Text Messaging: A Promising Tool for Managing and Improving Individual Care

Transcription

1 Text Messaging: A Promising Tool for Managing and Improving Individual Care November 5, 2015 Donald Bux, Director, Behavioral Health Care Management, Montefiore Medical Center Laura Galbreath, Director, SAMHSA-HRSA Center for Integrated Health Solutions at the National Council for Behavioral Health

2 Housekeeping How to participate Dial the conference by selecting Use Telephone in your Audio window. See example Submit your text question using the Questions pane Note: A copy of this presentation and the recording will be made available within 48 hours

3 Three-Part Webinar Series: How Technology Is Transforming Health Care Text Messaging: A Promising Tool for Managing and Improving Individual Care Using Apps and Other Technologies to Support Physical Health in Behavioral Health Settings Buy in from line staff Digital Self-Care: Using Technology to Improve Outcomes and Engagement

4 Adopting Technology www. TheNationalCouncil. org Coordinating Care of Populations Transparency & Benchmarking Replace & Extend Staff

5 Text messaging (SMS) a relatively inexpensive, accessible way to engage underserved populations

6 90% of all adults in the US own a cell phone 99% of text messages are read within the first 90 seconds Some 83% of American adults own cell phones and threequarters of them (73%) send and receive text messages.

7 Households with >$30,000/yr text twice as much as households who make <$75,000/yr Medicaid patients (79%) are more likely to use text messages than privately insured individuals Hispanics text 1.56x more than Caucasians African Americans text 2.24x more than Caucasians

8 In a survey of consumers with serious mental illness (SMI), 72% reported owning and using a mobile device 31% of texters preferred texts to talking on the phone, while 53% said they preferred a voice call to a text message.

9 Ways in Which Health Care Providers are Using Text Messaging Self-Management Support Treatment Plan Check-in & Support Patient Satisfaction Care Coordination / Transitions of Care Marketing New Programs Appointment Reminders

10 Montefiore Medical Center

11 Montefiore Medical Center Donald Bux, PhD Director, Behavioral Health Care Management, Montefiore Medical Center

12 Context: Montefiore Medical Center, Next Steps Care Management Program History Managed Addiction Treatment Services (MATS) initiative (2007) Funding from NYCDOHMH, OASAS, NYC Human Resources Administration

13 Context: Montefiore Medical Center, Next Steps Care Management Program Target population Applicants for cash assistance Mandated to substance abuse treatment History of high Medicaid expenditures for substance abuse treatment services Repeat admissions to inpatient treatment

14 Context: Montefiore Medical Center, Next Steps Care Management Program Field-Based Model Client identified & referred by NYC Human Resources Administration (HRA) Engaged at mandated chemical dependency (CD) treatment program Performance based contract, no PMPM billing Low client/cm ratio (approx. 25:1)

15 Context: Montefiore Medical Center, Next Steps Care Management Program Objectives: Enhance adherence to substance abuse treatment Reduce costs related to repeat admissions to detoxification/rehabilitation services Enhance compliance with other HRA mandates Reduce infractions, interruption of benefits, recidivism Improve access and adherence to other services Reduce reliance on cash assistance Increase employability/employment Assist in application for Supplemental Security Income (SSI)

16 Context: Medicaid Redesign in NY State Medicaid redesign team established in 2011 Collaborative effort of multiple state health agencies and other stakeholders Improve quality & efficiency, reduce cost of Medicaid services Reduce preventable admissions and ED visits Reduce unnecessary, redundant services Increase engagement in and adherence to ambulatory care

17 Context: Medicaid Redesign in NY State Medicaid Health Homes Organizational structure to provide care management and patient navigation services for high need/high cost Medicaid members Must include under a single point of accountability all of the following: One or more hospital systems Multiple ambulatory care sites (physical and behavioral health providers) Community based organizations, including care management and housing providers

18 Context: Medicaid Redesign in NY State Medicaid Health Homes Target population: Adults 2 or more chronic medical, behavioral health, and/or substance use conditions requiring ongoing medical management At risk for future hospitalizations, ED visits, or other crisis events Risk algorithm based on Medicaid claims history Diagnoses; past admissions, ambulatory care engagement, pharmacy claims history, other claims history

19 Context: Medicaid Redesign in NY State Health Home care management objectives: Outreach & engage individuals identified by DOH and managed care plans; Conduct comprehensive screening of all Health Home members for current risks and service needs across multiple domains; Develop and implement a comprehensive service plan Enhance engagement of family and community supports Ensure successful care transitions Model & objectives mirror those of Managed Addiction Treatment Services

20 Context: Bronx Accountable Healthcare Network (BAHN) Phase 1 designated Health Home Established January 2012 Service area: Bronx County, NY Lead agency: Montefiore Medical Center 1 other large hospital system 3 ambulatory care providers (medical, behavioral health, & chemical dependency) 3 community based social service organizations Approximately 17,000 Health Home members

21 Context: Next Steps Care Management Program Changes under Health Homes Shift from performance contract to PMPM Medicaid billing Need to maintain engagement with all clients every month Expansion from CD focus to all high-risk Medicaid patients Shift away from CD treatment settings Increased census & staff Increased caseloads (50:1)

22 Context: Next Steps Care Management Program Challenges Population not mandated to care Often disengaged from clinical services Difficult to engage via provider Greater dispersal of providers All medical, BH, & CD providers throughout Bronx Field engagement much more labor intensive Clients often have no telephone land line Cellular phone plans typically very restrictive Need for more efficient methods of communication with clients & providers

23 Text Messaging Platform: SenseHealth

24 Text Messaging Platform: SenseHealth Web-based platform Health care providers create, deliver, and monitor customized, SMS-based support plans for their patients Care plan goal reminders Motivational messages General health care information and tips Clients can respond to system with comments & questions Clinical staff can also use system to communicate via text with clients

25 Text Messaging Platform: Privacy Measures Client opt-in required Content restrictions No mention of specific disease states, medication names, or other information in automated messaging Care mangers trained not to include PHI in outgoing messages Automated algorithms screen outgoing CM text messages content originating from system Database security & auditing capability Maintains a history of all communication through the platform for auditing and record keeping purposes. All patient information and text messages are secured on Sense Health s servers.

26 Funding: Initiative by NYC Economic Development Corporation, Pilot Health Tech NYC Participants 15 care managers 67 clients English speaking Pilot Study: Design With texting-capable cell phones Willing to receive up to 120 text messages per month Randomization: 50% receive SenseHealth service; 50% care as usual

27 Thorough review by compliance office Initial meeting with staff to discuss program needs Staff training Initial training in staff meeting Subsequent trainings provided in 1:1 follow up sessions with research assistant Initial experiences Pilot Study: Implementation Staff buy-in & client enrollments low Perception of more work Confusion about use of system

28 Pilot Study: Implementation System and procedural modifications Streamlining of process for building client scripts Individualized training by SenseHealth team Simplification of user interface Later results Early adoption by key opinion leaders among staff Positive experiences and feedback from clients Substantially improved staff buy-in & client enrollment

29 Pilot Study: Product Customization Supervisor-level access to platform Monitor communications between care managers and clients Allows multiple members of care management team to communicate with a single client Client Alerts Real time alerts to care managers when certain keywords are detected in client messages to care manager to notify them of a potential problem or send a summary every morning.

30 Pilot Study: Product Customization Secure communication option Downloadable app to permit secure transmission of PHI Appointment reminders Allows care managers to input upcoming appointments and schedule automated reminder messages to clients Reduces time required for care manager to make reminder calls to clients

31 Pilot Study: Product Customization Custom Script Builder Streamlined process allowing care managers to create customized patient support plans Improve patient activation Provide educational content written by health and wellness experts. Sense Health Application Programming Interface (API) Allow integration of Sense Health data with existing care management systems, billing systems, and medical records

32 Pilot Study: Outcomes Increase in client motivation & self-efficacy (relative to control) 30% 25% 20% 15% 10% 18% 18% 22% 21% 28% 24% 5% 0% Conficent can adhere to medical treatment In control of health Understand recommended lifestyle changes Motivation to improve health Confidence to change for the better Understand medication benefits

33 Pilot Study: Outcomes 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Increase in self-reported patient medical & care management adherence 15% Likely to work on care plan goals 7% Remember care plan goals 40% Remember to keep medical appts. 12% Remember to fill prescriptions

34 Pilot Study: Outcomes 13% 12% 12% 11% 11% 10% 10% CM reported increase in client connectedness to care manager 10% 12% 90% of clients extremely interested in continuing with SenseHealth system 9% Ease of contacting client Ease of client to reach CM

35 Pilot Study: Client feedback I don t have friends or family, so texts helped me feel less sad and alone, texts knew what I was thinking - like a needle pinching me to get moving, made me think of things I should be doing even if I was feeling lazy. I really felt like my care manager was talking to me when I got a text. I knew it was a computer, but it still made me feel like she was there checking in with me.

36 Pilot Study: Future Directions Phase II pilot study Examine impact on health outcomes Appointment, Rx adherence Hospital admissions Expand to other care management providers Applications to other populations Medical patients diabetes, adolescents Psychiatric patients improve patient activation, medication reminders, stress management

37 Final Thoughts: Implementing New Technology Buy in from managers Must see the utility and advantages Buy in from line staff Need for support from managers to learn system and understand benefits May need to see for themselves User interface must be simple to navigate Must meet needs of the population (e.g., language) and program (interface with local EMR, auditability)

38 Key Components of Designing and Implementing Your Text Messaging Interventions Technological Specifications Operational Needs Content Development CQI / Evaluation Cost Policies/HIPAA

39 Questions & Comments Laura Galbreath, Director, SAMHSA-HRSA Center for Integrated Health Solutions at the National Council for Behavioral Health

40 Three-Part Webinar Series: How Technology Is Transforming Health Care Using Apps and Other Technologies to Support Physical Health in Behavioral Health Settings Buy in from line staff Thu., Nov. 19, 1:00 pm EST Digital Self-Care: Using Technology to Improve Outcomes and Engagement Thu., Dec. 3, 1:00 pm EST