Why Tackling No-Shows With AI Is the Fastest Way To Boost Clinic Efficiency: Koen Lepez, TurnUp

Every health system deals with them. Missed appointments. Last-minute cancelations. Patients who simply disappear without notice.

It’s a quiet but costly crisis—one that costs the healthcare industry over $150 billion each year. And for decades, the go-to response has been to treat it as a patient behavior issue: send more reminders, issue penalties, hope for the best.

This blog post is based on a recent episode of Keep IT Healthy, Momentum’s podcast about the builders, technologists, and innovators shaping the future of healthcare. In this episode, Jan Kamiński (our Co-Founder and CSO) sits down with Koen Lepez, CEO and Co-Founder of TurnUp, to explain that this approach misses the point entirely. The real problem isn’t the no-show—it’s the system’s inability to respond to it.

TurnUp’s solution? Stop treating no-shows as something to prevent, and start preparing for them. Explore how one startup is tackling the no-show problem not with reminders—but with data, AI, and a whole new way of thinking about scheduling.

Koen’s story is a masterclass in healthtech adoption strategy: what works, what fails, and how to design for impact in a system built on inertia. Here's what we learned.

Solving the Problem by Rethinking the Approach

TurnUp doesn’t just send better reminders. They’ve built a predictive AI engine that analyzes behavior, history, external conditions like weather and traffic—and forecasts with up to 85% accuracy whether a patient is likely to miss their appointment.

But the brilliance lies in what happens next.

When a likely no-show is identified, the system nudges that patient to cancel—gently, and without shame. Once they do, the slot is automatically offered to someone else who’s actively waiting for an earlier appointment. It’s a seamless swap that keeps schedules full, reduces frustration for staff, and makes better use of limited clinical capacity.

Instead of chasing patients down, TurnUp builds a system that bends with reality.

Why Most Solutions Still Fail

What makes TurnUp different isn’t just the AI. It’s their insistence on solving for all three affected parties: the provider, the front desk, and the patient. Most tools in this space just shift the problem around—reminding the patient more aggressively, or punishing them for not showing up.

TurnUp actually fills the gap. Even if the appointment isn’t rebooked, the simple act of confirming that the patient won’t attend allows the staff to adjust. A provider can take a break. Admins can reprioritize their work. Frustration and stress go down—because expectations are set, not broken.

As Koen puts it: “It’s not just about reclaiming revenue. It’s about restoring predictability and sanity to healthcare operations.”

AI Can’t Solve Everything. But It Can Solve This.

TurnUp’s approach to AI is refreshingly grounded. They’re not making promises of perfection—just probabilities that are good enough to change how the system responds. About 80 to 85% of no-shows can now be predicted, giving clinics the chance to act instead of react.

And while many providers remain wary of AI, especially when patient data is involved, TurnUp sidesteps this tension by using only aggregated, anonymized data. Their system doesn’t ingest everything—it just asks for the essentials, applies machine learning responsibly, and makes the outcome transparent to stakeholders.

That openness, Koen says, is what wins trust. Not just from decision-makers, but from data protection officers, staff, and patients alike.

Scaling a HealthTech Product the Hard Way (AKA the Real Way)

Of course, no matter how smart your tech is, scaling in healthcare is a grind. TurnUp’s first hospital pilot took nearly a year to get off the ground. Sales cycles are long. Procurement is complex. And priorities shift.

What worked for TurnUp wasn’t selling AI. It was showing up in clinics, asking how many patients didn’t come last week, and then quietly proving they could fix it. They hustled their way into practices with leaflets and follow-up calls, built word of mouth, and tailored their pitch to each organization’s pain points—whether that was lost revenue, overwhelmed staff, or long waitlists.

It’s a reminder that in healthcare, traction starts with trust.

Beyond No-Shows: The Bigger Scheduling Revolution

Koen is clear that TurnUp doesn’t want to stop at solving no-shows. The bigger vision is to reimagine scheduling altogether—using AI not just for prediction, but to recommend appointments based on health patterns, life stage, or proactive care needs.

That could mean auto-scheduling a follow-up before the patient even thinks to ask. Or helping solo GPs stay ahead of care gaps. Or automatically redistributing appointments when a provider is unexpectedly sick—relieving the front desk of the stress and workload of rebooking 100+ visits in a day.

It’s not about replacing humans. It’s about reducing the invisible, administrative drag on care.

Adoption Over Perfection

Koen’s advice to other founders in healthtech? Focus less on building the perfect product, and more on getting something real into people’s hands.

“You can build something incredible,” he says, “but if no one uses it, it doesn’t matter.” Early feedback is worth more than technical elegance. Pricing low—or even free—just to learn faster is often the smarter play.

Because in healthtech, adoption is the real milestone. Everything else is just potential.

The Takeaway

No-shows aren’t just a scheduling issue. They’re a signal of how rigid, outdated, and under-optimized healthcare operations still are. But with the right tools—and the right mindset—it’s possible to turn those missed appointments into moments of opportunity.

TurnUp is showing that predictive AI, when applied responsibly and empathetically, can give healthcare providers a new kind of superpower: not just to fill empty slots, but to build systems that work even when things don’t go as planned.

That’s the future we need more of.

Liked the read? Hear the full story on the podcast.

If you want the full story—complete with Koen’s tactical advice for breaking into slow-moving healthcare markets, real-world results from TurnUp’s pilots, and his big vision for AI-powered preventive scheduling—tune into the full episode of Keep IT Healthy. It’s packed with practical lessons for anyone building digital health products in complex, regulated markets.

We created Keep IT Healthy to give the mic to the people doing the real work of transforming care. Each episode features honest, unscripted conversations with healthtech leaders—from early-stage founders to clinical CIOs.

If that’s your world, or the one you want to build in, it’s your podcast.