Hitch Health: Automating ride-sharing to get patients to scheduled appointments

An automated patient appointment reminder software system designed to reduce clinic no-show rates is having its national rollout in April. Unique about the system is that it does much more than remind patient of an upcoming appointment. It identifies low-income, transportation-challenged patients, offers them free roundtrip rides, and makes all the arrangements---all without human intervention.

Chip Truwit, MD, chief of radiology at Hennepin County Medical Center (HCMC) and emeritus professor of radiology at the University of Minnesota School of Medicine in Minneapolis, co-founded Hitch Health with Susan Jepson, vice president of Upstream Health Innovations, HCMC’s innovation incubator. Dr. Truwit, also chief innovation officer of Upstream Health Innovations, has spent more than two decades focusing on ways to improve patient-centered care and physician engagement.

Hitch Health offers a proprietary software system that seamlessly integrates with the electronic health record (EHR) or the practice management system (PMS) of a healthcare provider to identify patients who would qualify for Medicaid-sponsored non-emergency medical transportation (NEMT). More than just a convenient ride to and from a physician’s office, clinic, imaging center, or hospital, NEMT was designed to address one aspect of the many social determinants that constrain access to healthcare among the Medicaid population. Transportation is believed to account for 25% of clinic no-shows in this patient population.

Once a patient is identified, Hitch Health automatically sends patients text messages to the patient’s cell phone, introducing the program and offering a ride 2-5 days before the appointment, in the patient’s preferred language, either English or Spanish. If the offer is accepted by the patient, the system leverages chat bot technology to maintain communication with the patient thorough SMS texting until the day of the appointment. The patient then receives a reminder the day before the appointment.

On the day of the appointment, Hitch Health’s software notifies the ride-share company Lyft to dispatch the ride. The patient receives another text message with the Lyft driver’s information and pick-up details. Healthcare staff receive real-time status updates on a Hitch administrative frontline dashboard tool regarding the time that the patient will arrive. Finally, when the patient is ready to return home, he or she simply texts “ready” and a Lyft ride is automatically dispatched.

Hitch Health undertook a six-month pilot phase in the Minneapolis-St. Paul metropolitan area. More than 4,000 rides were provided during this time by Lyft. Eighty percent of users had missed six or more appointments at HCMC during the prior 12 months, according to an HCMC spokesperson.

Hitch Health not only helps patients get needed medical treatment, but it also improves resource utilization for the healthcare provider. Getting patients to show up for their medical appointments is a major community health problem. Hitch Health states that Medicaid spends $5 billion annually on non-emergency transportation but that 3.5 million patients still miss medical appointments. Patients who do not get timely treatments may experience health crises that require a costly hospital emergency department visit and/or inpatient admission. Hitch Health estimates that no-show appointments cost health care systems $150 billion annually in lost clinic revenue and unproductive staff time alone.

Dr. Truwit said that Hitch Health, like all of Upstream’s work, is rooted in human-centered design. predominantly focused on challenges facing the safety-net population of medical centers like HCMC. This design work included following patients to clinic appointments.

“Witnessing their transportation headaches first-hand was an eye-opening experience for our design team,” he said. “Many patients who live just a couple miles away from a clinic have to take three different public buses to get there. Those who owned cars struggled to find parking in downtown Minneapolis. Medicaid reimburses taxis, but the complex process requires patients to make multiple phone calls to set up the service, to fill out a small mountain of paperwork, and to wait multiple hours for a taxi to actually arrive. Many are forced to carve out an entire day just to travel to and from an appointment.”

“On average, 19% of patients were missing their appointments – an extremely high no-show rate,” Dr. Truwit added. “Of these, one fourth said that they missed their appointment because they had no easy way to get there. It’s better to spend $15-$25 to get a patient to the clinic so that a healthcare problem can be taken care of in a timely manner before it becomes a bigger and much more expensive problem.”

Hitch Health’s seamless integration with Lyft’s seamless API integration removes barriers such as the need for a smartphone, an app, or a credit card. Hitch breaks down Lyft’s app into simple text message-based conversion. Patients participating in the pilot themselves requested that text messaging be used, as many patients do not have a data plan and therefore cannot access apps. Additionally, Hitch Health does not use phone calls and therefore does not waste patients’ minutes.

A national rollout of Hitch Health’s software is underway. One of its first new customers is West County Health Center in Sonoma County, California. It operates clinics at six locations. More than 60% of its patients are living at or below the federal poverty level and an estimated 300 people designated as homeless live in its service area. West County Health Center has allocated approximately $50,000 in grant money in 2018 to pay for the ride service, according to chief medical officer Jason Cunningham, DO.

“Hitch Health has completed its initial funding milestones, as investors believe Hitch Health can significantly impact health among the safety-net population,” Dr. Truwit told Applied Radiology. “Through its seamless, automated approach to transportation, Hitch Health believes it has already started to improve health outcomes by decreasing no-shows, increasing patient satisfaction, and improving the financial bottom line. As well, its efforts are helping hospitals and emergency departments with timely patient discharges. Hitch Health can also play a role in the delivery of well care and dental care both to the safety-net population and commercially insured patients.