about five years old. It really started focusing on health systems, helping people get rides home from the hospital. So, it's discharge time, when's your ride going to come pick you up? What happens when you don't have a ride? In the past, what would happen is they'd have what were called taxi vouchers. They work with a local taxi company and they give you a piece of paper and say, "This is worth X dollars. Use this to get home." Well, you have no idea whether that's actually what's happening. It's hard to track that from a management perspective. It's not easy to use from technology perspective. So Uber Health, which is part of Uber as a whole, we focus on the business-to-business area. We work a lot with other businesses, initially with health systems.

I think we have over 4,000 customers today across the United States. We've also expanded to Australia, and there's some companies in Europe and South America where we're talking about expansion as well. We are very much working with health systems and health plans. We're working with small practices in some cases. We're meaning to work with employers. For example, home health agencies who have home health aides that need to go to someone's home and help them with bathing or cleaning or whatever...if they don't have adequate transportation and they lose a shift, it's really hard now because of staffing problems to get that person the help they need.

So, we now provide rides so that there's always transportation available that is easy to use, easy to access, easy to coordinate. That's the other thing that we've done at Uber Health is even though everyone's familiar with the consumer app -- the thing that's on your phone and you order a ride -- Uber Health works through the health system. The care coordinator or discharge planner orders the ride on behalf of the patient who needs that ride. The patient doesn't need to have a smartphone, they don't need to have a credit card or an Uber account. All this can be done on their behalf. We can communicate with them through text messaging or we can use what's called interactive voice response. If they have a landline and phone, we can call and say, "Derek's arriving in his Rolls-Royce in ten minutes. Meet him at this place." And that allows us to overcome some of the digital divide, the gaps in technology that have actually worsened health inequities in some cases in our country.

Uber's already set up as a tremendous potential solution for rideshare. When I got here about two years ago is when we were doing rideshare. As you mentioned at the top of the show, now we're beginning to provide prescription delivery. We're beginning to provide food delivery, groceries, and someday we'll move on to meals as well. We're providing delivery of over-the-counter supplies from the front of the pharmacy -- bandages and acetaminophen and ibuprofen and whatever other non-prescription drugs people need. We're expanding to offer more services in a combined way, and we're also looking beyond just rideshare. Rideshare is one form of what they call non-emergency medical transportation, but people also use wheelchair accessible vans. They're using ambulances, although not for emergency transportation, just to get from one place to another.

What we're doing now is collaborating with a partner that will allow us to offer all of those different forms of non-emergency medical transportation from one place. That's really what we're building. We're building a platform to help clinicians and eventually patients will be able to directly use this themselves or health plan members and caregivers, their family members, so you can go to one place and you can book a ride. Suppose you're coming out of the hospital, you can book a ride home; you can book the medications that you're prescribed within the hospital to be delivered to you that day; you can book post-discharge meals for when you get home; you can book a ride back to your primary care doctor or specialty physician who's following you in five or seven days so that you get the adequate follow-up with your physician and make sure that everything's still going well after your hospitalization; and obviously the worst thing that happens, people get readmitted to the hospital.

This kind of packaged approach has been shown to be helpful in other settings to reducing readmissions. That's one example of where accessing not just one thing at a time, but everything altogether is really, really exciting and makes things much easier for the care coordinators, the clinicians, then ultimately for the patients.

Derek: I appreciate that overview. In the healthcare system, there's providers, there's payers, there's the patients. It sounds like with the providers, you're getting a good response in terms of the 4,000 customers that you're working with on the B2B side. How are the payers responding to all this? Are they getting on board? Are they saying, "Well, show us the study where this is going to financially benefit us." It sounds like a no-brainer, the way you describe it. 

Dr. Cantor: Yes, and yes and yes. Yes, they're getting on board. Yes, they're asking for the data. Yes, they're wondering whether it makes as much sense as it might seem. What's happening on the insurance side -- just to get a little more specific about health plan benefits -- Medicare, which pays predominantly for people over sixty-five and people with disabilities, did not cover transportation until recently when they added something called supplemental benefits, and now I think it's like 80 or 85% of the Medicare Advantage or MA plans now offer this transportation to at least some of their members. They will pay for a certain number of rides, or increasingly they use what's called they call flexible benefits cards. So it's like a credit card. You get X dollars per month or X dollars per quarter, and within that flexible benefit card, it'll pay for anything that's health related. It could pay for the delivery of bandages or it can pay for a ride to your doctor, or it can pay for you needed to have hearing aids

There are all these different things that you can buy that are health-related that are not traditionally part of medical insurance. What we're doing now at Uber is trying to figure out how can we connect, especially as we broaden our services beyond just the rideshare, how are we able to connect with flexible benefits cards? Some of them have what they call wallets within them. You might get $100 a quarter and $25 of them are related to transportation. That $25 is sitting there, and most patients or members don't know they have it. They don't know how much of it they spent.

Through our connections of our platform, which I've already mentioned, is like this two-sided marketplace that brings people together and allows for network effects, which is you go on there to get a ride, then you see, “Oh, I can get my prescription delivered, check.” or “I can do this.” There's an opportunity for both buyers and sellers on that platform to support broader needs than just the initial reason why either one of them went there. If we connect that back to flexible benefits, people can actually get those benefits more easily in a coordinated way and with the benefit that their providers can see what's going on, too. If you're a health plan, yeah, you're skeptical of course about all the supplemental benefits -- not just transportation and prescription delivery and food delivery -- but the other ones like dental and hearing and exercise and all the rest of it.

Those things are always being scrutinized very carefully as well. They actually are very interested right now in figuring out a solution where instead of having twelve different vendors, twelve different companies that they're working with to access these different things, there's one company, even though we're not the vendors necessarily that are dispensing the prescription that we would deliver to you. You can access any pharmacy by the way. It's not just the large chains. We'll deliver from any pharmacy and we can deliver any kind of medication, not just non-opioids, not refrigerated, non-injectables. We have partnerships that allow us to actually deliver all of the medications that you might need. That's something where the health plan is like, ‘this is great’ because we know today that 25 to 35% of prescriptions are what they call abandoned. Even though they're filled and sitting at the pharmacy, they're never picked up.

Well, if you could deliver them, then you know the person got that medication. This happens. There are a lot of barriers, not really within the scope of this discussion, but suffice it to say that transportation is one of them. Not only that, lots of people we've discovered go to pharmacies or grocery stores using their medical flexible spending benefits, let's say, and it's a round trip. Well, if I just deliver those things to you, you can save as much as 40% or even more. Actually, it's more like 60% because you're only using a one-way ride. The courier is coming from the store to your home. And because it's not taking people, they can make multiple stops along the way, so it's cheaper. There are lots of things that health plans like actually, and they love the ability to see what's going on because we share our data.

I mean, as a technology company being data-driven, it's just kind of core to who we are. We can actually share with all of our customers, "This is how many rides you've used. This is where they've gone." 

Derek: There's a lot of transparency.

Dr. Cantor: Exactly. Exactly. Actually that 4,000 of them includes the health plans and others. Health plans are a relatively small number compared to the health systems. But those that are thinking about how do we optimize our supplemental benefits, they're really excited about this. 

Then in Medicaid, which is the federal and state program for people who are lower socioeconomic status, they do have a transportation benefit that often goes underutilized. People end up in the emergency department because they didn't get to the doctor's office. We're helping to improve access to care for people who have difficulty with affording reliable transportation. The Medicaid plans have been very receptive to us.

Then even on the commercial side, which is the working people, they're starting to understand that again, this issue of abandoned prescriptions still sitting at the pharmacy, people not going to the doctor for routine healthcare because the employers are paying for all the healthcare and prevention actually does work...they're beginning to become a bit more interested as well. We're seeing movement broadly across the market, especially as we add more services. That makes us unique. We have competitors that do the rideshare. We have competitors that do grocery delivery. We have competitors that do prescription delivery. But no one really has this kind of platform yet that brings it all together in one place and that provides access to information about what the benefits are and how much is remaining. We're going to make it easier and more efficient and more effective by helping people improve their access to the services they need to stay healthy.

Derek: We talked about Uber being national, international in scope. Does Uber Health work as well in urban, suburban, rural environments and given this broad menu of services, is there special training or hiring that needs to happen in the Uber Health context maybe versus just the standard ride program that Uber has?

Dr. Cantor: Sure. Today, Uber is largely rideshare. It's still the overwhelming majority of what we do because we're just introducing these other delivery kinds of services. We do rideshare the same way for Uber Health that we do for everybody else because we don't want to diminish the driver pool because that's one of the hardest things about rideshare. Because of that too, you'll see that there are way more drivers in urban areas, way more drivers in certain suburban areas, way fewer drivers in rural areas. What we've decided to do to fill the gaps is to actually partner with other organizations that specialize in those areas. For example, we'll work with a rural transportation company, so we'll fill in that hole. Maybe it won't be an Uber driver, maybe it'll be a chair car, which transports wheelchairs that's used by another company.

In fact, like I mentioned, we're building out the whole array of non-emergency medical transportation through partnerships. Same thing with prescription delivery. Our couriers are delivering the overwhelming majority of prescriptions, but our partner can do the opioids and can do the injectables and refrigerated medicines and all of that. What we try to do is start with the core of rideshare or grocery delivery -- we can do all of that with our current courier system -- but where we need more healthcare-specific and healthcare-focused services, we partner with other organizations to be able to do that. That's the thing...because Caitlin and the rest of the leadership team and myself have such broad and deep healthcare experience and healthcare industry experience, we really understand the barriers within the healthcare system that the clinicians, the health systems, the health plans are facing in terms of trying to accomplish today what we call the Quintuple Goals of providing better quality care, doing it at lower cost with excellent patient experience, excellent provider experience and satisfaction and reducing inequities in healthcare.

By using our technology and by having these experiences that we've had over the years and working together, we're really beginning to see a lot of traction and add significant growth over the two years that I've been with the company and the future looks even bigger.

Derek: Uber Health is the platform and then you're plugging in or bolting on partnerships and services.

Dr. Cantor: Exactly.

Derek: Okay. Here's maybe a broader question. We may have touched on some of these themes, but what healthcare stories do you think are not well understood, or maybe they're under-reported based on your experience at Uber Health? You're getting access to data. It's probably anonymous in most cases, but you're still seeing patterns and trends. You're serving probably a different segment of society than maybe hospitals see or private practices see. What's going on out there that the audience should hear about from your perspective at Uber Health, just to stimulate some good thinking and hopefully some problem solving?

Dr. Cantor: We've got real challenges in the healthcare system from top to bottom and all throughout. To me, in my job as a chief medical officer, one of the most important things I do is make sure that the organizations I'm working with are always focused on patients. When you think about what's the experience of the average patient trying to make an appointment, go to that appointment, park, get home from that appointment, it's really hard. It's really hard to do something that in other parts of our lives it's pretty simple to do, like making an appointment. It's pretty easy to go online and book a restaurant reservation. There are twelve different companies that can help you do that. Making an appointment to see a doctor is actually no different, except there'll be only one person who's showing up for that particular interaction. Very few health systems have the transparency or the ability of their doctor's practices to just go online and book it at a time that is convenient to you. Maybe a time that's convenient to the doctor, but not necessarily convenient for you.

We're seeing that using transportation to improve access and convenience makes a big difference. It helps people get to appointments, especially if there are populations like people who are being treated for cancer, so they're getting chemotherapy or radiation, they need frequent visits to be able to get those treatments. We can really help with that kind of use case. People with behavioral health problems -- especially substance use disorders where they're going to a program every day -- we can really help make sure that that happens and the person gets to where they need to go. People on dialysis are getting kidney care three times a week and you know what those three days are, and you know what time it is every week. That's the kind of thing where we do a lot of that kind of transportation because it's just more efficient, more effective for us, and our rides are reliable.

That's the thing too. The platform we use is a platform that most people are familiar with. It's very simple, very intuitive. It also -- just like the program we use in our phones -- you can see where the person is in real time. If you call for a ride to be there at two o'clock and the driver shows up late, or if the patient shows up late, usually in the clinic, you're like scratching your head going, "Where's Mike?" Well, you can actually see, if you've ordered that ride, that Mike's on his way. Mike will be here in twelve minutes. Or, Mike's stuck in traffic. All those things become much more transparent because of the technology that enables that insight into what's happening in real time to that particular patient. I think what we're seeing is that there are ways to make the system work better, more smoothly, at least from a transportation perspective.

To be honest, I knew a little bit about transportation. One of my areas of focus in the past was working with older drivers. This is an area where law and medicine intersects in terms of licensure and liability and all the rest of it. What's really clear is that a lot of older people keep driving when they shouldn't be driving, and Uber could be a great alternative for them. A lot of people don't think they can afford it. In fact, in many cases it’s maybe less expensive than the cost of running a car these days, especially with recent post COVID changes and inflation and all of that. 

We're seeing that this alternative actually turns out to have a really significant impact on people's health because it's addressing access to care. We did a study with Washington DC with two Federally Qualified Community Health Centers and pregnant people. In Washington, DC, even though it's a small city, it turns out there are transportation deserts where it can take an hour on public transportation to get from one side of the city to the clinics. We worked with a partner called Surgo Health. They did the analytics to figure out where were those transportation deserts. We then worked with the community health centers. We transported pregnant people from their homes to the clinic and vice versa. We found that on average, those folks had at least one more prenatal visit compared to people who didn't have access to transportation provided by Uber. It saved about thirty minutes per ride because the person would just get in and go, and not have to do a lot of stops. Especially if you're a young mother and you already have kids, imagine how much easier it is to take an Uber than it's to try and get your kid on the bus or the Metro or whatever. It's really, again, a case where there's a clear healthcare need and value for people showing up frequently and all the time. Uber Health and rideshare actually makes a difference.

Derek: I think we mentioned the concept of value-based care. There's always another article coming out about value-based care, another company being formed. I guess part of that is keeping costs lower, but getting better outcomes. It seems like Uber Health can be part of that. Maybe just take a step back more broadly and talk about value-based care from your perspective and what's most important in terms of society making progress on healthcare costs and outcomes. Any advice you have for the audience and some of our aspiring doctors listening?

Dr. Cantor: Sure. The way that healthcare systems are paid for the United States is what's called fee-for-service. So you showed up, doctor or nurse did their thing, they got paid. Next patient, same thing. The more patients you see, the more procedures you do, the more visits you have, the more you get paid. If you were giving bad quality of care, if you were over-treating people, no problem. You still got paid. Value-based care is actually about moving away from that fee-for-service, show up, get paid, to instead pay you to accomplish healthcare goals and healthcare outcomes, so how much money you make will depend on your ability to manage the health of a population of patients." Let’s take asthma for example. A person with is beginning to have a flare. If the primary care doctor reaches out to them and says, "I see you're in trouble. Come to the office. We'll give you breathing treatment here and see if we can calm this down.” You avoid the emergency department visit, you avoid the hospitalization potentially. And more importantly, having an asthma attack is no fun. If you can break that early and keep people from getting really sick, that's a much better patient experience too. 

Value-based care is really about accomplishing those Quintuple Goals, beginning with better quality, lower cost, better patient experience along with provider satisfaction in reducing inequities.

Uber, because it is helping with access to care, is perfectly aligned with ‘we're going to spend money on a ride.’ So, we'll spend $40 for a round trip on Uber to bring that person to their primary care doctor's office because they're just starting to have an asthma attack or because they haven't had their blood pressure checked or their blood sugar checked in months, instead of going to the emergency room and they get really sick. That's exactly the kind of thing that Uber Health can deliver, literally and figuratively, is help with that. 

When you think about food as medicine, which is a major movement now within the US healthcare system delivering food today, we deliver groceries, soon we're delivering healthy meals, being able to deliver front-of-store things people need to take care of their own wound or a headache or whatever it might be. All that allows people to kind of stay in the home and to get what they need at home. I'm a huge believer that we're always better if we can bring care to the patient instead of bringing the patient to the care. To the extent that we're able to actually use the things that Uber can do as a logistic company to move people and move things in the service of better quality, lower cost, better patient experience, better provider satisfaction, and reducing inequalities, Uber rideshare checks those boxes, Uber prescription delivery checks those boxes, Uber front-of-store, over-the-counter pharmacy, food delivery, all of that meets those goals. In the value-based care system where you can save money by being proactive and preventive and keeping people away from hospitals and emergency rooms, Uber is potentially a really good set of solutions for the healthcare system and ultimately for the patients as well.

Derek: Yeah, that makes sense. You keep the beds free for the most critically ill.

Dr. Cantor: Exactly.

Derek: And your healthcare providers focus on them and then have folks at home in the comfort of their own home handling a lot themselves.

Dr. Cantor: Exactly. Something we're working on now is caregiver support because so many people depend on their families or neighbors or friends to be able to stay where they are and get care in the home and to age in place or live in the community. And so we're now starting to work on some thoughts we have about how to improve access for caregivers. If someone has a health plan covering their ride to the doctor, making sure that it's okay for them to bring their daughter with them, let's say, or their husband or whoever. So, making sure that we can support the family caregivers, community caregivers is another area where we think there's a lot of opportunity for growth and support.

Derek: Fantastic. I think we're coming up on time. I guess last question for us on this podcast, you've carved out a fascinating and impactful career. Any advice for our listeners who are in medical school right now in terms of approaching their career?

Dr. Cantor: Yes. My advice would be to understand that in the past when you finished your medical training, there were two paths: either you stayed in academic medicine and went on to do research or teaching or clinical work or all the above, or you went on into private practice and you hung out your shingle and you took care of patients in a fee-for-service system. Today, the academic path is still there, of course, but the private practice, hang out your shingle path is no longer the same. Most physicians are employed in the United States who are working for large organizations, and many doctors like myself work in nonclinical settings. We work for health plans, we work for healthcare systems as leaders. We work for companies like vendors that are supporting the health system like Uber Health. We work for pharma and life sciences, so we can work in that area. We do biotechnology. 

The career paths for physicians are actually way different and way broader than they used to be. We still need great clinicians, we still want great clinicians, but understanding from a business perspective how you have a career path that incorporates clinical care and being compensated adequately for it and protected legally and all the rest of it, is something that our medical schools still don't prepare us for as physicians. I think it's really important as you go through medical school and your medical training to talk to the physicians, talk to your mentors, not just about "How do I become the best geriatrician," or whatever specialty you choose to pursue, but "How do I have the career where I can make the most difference, even if it isn't 100% clinical?" 

It's really important to know from the beginning that you're not confined to only clinical care. If you choose that path, fantastic. But there are other options if you're interested in doing something different and you don't have to totally give up clinical care. I still make house calls one day a month. Love it. I used to do more work than that, but that's about all I can spare in terms of time these days. There are so many opportunities and options for physicians, and there's very little out there about this. Don't hesitate to reach out to people who you think are doing things that you'd like to do yourself as a physician and learn more because those paths are open and they're only going to expand in the future.

Derek: Dr. Cantor, thanks so much for those words of wisdom. Very helpful. We appreciate it, and we really enjoyed learning more about Uber Health today. I certainly learned a lot myself, and it seems like you and the company are really on to great things.

Dr. Cantor: Yeah, we're doing really well and appreciate the opportunity with you today and to share a little bit of my experience. The world is different. Uber was not a healthcare company five years ago. Who knows five years from now, not just what Uber will be doing, but what other people will be doing to make it easier for people to access care and to accomplish the Quintuple Goals. Thank you so much for this opportunity with you today.

Derek: I'm Derek Apanovitch. Thanks for checking out today's show. Remember to do your part to Raise the Line and strengthen the healthcare system because we're all in this together.