Ken Van Cara (Alacura)

I started with Alacura in 2019. I quickly became fascinated with the medical transport benefits space when I found out how much medical transport costs, particularly air transport. Like so many things in health care, if we have good technology and, let’s face it, being able to move patients quickly and effectively is good technology, we tend to overuse it. The result is that lots and lots of people get moved by rotor, and most don’t believe they have any choice. People end up with bills of multiple tens of thousands of dollars which they end up paying for years, or they end up in medical bankruptcy. That is the problem that I was excited to solve, and ultimately that is what attracted me to Alacura. It is our fundamental belief that patients should have a choice about their care, and they should know what those choices are. Alacura’s thesis is that no patient or their family should have to pay for an incredibly expensive medical service that they don’t need, particularly if they didn’t engage that service or didn’t believe that they had any choice. 

Our goal is to get patients on the right kind of transport, one that supports their clinical needs, that is covered by their benefits if possible, and one that does not leave them with significant unintended financial consequences and debt. 

Richard Lungen (HC9) 

Can you tell us in more detail about how Alacura is solving this problem? 

Ken Van Cara (Alacura)

Alacura engages with the sending hospital and with the patient before a transport happens and before someone has said that they need to be put on a helicopter for a transport that is only a few minutes up the road.  

We talk to that patient, or in some cases their family, about what makes sense for their unique medical situation and needs.  Many times, for instance, a ground transport is faster than an air transport and much cheaper for both patients and health plans.  Our goal is to have that discussion. We engage with the sending hospital and the receiving hospital, making it simpler for the patient and clear that they have a choice about their care, including transport. 

Richard Lungen (HC9) 

I imagine a lot of people don’t know that they have the choice. They also may be wondering what the best choice is. Can you talk a little bit about the outcomes based on those choices, and how Alacura makes sure that people are getting to the right modality of transport that they need at the time? 

Ken Van Cara (Alacura)

At its heart, Alacura is a clinical team that wants to ensure that a patient gets the care and treatment that support their needs. As our nurses and emergency physicians engage with the patient, we review the clinical situation, how the patient is presenting and what mode of transport best serves their needs. 

One of the big myths in transport is that air ambulance is always faster and that faster always produces better outcomes. The reality is that rotor transport is seldom faster under 60 miles, because even though it’s faster in terms of travel time, it’s not necessarily faster bed to bed. Among other things, helicopters are required to follow the FAA rules, including filing flight plans and managing pilot duty times and between shift rest periods, etc. Studies have found that while transport time is shorter, helicopters take an average of 28 minutes longer to arrive.   

But of course, there are situations in which a patient truly needs to be moved without delay, and it does make a difference in treatment outcomes. For true emergencies like an aortic dissection, a massive stroke on the spot, or a cardiac event when you don’t have the required services at the sending facility, air might be the best form of transport.   

Other situations are urgent rather than emergent. Perhaps a child has a badly broken femur, and his growth plates haven’t formed yet. He may need to see a pediatric bone specialist before the break is set. While this needs to happen in a timely fashion, it’s not time sensitive to the degree that minutes make a difference. That patient is a perfect candidate for ground transport if a ground ambulance is available. Our staff of nurses, paramedics and doctors reviews each case and provides decision support on the best transport for the situation.  

I would like to caveat this by saying that if the treating physician believes that immediate transport is necessary to avoid risk to life or limb then they should put them on a transport immediately. But the reality is, again, all transports are time-sensitive, but a great many of them aren’t life and limb emergencies. 

And there is a true cost-saving need here. The average bill for a rotor transport in the U.S. is about $55,000. No one should have to pay $55,000 for transport that they don’t really need. 

Richard Lungen (HC9) 

How does the process work today? Who’s making the decision about air transport? 

Ken Van Cara (Alacura)

Interestingly, most people assume that the ordering physician is writing an order and saying, this patient must go by air. But generally, that’s not what is happening. What the physician is often saying is that they can’t serve this patient effectively at the current hospital and that the patient needs to be moved to a different hospital where they can be served effectively. When Alacura works with the physician, we’re never telling them how to treat the patient, but we are asking, “Does it make sense to use a ground ambulance if they can be moved in a timely manner?”  

And every time but one in my six years here, we’ve had the physician say that it’s fine to use ground as long as we can move them safely and effectively. We’re also finding that hospitals are generally enthusiastic about the support. If you’re talking about moving from a smaller hospital, whether a rural or suburban hospital, to a larger facility that has more services, nine times out of 10, it’s a charge nurse or a social worker that is making the call to try to get this patient transported.  We’re taking that administrative work off the hospital, and they really like that because they can dedicate more time to patient care rather than coordinating logistics. 

Richard Lungen (HC9) 

And from the standpoint of the health plans, obviously, this keeps them from having to bear the cost or if it ends up that it’s not in network. Can you please take a minute to talk about the competitive landscape for Alacura as you see it? 

Ken Van Cara (Alacura)

From a competitive landscape perspective, Alacura is the only company doing what we do today. The market is full of transport providers, but there is an economic incentive in what they do. That’s part of the challenge in air ambulances. If you have a helicopter, you can’t make any money unless you’re flying that helicopter. You need to charge for the sunk cost of owning/maintaining a helicopter.  

Richard Lungen (HC9) 

I’d love to talk a little more about how you do what you do.  Are you a tech company, a service company or a tech-enabled service company? 

Ken Van Cara (Alacura)

Alacura is a tech-enabled service. We’re very clinical in focus, but we have a technology-enabled platform that lets our nurses, our paramedics, and our doctors see the needed information about a patient and transport in real time. They can see the patient condition, presentation, etc., that EMS does, but what’s different about our platform is that it also geolocates for any given hospital and determines the closest and most appropriate facilities with available beds.  

With ambulance service, it’s critical to understand which providers offer which services. The situation may call for basic life support, advanced life support, or specialty transport for patients like NICU babies, and Alacura needs to be able to match the need of the patient with the correct service in a timely manner.  

Our tech-enabled platform puts all of the required information immediately in front of our nurses or paramedics who are supporting transport, as well as in front of our non-clinical transport coordinators who are handling logistics. It’s our tech platform that allows them to make decisions in real time. As I’ve mentioned, while not all transports are emergent, all are time sensitive. A hospital is not going to wait days for a prior authorization on a flight. They’re not going to wait a single day. They’re not going to wait six hours. They’re going to locate a transport provider and be wheels up in minutes. Alacura has to be able to provide another option as quickly as possible because otherwise the patient is going to get moved by whatever mode is most expedient. Our technology enables us to make sure that happens as quickly as possible while at the same time protecting the patient from financial harm.  

Richard Lungen (HC9) 

As we look ahead, what’s next for Alacura?  

Ken Van Cara (Alacura)

I’ll say a couple of things about where Alacura is going next. I think one of the things we realized early on was that you can’t have the healthy utilization of air ambulances unless you’ve got a good network of ground ambulances available as well. So, both air and ground must work. Ground ambulances have been going through a very challenging time.  Ground ambulance has always relied very heavily on volunteer paramedics and volunteer employees. During COVID, lots of ground ambulance technicians, operators and paramedics left and never came back thanks to burn out.  Additionally, the cost of fuel has risen, as have salaries for drivers and clinical staff.  Many small ambulance companies have gone out of business as a result, and that creates a challenge for everyone. 

With that in mind, one of the spaces I see us operating in, in the future, is in treatment in place. Today ground ambulances can only get paid to take you to the ER and our ERs are overrun with folks that have lower acuity conditions or are going to the ER for what amounts to routine care, and that’s because the ambulance paramedic can’t be compensated to treat you or take you to your doctor or urgent care.  For us to reduce the total cost of care, enabling treatment in place or at the appropriate site of care is important. Ambulances actually do a good amount of treatment today, but they don’t get paid for it.  I see us operating in that space where we help ambulance companies to get paid for the work they do in treating patients. It looks like an adjacent space today, but it is really fundamental to making the health care system operate effectively. Hospitals have become much more specialized, and being able to get patients to the right site of care is a huge part of the value proposition. 

Richard Lungen (HC9) 

Thank you, Ken. I have one final question. Why did you choose HC9 as an investor?  

Ken Van Cara (Alacura)

Well, it helps that I know some of your Limited Partners at HC9 really well, but also, you and your team are health care experts.  I really appreciate how well you know the lay of the land, both on the health plan front and on the hospital side. We must serve both of those constituencies, and your team is thoughtful about that.  And you’ve got great relationships. You have created a community amongst the healthcare organizations and teams that they work with that really allow us to easily connect and work strategically on how we make healthcare better. I think that we have a common DNA in that we believe we can make healthcare work better. That is what I like about HC9 in particular.  

About Alacura:

Alacura is a company that specializes in arranging and managing medical transfers for patients, hospitals, and payors. It offers clinical assessments, rapid response, and total benefits management to reduce costs and balance billing.

For more information visit alacura.com