Nancy Williams texted her Lyft driver for a ride after a doctor’s appointment at Whittier Clinic in Minneapolis. (Minneapolis Star Tribune/The Minnesota Star Tribune)

When patients don't show for a doctor's appointment, the clinic takes a financial hit since there's less revenue for covering overhead costs.

The impact could be even worse under new "value-based care" contracts that give clinics financial incentives to make sure patients get preventive services to help avoid six-figure hospital stays down the road.

Those are two key reasons why Dr. Chip Truwit and a colleague launched Hitch Health, a Minneapolis startup that's among a select group of firms pitching clinics and health systems on the idea that making it easier to get to appointments can improve the quality of care while also lowering costs.

"There are all sorts of reasons for no-shows, but a quarter of it is due to transportation problems," Truwit said. "It's better to spend $15 to get a patient to the clinic so you can take care of a problem before it becomes a big problem."

Hitch Health was developed out of Upstream Health Innovations, an innovation center connected to the health system that includes Hennepin County Medical Center (HCMC) in Minneapolis.

The company's software connects with a health care provider's electronic health record to identify patients who could benefit from the program and automatically sends a text message offering a ride. Patients don't need a smartphone, app or credit card to accept the ride.

Clinics that are using Hitch Health say they're optimistic about the program, although they're still gathering data to show the return on investment.

The nation's largest ride-sharing companies are trying to fuel the trend, which includes startups in Boston and Detroit that are coordinating health care rides among other services.

Earlier this month, Uber launched a program focused on partnerships with health care providers, citing no-show rates as high as 30 percent. Lyft rolled out its health care rides venture in 2016 and expanded it earlier this year. Hitch Health is one of Lyft's health care partners.

Neither company formally releases financial data, but leaked numbers suggest they're both still losing money and looking for ways to generate more business, said Mike Ramsey, an automotive analyst with Connecticut-based Gartner Inc.

"I think there's logic in them getting into it," Ramsey said of the health care push.

Not everyone is on board with the idea.

Waleed Sonbol, the owner of Blue and White Taxi in Minneapolis, says Hitch Health should utilize cabs that satisfy requirements for nonemergency medical transportation (NEMT) in Medicaid, the state-federal health insurance program for lower-income residents.

Medicaid provides free rides to the doctor for beneficiaries, and cabs that participate in the program must satisfy NEMT standards for vehicle inspections plus checking and monitoring the background of drivers, Sonbol said. He thinks there are troubling gaps with the insurance provided by ride-sharing companies.

"Last year, we did 335,000 NEMT rides," Sonbol said. "It's what keeps our drivers [working]."

Truwit, the physician who co-founded Hitch Health, said via e-mail that the startup opted to work with Lyft "because, early on, it was the only major ride-sharing service that provided drivers and passengers with significant insurance coverage." A spokeswoman for Hitch Health pointed to Lyft's own requirements for background checks and vehicle inspections, plus real-time ride tracking and a 24/7 critical response line.

While medical trips seem to be emerging as a new front in the ongoing turf war between cabs and ride-sharing companies, startups are trying to focus the discussion on potential patient benefits.

Many patients successfully navigate the Medicaid system for NEMT rides, Truwit said, but the level of no-shows suggests it doesn't work for everyone. Some patients complain it can be difficult and time-consuming to arrange NEMT trips, he said.

Truwit thinks it's only a matter of time before ride-sharing programs become part of Medicaid, but he says programs like Hitch Health have a wider audience. The startup has provided more than 4,000 rides thus far, Truwit said, and patient reviews have been very favorable.

In 2015, HCMC received a $2.5 million grant from the UnitedHealth Foundation to fund the innovation center, and some of the grant money has paid for patient rides during the startup's pilot phase. The Hennepin Healthcare system retains an ownership interest in Hitch Health.

Currently, Hennepin Healthcare is evaluating whether to pick up costs for the program, which was launched in June 2017.

"Hitch Health is targeting a precise patient group — 80 percent of Hitch Health users did not show up for six or more appointments the prior year," Christine Hill, a spokeswoman for the health system, said in a statement. "When participating in the pilot, those patients did not miss any appointments."

In Detroit, hospitals have been working with a startup called SPLT to arrange Lyft rides for patients who don't qualify for Medicaid transportation benefits and lack transportation options, said Anya Babbitt, the company's chief executive. In February, the Henry Ford Health System launched a pilot program with the startup.

SPLT, which also coordinates ride-sharing in industries other than health care, was acquired earlier this year by a German company.

In Boston, a startup called Circulation said last month it has added 500 transportation partnerships with health care facilities, bringing its total to 1,500 such organizations across 45 states. Last year, Circulation announced it had raised $10.5 million from strategic partners.

Hitch Health has plans for growth, as well. Among its first customers is West County Health Center in California, which is tapping about $50,000 in grant money this year to pay for rides. The program is part of an experiment to see if patients realize care improvements as a result, said Dr. Jason Cunningham.

The nonprofit health center doesn't have unlimited dollars to invest in transportation for patients, Cunningham said, but clinic officials believe the service will deliver offsetting savings. Following an initial testing phase, the health center is now in the process of rolling out Hitch Health for more patients.

"We believe that this is a good investment," Cunningham said. "We think it's going to be cost-neutral."

Christopher Snowbeck • 612-673-4744 Twitter: @chrissnowb

Nancy Williams jumped into her Lyft outside Whittier Clinic after her doctor's appointment Thursday in Minneapolis. Startups in the Twin Cities and across the country are scouting a surprising new growth opportunity: Rides to the doctor. (Minneapolis Star Tribune/The Minnesota Star Tribune)