To help patients show up to their medical appointments, Minneapolis-based Hennepin County Medical Center (HCMC) and its innovations group, Upstream Health Innovations, has developed Hitch Health, a proprietary software technology that communicates with the EHR and ride-share service Lyft. When an appointment has been made, a ride offer via an SMS text message is automatically sent to the patient based on filters that determine if they are eligible. By leveraging technology, this approach is improving no-show rates and increasing patient satisfaction, according to the developers.
Hitch Health’s web site describes how it emerged from a human-centered design project, in which researchers used ethnographic techniques, interviewing Minneapolis patients, spending time in their homes, and following them to clinic appointments. Dealing with taxis, parking or public transportation can be challenging. Many patients were forced to carve out an entire day just to travel to and from an appointment. On average, 19 percent of patients were missing their appointments – an extremely high no-show rate.
Hitch Health noted that Medicaid spends $5 billion on non-emergency medical transportation to help patients travel to clinics each year, but 3.6 million Medicaid patients still miss their medical appointments. Skipped medical care disrupts continuity and compromises the quality of care, leading to an increased likelihood of emergency room visits and preventable hospital admission. At the same time, Hitch estimates that these no-show appointments cost health care systems $150 billion each year in lost clinic revenue and lost staff time.
Hitch taps into Lyft’s enterprise application programming interface (API), which allowed it to build on the ride-sharing platform. Its team linked the EHR with existing ride-share technology without requiring the patient to have a smartphone. (Multiple studies have found that SMS text messaging is the best way for the medical community to reach low-income patients.) Hitch breaks down Lyft’s app into simple text message-based conversation.
Here is how the process works:
- Accessing the EHR, Hitch’s software determines which patients are eligible for a ride based on filters such as insurance type, treatment, and condition.
- An eligible patient with an upcoming appointment automatically receives an SMS text message five to seven days before the scheduled visit offering a ride to the clinic. Instructions are in English, but Spanish is next. All the patient has to do is respond “yes” to get picked up on the day of their appointment.
- The night before, a reminder text is sent to the patient confirming the ride and the estimated time of pickup for the next day.
- On the day of their appointment, a patient will receive the Lyft driver’s information and pickup details via text message.
- Meanwhile at the clinic, staff members receive real-time status updates on when the patient will arrive.
- When it’s time to go home, the patient texts “ready” and a Lyft driver will arrive in minutes.
Hitch plans to continue refining and scaling its technology through more pilot programs. In July it began a pilot program with Hennepin Health, a managed-care program that serves residents who are eligible for Medicaid and MinnesotaCare. The goal is to gain compliance for Safe Harbor rules and become a covered benefit for Non-Emergency Medical Transportation.
Hitch is also in discussions with other health plans including Providence Health & Services and UnitedHealthcare Community & State. Hitch wants to eventually offer its software to safety net health plans around the country.
Working to improve its EHR integration, Hitch plans to launch separate pilots with Epic and athenahealth.