The Payments RX For Health Care No-Shows

Patient no-shows are a serious problem – for the patient who does not get necessary care, and the provider who loses revenue.  Transportation is a point of friction for the relatively less well off and the elderly. Getting patients where they need to go – by matching them to rides — is Hitch Health’s prescription, as interim CEO Susan Jepson tells PYMNTS’ Karen Webster in our latest Matchmakers.

Any business would hit a speed bump – not to mention a revenue bump and a profit bump – when customers don’t show up.

How about a business where the no-show rate is 15 or 30 percent? The ripple effects can be outsized.

Especially when it’s a matter of life or death – or, at the very least, the difference between, literally, sickness and health.

So it is with health care, where the business model is predicated on patients showing up. On the one hand, they get the treatment they need. On the other hand, the health care provider – from the individual practitioner to the clinic – gets revenue and income. Both sides of the relationship benefit, naturally.

But as the saying goes, getting there is half the battle.

Or, to cite a quote attributed to a nebbish auteur known as Woody, “80 percent of success is just showing up.”

In the latest Matchmakers, Hitch Health co-founder Susan Jepson, who also serves as interim CEO, told PYMNTS’ Karen Webster that getting patients to and from is no easy task, particularly with vulnerable populations like the elderly or those on Medicaid. Simply put, they may not have the means or money for transport, and thus miss appointments.


No-show rates, depending on the practice, may be as high as 30 percent – translating into a $150 billion annual problem for the health care system at large.

Thus: Hitch Health, which uses patent-pending tech to make a match – in this case, the patient with a ridesharing service (Lyft) to ensure they get to and from appointments in a timely manner.

The idea was born of Jepson’s own experience with Upstream Health Innovations, a health care group in Minneapolis. “We have a very high Medicaid population; as part of our methodology or process, we use something called human-centered design,” she told Webster.

“You really try to get into the shoes of your end users,” she adds. “And so we shadowed our patients from the beginning of their journey, from making an appointment, to actually coming to our facility, to waiting in line … to then going home. And what we discovered was that transportation was a huge barrier for our patients.”

It was a time-consuming barrier, as well, as some patients would wait for hours for taxis, impossible to track in terms of timeliness. Jepson said research showed that some patients opted instead for Lyft or Uber, with the caveat that, of course, they still would have to schedule a ride.

Thus there is Hitch Health, which uses patent-pending technology that automatically interfaces with patient medical records to grab data, such as appointments and street addresses, and schedules those rides as needed. Those alerts come via SMS text message, letting the patient know when and where their Lyft will arrive. No app here, in a nod to the fact that the elderly and relatively less affluent patient populations may be less facile with technology, or may not have the latest gadgetry at hand in the first place.

Add to that the fact that in general, primary care appointments have the highest rates of absenteeism, and cancer appointments have a 17 percent no-show rate, and one can see the magnitude of impact, the urgency and the benefits of, well, just showing up.

Said Jepson, 25 percent of no-shows are tied to lack of transportation, indicating that at least part of the problem – and a significant part, at that – can be solved with access to a ride.

Medicaid has proved a fertile first market for Hitch, said Jepson.

“People aren’t always focused on that population when it comes to digital technology,” Jepson said. “And so from there, though we think there’s millions of use cases that can be applied, we wanted to get it right, to first make it as simple as possible.” By way of example, she said that “when we first started testing this, we tested it in a clinic. It’s considered a primary care clinic, but they have about a 31 percent no show.”

As with any new platform and matchmaking effort, learning and repeated iterations have remained part of the process.

As Jepson told Webster: “We have the benefit of being able to sit with our patients, so we actually had about 30 or 35 iterations of the text messages to see how the patients would react if they received something like this. The Hitch Health program isn’t marketed, so it’s basically the patient receives a text on their phone.

“Our patients told us that it seemed too good to be true, and that they would want a number to call to validate the program,” she added. “So then that drove us to actually stand up a small call center so the patients could call to validate [the rideshares].”

But with health care, perhaps there are regulatory hoops to jump through that are not extant in other verticals.

Jepson noted that Uber and Lyft are not currently approved at any of the state levels to convey Medicaid transports – and where the government program pays for transportation.

In that absence, said Jepson, “we went forward and asked health systems if they would be willing to pay for the rides, because we were able to demonstrate a significant ROI.” She noted that any health care operation operates with a heavy fixed cost load. If the providers are not seeing the patients, of course, revenue does not accrue.

Making sure that patients are on time is also important. Said the executive, technology can also serve as an aid to the health care professional. As Jepson noted, “we built a dashboard for our frontline staff, so they can see that the patient is on their way. We can also see if they’re running late because of traffic … so that was one of the other goals, to actually be able to level [patient] load. If one patient got there a little early and they saw the other patient was running late, they could see that early patient first.” In addition, the surety of the Lyft ride helps boost productivity at the front desk.

“People who work in clinics and health systems are extremely busy … and patients will go up to the front desk and try to figure out how to get a ride home … this way it’s all automated,” said Jepson.

Jepson noted that future plans include looking at special transportation services – for the elderly, for example, an eventual door-to-door service that could be borne in partnership between Hitch and other vendors. Commercial applications of the Hitch model may also be in the offing.

All in all, making sure that patients get to where they need to go is “just one piece of that economic model,” said Jepson.

“The second is that you actually start to improve overall health. You don’t see as many people arriving into the emergency room if they’re getting their primary care visits and maintaining their health. That’s a longer-term component,” she told Webster.