- To Nancy R. Wharfield, MD, associate chief medical officer of the California-based Gold Coast Health Plan, mHealth messages have one huge advantage over post cards and robocalls when reaching out to her Medicaid members.
“They make you feel like you’re in a conversation,” she says.
That may make all the difference for someone in GCHP’s Medi-Cal program who’s dealing with a chronic condition or two but doesn’t have a doctor and has very little inclination to seek one out for primary care or wellness tips. If an interactive message on a smartphone can start a conversation that makes the user feel engaged, then that person just might schedule a doctor’s appointment, take a medication when needed and follow care management advice.
And that, in turn, might help reduce the millions of dollars spent each year on California’s Medi-Cal patients for healthcare services that could have been avoided.
Gold Coast Health Plan, based in Ventura County, is one of several around the country turning to mHealth to improve engagement with underserved populations, a key tactic in the effort to reduce Medicaid costs and take it out of the government’s budget crosshairs.
Health systems and health plans are using targeted messages on mobile platforms to reach populations who are traditionally hard to reach – like the homeless, minorities, migrant workers, LGBT and HIV/AIDS populations, even those with addictions. They’re tailoring messages to these specific groups of people in hopes of developing a rapport and improving engagement with local healthcare providers.
Gold Coast is now in the midst of a two-pronged mHealth study, launched by Harvard Medical School’s Department of Health Care Policy and mPulse Mobile, to evaluate the effectiveness of interactive text messaging programs on the Medicaid population. One study focuses on guiding members with chronic conditions, such as asthma, to enroll in a care management plan, while the other focuses on getting new members to select and visit a primary care provider soon after enrollment.
“There is a major need for innovation in care delivery and how we can engage patients outside of just the office visit,” Ateev Mahrotra, MD, MPH, a program researcher and associate professor of healthcare policy and medicine at Harvard Medical School, said in a press release following the study’s launch this past April. “I’ve spent much of my career studying the ability of different interventions to drive advancements in population health management, and I’m excited about the possibility for mPulse Mobile to engage individuals in their health using tailored and interactive text messaging to improve outcomes and lower costs.”
“Harvard’s interest in studying the efficacy of these programs further validates the need for innovative mobile solutions that reach members and drive engagement, particularly with underserved populations,” added Chris Nicholson, mPulse Mobile’s CEO, in the release.
Wharfield, meanwhile, hopes the study will help frame new patient engagement strategies Gold Coast, which works with roughly 200,000 Medi-Cal members.
She said the health plan’s efforts to reach out to Medi-Cal members through post cards and automated phone calls were met with little response – members would toss the cards into the trash and ignore the phone calls.
“We’ve been very frustrated,” she said. “Our members have a pretty loose association with the idea of a primary care manager, and managed care is something that’s new to our county. So this involves a change of culture.”
Wharfield said the members she’s trying to reach are often just trying to make ends meet, and have little time for computers or Internet. They won’t pay attention to messages that are just sent their way – but they will be interested if someone want to talk to them.
That’s where mHealth comes into play. A text messaging platform that encourages a response will go a lot farther than a post card or a recorded voice on the phone.
Wharfield said Gold Coast learned that lesson during an mHealth outreach effort targeting members with diabetes.
“We were getting all these text messages back that were really touching,” she said. “They liked that someone was actually reaching out to them.”
Wharfield said she’s hoping the Harvard Medical School/mPulse Mobile study will help Gold Coast refine its mHealth strategy to deliver more targeted messages that compel members to take a more active role in their care management.
“We’re taking baby steps now,” she said. “Most of our communication with members now is through algorithms. We need to create a process that lets them step out of that.”
In the future, she sees the health plan using an mHealth platform to target care gaps in chronic disease management for populations like those with HIV/AIDS, or putting out the word on flu shot clinics and health screenings for at-risk populations.
The challenge, she said, is in finding a language and tone that resonates with members and makes them want to continue the conversation.
“For a managed Medi-Cal plan to be able to interact with our membership in a personal way – it’s exciting,” she said. “We’re finally able to reach people.”