caremessage TM Improving Lives. Strengthening Communities.
OVERVIEW CareMessage is a nonprofit organization that empowers providers with mobile technologies to improve health literacy and self-health management for underserved populations while fostering more efficient care delivery.
"We face a national crisis to transform primary and preprimary care in order to control the burgeoning costs of healthcare. The greatest opportunity to solve this gap lies in leveraging technology in creative ways to bridge the gap between resource-constrained providers and an increasingly diverse and underserved population. This is precisely why CareMessage s model has been well received with key early adopter providers and payers in California, and why I think it has the potential to become standard of care in low-resource healthcare organizations nationwide. I wholeheartedly endorse CareMessage s work. David Lawrence, MD Former CEO, Kaiser Permanente
BACKGROUND / PROBLEMS & FACTS Low Health Literacy & Poor Self-Health Management Inefficiencies and Waste $106 60% 238 Billion Medicaid beneficiaries have basic or below basic health literacy level compared to 36% of the general US population. Estimated annual economic drain of low health literacy among all populations. SOURCE Vernon JA and Trujillo A. Low Health Literacy: Implications for National Health Policy. Rep. Washington: George Washington University, 2007. < LowHealthLiteracyReport10_4_07.pdf
BACKGROUND / PROBLEMS & FACTS of low income patients need and want more 78% communication with their healthcare provider but have no access to electronic or mobile self management services (UCSF, 2013) SOURCE Rush-Monroe, K. Electronic Health Communications Often Unavailable To Lower Income Patients. UCSF. Feb 2013. <http://http://www.ucsf.edu/news/2013/02/13575/electronic-health-communications-often-unavailable-lowerincome-patients
BACKGROUND / WHY MOBILE? PERCENTAGES OF PEOPLE WHO OWN MOBILE PHONES No HS Diploma Rural Resident 36% 40% 83% 85% 86% of households with an income < $30,000/yr who own a cell phone Annual Income $30,000 $60,000 52% 90% Annual Income >$30,000 Ages 18 29 43% 83% 80% 97% 43% of households with an income of < $30,000/yr own a smartphone 0 25 50 75 100 Smartphone Cellphone SOURCES Smith, A. Americans and Text Messaging Pew Research Center. Sept 2011 Smith, A. Smartphone Ownership - 2013 Update Pew Research Center. June 2013
BACKGROUND / WHY SMS? SMS usage is more prevalent in lower income and less educated populations. USAGE BY INCOME LEVEL USAGE BY EDUCATION LEVEL 60 70 Mean # of SMS Sent/ Received per Day 45 30 15 Mean # of SMS Sent/ Received per Day 52.5 35 17.5 0 <$30K $30K 50K $50K-75K $75K+ Income Level 0 Less than HS HS Diploma Some College College+ Education Level SOURCES Smith, A., Americans and Text Messaging Pew Research Center. Sept 2011
THEORY OF CHANGE / LITERATURE REVIEW SNAPSHOT The effectiveness of text messaging is supported in the literature. Reduce no-show by sending appointment reminders The ease with which large numbers of messages can be customized and sent by SMS text messaging, along with its availability and comparatively low cost, suggest it may be a suitable means of improving patient attendance. Results: The no-show rate was significantly lower for patients enrolled in text message notifications vs those who were not (14.2% vs 23.4%). Promoting adherence by sending medication reminders Real Time Medication Monitoring with SMS reminders improves adherence of type 2 diabetes patients, especially the precision with which patients follow their prescribed regimen, and is well accepted by patients. Results: Over a six-month period, patients receiving SMS reminders took significantly more doses within predefined time windows than patients receiving no reminders: 50% vs. 39% Enhancing self-care by sending educational content and remote monitoring For certain patients, cell phone based text messaging may enhance chronic disease management support and patient-provider communications beyond the clinic setting. Results: Two-thirds (66%) of patients provided glucose readings when prompted during the study, compared with 12% at 2 preceding clinic visits.
THEORY OF CHANGE / LITERATURE REVIEW SNAPSHOT of participants in a weight loss program said that text messages helped them in 80% their struggle to adopt healthy habits. Participants in the group lost a total of 4.5 more pounds in the 12-week duration of the program. SOURCE Versel, N. Study finds text messaging effective for weight loss. VCU. Oct 2013. < finds-text-messaging-effective-for-weight-loss/
TEAM / FOUNDERS Vineet Singal CO-FOUNDER/CEO Vineet Singal has no shortage of passion and dedication to the work he does. He is a Stanford graduate, and currently on an indefinite leave from Mayo Clinic School of Medicine as he has decided to focus all his passion and energy on the work he does at CareMessage. Two life events shaped Vineet Singal's decision to use technology to improve patient care: his struggle with weight and pre-diabetes and his work at a free clinic that serves low-income residents in Galveston, Texas. Singal weighed nearly 225 pounds when he was a freshman at Stanford University. After forming a habit of bicycling, running and weight training regularly and eating better he lost nearly 80 pounds in two years. The experience taught him the importance of motivation and forming good habits. Through his work at the Texas clinic, which he also did during college, he realized that low-income residents needed extra help to form healthy habits. "Education is essential in improving health and preventing diseases from happening," Singal said.
PRESS / PEOPLE ARE NOTICING Press Major Funders
PRODUCT TEAM / ENGINEERS + DESIGNERS + PHYSICIANS + SCIENTISTS = PURPOSE Manuel Rivera CHIEF PRODUCT OFFICER Manuel Rivera is a software engineer who leads all aspects of CareMessage's product development. He comes to the organization with a passion for health IT and expertise with real-time client-server communication, computer graphics, and interaction design. Manuel has an MS in Telecommunication Engineering from the Technical School of Madrid (UPM) with a specialty in Biomedical Engineering and has studied the social impact of technology at UC Berkeley. Cecilia Corral DIRECTOR OF PRODUCT MANAGEMENT Cecilia leads program development efforts for CareMessage, and works with our partners to test and refine our products. She is proficient in the process of usercentered design pioneered by the Hasso Plattner Institute of Design (d.school) at Stanford University and graduated from Stanford with a degree in Product Design under the guidance of David Kelley, the Founder of IDEO and Stanford d.school. A native Spanish speaker who grew up in Mexico, Cecilia has a unique understanding of cultural and linguistic barriers within the Hispanic community. Greg Burrell, MD DIRECTOR OF CONTENT & CLINICAL SOLUTIONS Greg leads clinical review and oversight of CareMessage's programs and works closely with the CareMessage Clinical Review Board. He comes to the organization with a passion to educate and empower patients to make smarter healthcare decisions, as well as creating and implementing new technologies that improve healthcare outcomes. Greg is currently an Assistant Professor of Clinical Medicine at UCSF. He received his bachelors from Northwestern, his MD from the University of Chicago and completed internal medicine residency at UCSF.
PRODUCT TEAM / ENGINEERS + DESIGNERS + PHYSICIANS + SCIENTISTS = PURPOSE Patricia Sanchez PRODUCT MANAGER Patricia helps develop many of CareMessage's programs, especially those focused on childhood and adolescence health issues. She comes to the organization with a passion to improve health literacy among low income populations. She has over 8 years of experience creating health education materials that are both culturally and low literacy appropriate. She has worked with a Medi-Cal managed care population at the Contra Costa Health Plan, and holds a Masters in Public Health (MPH) from San Diego State University. James Pan USER INTERFACE DESIGN James helps us with all the creative stuff - user interfaces/experience, visual design, and almost all the photos you see on our website James has a true passion for design, and believes that design has the power to change medicine and healthcare as it is essentially a study of how we communicate. In his spare time, James enjoys photography, dance music, and attends medical school at Stanford University. Fun fact - James is blessed with the useless ability to make latte art Nicolas Chapa MOBILE UX DESIGNER Nicolas has worked as the Mobile Team Lead for the Stanford Persuasive Technology Lab. He manages the Mobile Messaging Testbed for the lab. Previously, he was the Mobile Community Manager for Plug-n-Play Tech Center, a startup incubator. His research has led to work with startup organizations, Fortune 500 firms, leading strategy consultancies, mobile carriers, and global handset makers. He was instrumental in refining the UX for Juntos Finanzas, a company dedicated to helping unbanked Latinos save more money. Nicolas graduated with a degree in American Literature and Culture from UCLA.
What are the features? 1. Patient, Staff and Group Management 2. Appointment Management 3. Event Management 4. Disease-Management Educational Programs 5. Followup and Data Collection 6. EMR Integration/Direct Interface
Patient, Staff and Group Management 1. Staff Management: Give multiple people access to the platform, and limit how much data they are able to see. 2. Patient Management: Store any and all patient data. The data entry fields are flexible so you can also store patient data relevant to your clinic. 3. Group Management: Categorize your patients into any number of groups useful for group events and cohort-based disease management.
Appointment Management 1. Automatic appointment SMS and/or voice reminder sent out to patient along with clinic address and any other relevant info. 2. Patient can respond directly via text or voice if they can, cannot or maybe attend. 3. RSVP Information is displayed on the CareMessage platform or EMR.
Event Management 1. Automatic appointment SMS and/or voice reminder sent out to group 2. Group can respond directly via text or voice if they can, cannot or maybe attend 3. RSVP Information is displayed on the CareMessage platform 4. Group can also interact with each other directly via SMS (group chat)
Disease Management/Patient Ed 1. Provide ongoing patient education to patients outside the clinic setting. 2. Encompass a wide variety of diseases and conditions: diabetes type 2, hypertension, high cholesterol, HIV, congestive heart failure, substance abuse, mental health, nutrition, exercise, stress management etc. 3. Highly engaging and tailored for low income populations: third grade reading level, multi-lingual, culturally relevant, individualized. 4. Programs range in length: A) shorter 4-6 week module covering a specific topic and B) longer 3-12 month programs covering an entire disease condition
Multiple Enrollment Methods Enroll patients Via platform (by clinic manager, RN, MD, or front desk) Via large data upload (clinic list, Excel file, database file) Self-enrollment (text a keyword to begin enrollment) EMR integration (All-Scripts, NextGen, eclinicalworks, Practice Fusion, Epic)
PROGRAM / STANDARD IMPLEMENTATION & WORKFLOW PATIENT ONBOARDING ADMINISTRATION/ MANAGEMENT OF TECHNOLOGY PATIENT ENGAGEMENT IN PROGRAM EVALUATION OF TECHNOLOGY AND PROGRAM When: at time of office visit; commencement of workshops Acquiring patient info: patient will fill out a short form with provider Data entry: manual, spreadhseet upload, integration with EMR Staff administrators and Care Managers oversee technology capabilities: Appointment & Event reminders Medication reminders Health coaching Caregiver support Patients are seamlessly engaged in care: Pre-defined educational streams with interactive and branching logic Indefinite/on-going reminder capabilities Ability to enroll in groups and interact with peers for additional motivation and support Evaluate effectiveness of program: Reporting and visualization of self reported metrics (blood sugar Survey questions Data collection to show metrics on the following: ease of use of technology, knowledge change, health outcomes change and cost reduction data (when applicable). Time cost: ~3 min/ patient (one time) Time cost: ~2 min/ patient/month Time cost: None. Process is automated. Time cost: None. Self reported data is collected from patient via SMS and outcomes data is seamlessly ported from provider to Anjna platform.
PROGRAM / EMR INTEGRATION PROVIDERS ENTER: Demographics Diagnoses Lab Results Imaging Results Etc Electronic Medical Record: caremessage TM Highly individualized messaging capability: - Targeted preventive and chronic care services - Pre-appointment discussion of med adherence, and any issues - Reminders to a specific group of people about events, resources
PATIENT EXPERIENCES SANTIAGO Shift worker at Staples Center, Los Angeles ON MOBILE TEXT MESSAGES It was easy to read it and to say yes or no. It was helpful for me because I felt like this person was taking the time to care about me, that somebody else is interested in my life.
PATIENT EXPERIENCES TOMASA Hotel worker; Married with two kids ON MOBILE TEXT MESSAGES It's gonna help me if you send me reminders. Sometimes it takes only one word if you're down to elevate yourself.
PRODUCT / PROGRAM CREATION Our program development process takes an interdisciplinary approach, bringing to the table designers, health educators and behavioral psychologists. PHASE I PHASE II PHASE III User Interviews We start by gaining an understanding of our end-user through interviews with patients, clinic managers, health educators, etc. Observations We sit in on group meetings, classes, and one -on-one health education appointments. Research We compare our findings with existing information around health educational content, proven interventions, etc. Define We take all the gathered knowledge to define our strategy by key topic areas that must be covered. Create We take our strategy and create the texting campaigns or educational modules, optimized for our user group and taking into consideration the timing, tonality & delivery times for each message. Review & Iterate All content is reviewed by members of the content development team and key medical advisors. Additionally, all content is approved by the client before user testing. After release, content is constantly improved upon iteration.
PRODUCT / PATIENT INTERACTION Educational Content José Male, 56y/o, Spanish speaker Health Management Health tracking and management tips based on health conditions. Nutrition Nutritional goal setting and tips based on cultural factors. Exercise Exercise goals and tips based on current fitness level and cost factors. Low Fitness Level Interested in no cost options Patient Setting Goal Walking 5d x 20min Goal Check In Exceeded 20min Health Check in Felt Good Stress Management Stress assessment and tips on reducing stress based on source. Tailored, Culturally Relevant, and Disease Specific.
PROGRAM / COMPLIANCE WITH PCMH SECTION 2D SECTION 4A SECTION 3D List of patients contacted Multiple preventive care services Multiple chronic care services Communicate with patients not recently seen Contact patients on specific medications Self-management goals documented Self-managements tools offered Provides education, counseling, and resources for patients Encourages healthy behaviors Shortens in-clinic med reconciliation process Assesses patient understanding of medications Documents OTC, herbal meds Assesses medication issues and adherence barriers Fully capable Fully capable Fully capable Q2 2014
PROGRAM / COMPLIANCE HIPAA Compliance 1. Fully HIPAA compliant, encrypted platform and texting software 2. HIPAA details: A. Consent not needed for basic reminders, follow-ups, one-time events B. For sharing PHI, one-time only electronic/paper consent can be obtained C. Full compliance with current rules and regulations for texting any PHI (disease names, medication names, etc) to patients D. Full legal team dedicated to ensuring our ongoing HIPAA compliance as new features are added
EARLY ADOPTION / CASE STUDIES CUSTOMER STATUS APPT EVENT EDU AGE GROUP ETHNICITY MAJORITY Unite Here Health Launched + + Adults (Middle Age) Hispanic St. Anthony s Medical Center Launched + + + Adults (Middle Age) Hispanic Sinai Health System Chicago, IL Launched + + + Adults (Middle Age) African-American Queenscare East Los Angeles Launching soon + + + Adults (Middle Age) African-American
EARLY ADOPTION / CASE STUDIES CUSTOMER DESCRIPTION MAIN FOCUS GOALS Unite Here Health Multiple cities Unite Here Health is the health plan for members of the Unite Here labor union, which has more than 250,000 active members whom work primarily in the hotel, food service, laundry, warehouse, and casino industries. UHH wanted a way to keep in contact with their members, and let them know about perks and benefits that are available to their members. Exercise, nutrition, health programs Alert members of health events, programs Provide outreach and educate members St. Anthony s Medical Center San Francisco, CA St. Anthony s Medical Center in San Francisco is a community-based, non-profit clinic in the heart of San Francisco s Tenderloin district. Their mission is to ensure that patients with lack of insurance, lowincome or homelessness do not fall between the cracks in our healthcare system. They have been thrilled to use CareMessage to educate their patients about chronic health conditions such as diabetes and hypertension, as well as use appt reminders to reduce no-shows. Diabetes, HTN, community outreach Reduce no-shows Improve education about chronic illness Provide outreach Sinai Health System Chicago, IL Sinai Health System in Chicago is a large health system that serves 60% Medicaid. They have significant issues with no-shows for appointments. Would like to implement text messaging technology for chronic disease patients, starting with Diabetes Management. Community Programs Reduce no-shows Improve chronic disease management (DM, HIV) Queenscare East Los Angeles, CA Queenscare is a large network of non-profit health clinics in Los Angeles that is specifically targeted at low-income families. They are specifically interested in using CareMessage to help educate patients about chronic conditions such as DM, CHF, HTN, and HIV. They want to have increased alignment with MU2 and PCMH guidelines as well. Varied Improve chronic disease management (DM, CHF) Help patients avoid ER, hospital if possible
Validation / PROVING IMPACT OUTCOME APPOINTMENT REMINDERS EVENT REMINDERS NUTRITION STREAM EXERCISE STREAM DIABETES ASTHMA Knowledge Change N/A N/A Survey Survey Survey Survey Behavior Change Lower no-show rates Lower no-show rates Achievement of nutritional goals Achievement of physical activity goals Improved adherence, understanding Improved adherence, understanding Use of tech (engagement) Response rate Speed Response rate Speed Response rate Speed Response rate Speed Response rate Speed Response rate Speed Cost-savings Improved efficiency Improved efficiency Lower use of high cost resources Lower use of high cost resources Fewer hospital days, complications Lower use of high cost resources Improved outcomes N/A N/A General metrics, BMI, BP, QOL General metrics, BMI, BP, QOL A1C ER visits Quality of life
VALIDATION / EARLY CAREMESSAGE RESULTS of participants (Stanford Prevention Research Council) 97% increased their activity as a result of the CareMessage exercise program (as measured by pedometer). SOURCE
VALIDATION / EARLY CAREMESSAGE RESULTS Case Study: Stanford Prevention Research Center 30 Hispanic, low-income adults, median age: 60.5 Focused on motivating them to exercise more Reading Level of Messages: 1.2-5.8 6 week program 25% first time SMS users SOURCE
VALIDATION / EARLY CAREMESSAGE RESULTS Case Study: Stanford Prevention Research Center Highly Engaging Up to 80% response rate for messages about goal-setting & social support (average response rate of 63%) Behavior Change Outcomes Improved activity for 97% of participants Satisfaction Scale of 1-7, 6.5 for satisfaction, 85% would recommend to friends & family Next step: Duplicate results in a larger study
VALIDATION / CAREMESSAGE Most important metrics?
What s Next 1. Smarter, adaptive content that tailors future content based on past responses A. Branching logic means patients will receive content tailored precisely to their knowledge and interest level 2. Data trends from tens of thousands of patients receiving messages in 2014 A. Which messages were best received B. Which concepts patients learned best from the modules 3. Expanded patient mix (hospitalized patients, post-surgical patients, others)
What s Next 1. Even greater alignment with Meaningful Use (MU2) and Patient-Centered Medical Home (PCMH) guidelines A. Expanding to meet 3A, 3C, remaining portions of 3D B. Establishing care plans, and identifying when treatment goals have not been met C. Integrating with EHRs to provide intelligent, individualized messages to each patient 2. Seamlessly assisting the transition from home to clinic, and from hospital to clinic
What s Next / EMR INTEGRATION
WHAT S NEXT / CAREMESSAGE What would you like to see next?
SUMMARY / UNIQUE VALUE PROPOSITION 501(c)3 Better technology fit for low income patients vs. email, smartphones, and direct mail Tailored content in multiple languages Developed by world-class medical faculty and behavior change experts A unique, sustainable non profit model to serve the underserved
We fundamentally believe in the power of technology to improve people s lives and strengthen communities. JOIN US. @caremessage