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Clinical Trial Results: Text Messages Can Reduce Heart Attacks

The results of a 6-month study released by The Journal of the American Medical Association (JAMA) indicate that patients recovering from a heart attack are less likely to have a repeat heart attack if they receive text messages that engage them about their health routine. This study consisted of sending about 350 patients with coronary heart disease 4 messages per week over the course of 24 weeks while sending no text messages to a similarly sized control group. The semi-personalized messages were delivered at random times on weekdays with no more than 1 message delivered to each user per day. These messages were not interactive.

This graphic from The Wall Street Journal summarizes some key results nicely.

Wall Street Journal Text Message Graphic

Part of what makes this study so compelling is that the results are objective. Rather than relying on surveys or other forms of self-reporting, this study demonstrates tangible improvement in health categories like LDL, blood pressure, and heart rate.

It is not surprising to see text messages making this kind of impact on patients. Here are three reasons why:

1) Read Rate

98% of text messages are read (compared to 20% of emails, for context). This is one of the biggest strengths in communicating via text message. There are no apps or websites to open, so it takes minimal effort to receive messages. Most newer smart phones show messages on the screen as they arrive. These recipients do not need to even unlock their phone to receive the communication. Text has also become one of the primary forms of modern communication; over 80% of American adults text, making it the most common phone activity.

2) Information in Easy-to-Consume Chunks

Most hospital visits end with a doctor or nurse providing a lot of post-care instructions and valuable health information in one long monologue. It can be pretty difficult for patients and caretakers to grasp and remember everything they are told, especially if they just had a life threatening health issue like a heart attack.

Text messages delivered over a longer period of time allow patients and caregivers to receive this important information in more digestible chunks. Unless the patient deletes the text, they can also refer back to it at any time. This increases the likelihood that patients and caregivers can access the care instructions and information they need when they need it, which in turn makes them more likely to take proper care.

3) Staying Front of Mind

Text messaging workflows like the one in this study take place over a number of weeks or months. This keeps the messaging program front of mind as there is ongoing, frequent interaction between the patient and the content. Even if the patient does not read every message they receive, simply getting in the routine of regularly receiving health-related text messages keeps them focused on their health.

Differences Between the JAMA Study Text Messaging Process and mPulse Mobile’s Interactive Text Messaging Workflows

The JAMA study pulled random text messages from a library of relevant messages, personalized them with basic information like the patient’s name, and sent them at random times. This is a great start, and the results are clear. This process helped people get healthier in the months following their first heart attack. That is no small feat.

mPulse’s technology and techniques remove a lot of the randomness from the JAMA study and allows for two-way communication. We also employ insight-driven workflows to remove the randomness from the day, time, and type of message we send to each person. These insight-driven workflows continue to get smarter the more each person engages with our messaging to tailor both the types of messages they receive and when they receive them. Tailored content and delivery is more engaging than random content and delivery, so patient health outcomes tend to be even more positive.

Results: People Want Mobile to Play Larger Role in Healthcare

As if by design, Adobe Digital Insights (ADI) released their findings from a survey of 1,000 U.S. healthcare consumers just a day after mPulse Mobile shared the results of a study of our own during The 6th Annual World Congress Medicaid Summit. ADI’s study focused on people that use mobile apps for health-related tasks, ranging from fitness to prescription refills and paying medical bills, and our study focused on the rates of mobile engagement in a Medicaid population. The results tell a similar story: people see high value in using their mobile devices to engage more with healthcare.

The results of ADI’s study are pretty interesting. This first chart shows that the majority of people that have used smartphones for health-related tasks would like to exclusively use smartphones for these tasks. That’s pretty compelling data. It indicates that once people make the leap into using mobile devices to manage their healthcare, they are likely to have a positive experience and want more. This implies that more effort should be made to engage people with mobile healthcare solutions.

Exclusive Smart Phone ChartOur study used interactive text messaging over the course of 3 months with 17,000 newly enrolled Medicaid plan members. Of this population, 91% found text messages improved their overall knowledge of the plan’s services. More specifically, we saw a 48%-point improvement in new member knowledge of how to get care with the plan. By delivering a mobile healthcare experience via text message, a way almost everyone understands, people do not need to be digitally savvy to engage. They simply need to understand text messaging.

Text Message Read Rates Graphs

The power of leveraging mobile devices to improve healthcare is clear. Unfortunately, healthcare plans and providers are way behind on mobile engagement according to ADI. When comparing the amount of mobile website visits to desktop website visits, ADI found the categories Health Insurance and Health Provider near the back of the pack.

Mobile vs Desktop

Why does this matter? Let’s look back at the mPulse Medicaid study. We found that 75% of Medicaid plan members in our study use a smart phone as their primary source of internet access. If the vast majority of health insurance and health provider website visits are conducted via desktop and the vast majority of Medicaid plan members are accessing the internet from a mobile device, it is pretty clear that Medicaid populations are not easily accessing the information they need, or are at least unlikely to have a positive experience doing so.

‘“The problem is that the health-care industry, in general, hasn’t yet caught up to be able to deliver on people’s digital demands and expectations,” said Matthew Roberts, an analyst at ADI. “Furthermore, we’re seeing that the companies that are delivering smartphone experiences, such as apps, are not doing enough in driving awareness and adoption.”’ from ADI’s post on the survey results.

See ADI’s survey results on slideshare

It is time for health insurance companies and healthcare providers to focus on mobile, and for those focused on mobile to double-down on strategies to increase adoption. The technology exists for healthcare organizations to make big improvements in how they interact with people, and both the demand and benefits are clearly present.

Further Reading: Healthcare Apps: The Good, The Bad, The Ugly

Interactive Text Messages Engage and Activate Medicaid Members, Research Finds

New study from mPulse Mobile, in partnership with Inland Empire Health Plan (IEHP), suggests positive link between two-way text messages, improved health activation, and cost savings

Los Angeles, Calif. (July 6, 2016) – Interactive and tailored text messages are successful in improving member knowledge of plan offerings, and promoting self-activation among Medicaid members, according to study results released today by mPulse Mobile. Conducted in partnership with Inland Empire Health Plan (IEHP), a rapidly growing Medicaid and Medicare health plan in Southern California, the study’s findings are significant as healthcare organizations moving to value-based care seek to achieve greater member satisfaction, optimal health outcomes, and lower costs.

As Medicaid-centric health plans including IEHP grow, delivering actionable information about members’ health is a priority. With a 98 percent read-rate, text messages are a high-impact, low-cost method of engagement. mPulse Mobile’s Medicaid Plan solution enabled tailored two-way mobile engagement based on the insights of member demographics, behavior, and response sentiment, allowing IEHP to reach, engage, and activate members to facilitate improved overall health.

Positive outcomes from the 3-month study of 17,000 newly-enrolled members include heightened awareness of appropriate settings for care, effective use of IEHP resources, increased response rate and engagement, and self-activation. Specifically:

  • 91% of members found that the text messages improved their overall knowledge of IEHP services
  • The number of members who reported they would visit the ER for a minor condition dropped from 11% to 4%
  • 10% of members participated in a series of health challenges with a 33% completion rate
  • The engagement score, based on response behavior and sentiment, for the study group was 2.5 times greater than the control group

The results also strongly suggest that receiving timely information regarding available healthcare services empowers individuals to utilize cost-effective resources. As the ER is the costliest setting to receive care, and Medicaid members visit the ER at twice the rate of those with private insurance, the positive impact of two-way text messaging on appropriate resource utilization is particularly encouraging.

“mPulse Mobile’s understanding of the Medicaid population and insight-driven mobile engagement solution has enabled us to connect and engage in a two-way dialog with our members, a conversation that’s led to improved knowledge of our services, generating better health outcomes,” said Susan Arcidiacono, IEHP’s Chief Marketing Officer. “We’re eager to apply these learnings to our broader member base and continue working with mPulse Mobile to implement innovative mobile strategies to improve population health.”

mPulse Mobile Co-founder and CEO Chris Nicholson and Behavioral Data Scientist Rena Prayaga will present the study’s findings for the first time publicly on July 13. Their presentation, ‘Utilize Interactive Text Messaging to Improve the Health of the Medicaid population,’ is a featured session at the 6th Annual World Congress Medicaid Summit in Tysons Corner, VA.

“Healthcare is increasingly becoming a consumer-centric industry, and it’s imperative that healthcare organizations offer convenient and seamless customer experiences,” said Nicholson. “The study results prove that connecting with consumers on their mobile phones in a way that is highly-tailored and directly relevant to them can make a marked improvement in the health of an individual and population.”

About mPulse
mPulse offers healthcare organizations consumer-focused mobile engagement solutions that improve member and patient engagement and create administrative efficiencies. mPulse Mobile enables the leading health plans, providers and pharmaceutical companies to improve the health and wellbeing of consumers by making healthcare communications relevant to the modern lifestyle.

About IEHP
IEHP, Inland Empire Health Plan, is a not-for-profit Medi-Cal and Medicare health plan located in Rancho Cucamonga, California. With a network of over 4,000 providers and more than 1,700 employees, IEHP serves more than 1.14 million residents in Riverside and San Bernardino counties who are enrolled in Medi-Cal, Cal MediConnect Plan (Medicare), or the Healthy Kids Program. Through a dynamic partnership with providers, award-winning service and innovative products, IEHP is fully committed to providing members with quality, accessible and wellness based healthcare services.


Healthcare Apps: The Good, The Bad, The Ugly

It is hard to imagine a week going by without hearing about a new app in the healthcare industry. It makes sense, though. As mobile devices become more sophisticated and better protected (was anyone else’s mind blown when Apple launched fingerprint technology?), consumers feel safer using them for important activities and sharing private information. The impact of apps in healthcare seems largely positive and they should only become more important as technology and regulations continue to evolve, but plenty of skepticism still remains.

First, a few quick facts to define the landscape:

To summarize, consumers continue to perform more activities on mobile devices than ever before, a very small portion of available health-related apps are downloaded, and the majority of apps are used only once.

There is a clear issue with getting consumers to actually use apps. After all the time, money, and energy spent building an app, marketing it, and finally earning a download only to find that consumers never come back is frustrating. These stats are even more depressing when there are so many valuable apps currently available and in development. Companies are spending big bucks to develop apps that may change healthcare forever.

Today alone, there are two featured stories on about exciting new apps. One monitors respiration real-time while the other coaches kids to help them lose weight. This is not an unusual day. Apps with concepts like this are announced and released all the time. There are even companies like Zoom+ that are trying to bring healthcare almost entirely to the mobile phone. (Keyword being “almost.” It’s tough to imagine a phone performing an appendectomy.)

So the future for healthcare apps is simultaneously extremely bright and somewhat murky. The technology and abilities are mind blowing, yet adoption and use remain a challenge. Intelligent text messaging is a key to increasing adoption and getting consumers to complete the activities an app requires to remain valuable to them.

Here is an example:

There are a variety of apps that help consumers manage their health, be it overall fitness, diabetes, medication adherence, or any number of other health issues. Many of these apps require data from consumers in order to be effective. This data typically comes either from wearables that sync with the app, consumer-input data, or a combination of both. When consumers download the app, they typically log in, provide basic info, and then start looking around at all the features and overall experience. All is going fine and well until the consumer encounters something that requires a second effort on their end. Providing their current weight requires them to go step on scale and return; a prompt to sync a wearable could send them into an online shopping environment loaded with distractions. And then they lose momentum, interest wains, and they never return.

The challenge with apps is they require the consumer to click on them, and in healthcare likely log in, every time they use them. This is an unavoidable barrier unless security and regulations change dramatically. So how do organizations get consumers to care enough to log into an app regularly?

Here are some ideas:

  • Push Notifications: When a user enters an app for the first time, ask them to turn on push notifications. This enables the app to send alerts or reminders to the user on their mobile device. Downside: Many users (roughly 60%) do not opt-in to push notifications.
  • Digital Marketing: Once a consumer downloads the app, targeted online marketing can remind them about the necessity of the app. Downside: Expensive with limited data to judge success.
  • Text Messages: An intelligently-timed text message can encourage consumers to take the action the app requires (like measuring weight) and log back in with a simple tap of the link. Now the app has the information it needs to be more valuable to the consumer which is likely to increase adoption. If not, another intelligent text should do the trick. Example Text: Joanna, don’t forget to take your blood pressure and post it link to app so we can keep your doctor up to date.

Seeing the level of innovation in mobile healthcare is completely thrilling. It really feels like the dawn of a new era. Making sure consumers do their part and experience this innovation through apps requires an extra step to keep them engaged. By leveraging push notifications, ongoing marketing, and text message workflows, organizations are likely to see much stronger app use numbers and generate better outcomes across the board.

mPulse Mobile is the industry leader in a variety of healthcare solutions to support over 200 use cases. Driving traffic to apps is one of them. mPulse also creates intelligent workflows for two-way interactive text messaging that engages patients and consumers to get the information and care they need.