Healthcare Dive: How providers are working to stem missed appointments

Health systems have found mixed results with products that aim to get patients to their appointments.

Patient no-shows are a costly, intractable headache for healthcare providers. Millions of patients cancel, skip or reschedule appointments with their clinicians every year, creating vacant schedules and expenses that can cost the industry by one estimate $150 billion annually.

Faced with such high cost, providers and payers alike have increasingly looked to tech for answers. Stakeholders across the industry — from insurers and providers to EHR companies — are engaging directly with Uber and Lyft following the companies’ high-profile entrances into the market.

Trouble getting to a provider, however, is just one of many factors fueling missed appointments. Other issues patients cite include cost of care, socioeconomic restraints, long wait times and scheduling conflicts.

Despite big promises from tech companies, an app and a platform can’t solve all of healthcare’s woes.

“How much of this is, they’re really not that into you?” Krisda Chaiyachati, lead author of Penn Medicine’s early 2018 study of Lyft’s impact on missed appointments among Medicaid patients, told Healthcare Dive. “And how much is a true need and a gap in getting there?

That’s the question a slew of organizations are trying to figure out, from marquee ridesharing companies and non-emergency medical transportation (NEMT) brokers to telemedicine companies and mobile health clinics.

Here’s a snapshot of current efforts to reduce missed appointments:

Non-emergency medical transportation

The ridehailing industry’s promises won some support in findings this week from Lyft and tech company Hitch Health. The companies launched a pilot at Hennepin Healthcare’s internal medicine clinic in Minneapolis last year targeting patients who have missed appointments in the past. After a year, Lyft and Hitch found their pilot reduced no-shows by 27%.

Those results should put the wind back into the sails of industry rideshare hopefuls that may have been disheartened by the results of a Penn Medicine study published earlier this year.

That study, which looked at how complementary rideshare impacted missed appointment rates among Medicaid patients in west Philadelphia, demanded industry attention for its findings: Chaiyachati and his team found that the service “really didn’t make a dent” in no-show rates.

Chaiyachati, who said the study was done in part because of the hype around ridesharing, told Healthcare Dive he found the results surprising. Given the fact that anywhere from 35-50% of Medicaid patients in that area miss appointments on a daily basis, he said, “How do we advance their care plans at the end of the day?”

Transportation is the third-most frequently identified reason for missed appointments among older adults by American Hospital Association’s count. The access gap has created a market worth over $3 billion, according to an estimate from the Transit Cooperative Research Program.

According to the Journal of the American Medical Association (JAMA), CMS was accountable for pumping at least $2.7 billion into that market by way of Medicaid NEMT benefits as of 2016. While these benefits have been available for Medicaid enrollees since the program’s inception in 1965, ridesharing’s introduction to the industry has breathed new life into the sector.

“I’ve had so many hospital [executives] grab me by the shoulders and say, ‘You don’t understand how big of a problem missed appointments are for our facility,'” Mark Switaj, founder of medical transportation platform RoundTrip, told Healthcare Dive.

Switaj does have somewhat of an idea of how big the problem is. Before launching RoundTrip, an all-in-one transportation coordination platform, he worked for Envision Physician Services in Horsham, Pennsylvania, and medical transportation giant American Medical Response.

The founder told Healthcare Dive his “firsthand look how patient transportation services are designed” helped him understand how to help modernize the industry. RoundTrip isn’t a transportation company itself. Rather, it’s a “single touch-point” that connects providers, payers and existing transportation services. The platform has a built-in appointment reminder system and is HIPAA-compliant.

The company has forged partnerships with Lyft, Greater Richmond Transit Company, advanced NEMT services and a number of smaller, rural transportation companies. Hospital systems, insurance networks and patient coordinators cover the cost of the trip for most riders, 80% of whom Switaj said are Medicaid enrollees.

RoundTrip, like Lyft and Uber, also stands to gain from the growing Medicare Advantage market and the “fairly revolutionary” possibility of CMS allowing managed Medicare plans to offer a transportation benefit.

Cigna’s Medicare Advantage arm partnered with Lyft in May 2017 to provide nonemergency rides to members in a handful of states. Between May and November of last year, Lyft gave more than 14,500 nonemergency rides to Cigna-Health Spring members. The payer said 92% of members who used the service have made it their preferred means of transportation.

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