EXECUTIVE SUMMARY

Case management texting can be an effective and affordable way to engage with high-risk patients and encourage them to follow health regimens.

  • Sharp Rees-Stealy Medical Centers in San Diego saw a 70.8% improvement in HgA1C levels for diabetes patients in the case management program.
  • The total number of unique patients receiving service in the diabetes program rose by more than 1,800.
  • The texting program also has saved costs for the heart disease and diabetes populations.

Healthcare organizations continuously deal with patient populations that need ongoing management or guidance. In-person visits and phone calls can be prohibitively expensive when the population is in the tens or hundreds of thousands. One organization found a solution: using targeted text messages to engage people personally, but much less labor intensively.

Sharp Rees-Stealy Medical Centers in San Diego have found case management with text messaging is a success.

“Of our patients living with diabetes, we have seen a drop in HgA1C for patients in a texting program of 0.679, which shows an improvement in 70.8% of those enrolled,” says Janet Appel, RN, MSN, CCM, director of informatics and population health at Sharp Rees-Stealy Medical Centers.

The diabetes program also has increased its unique patients serviced from 5,127 to 6,965 through texting, Appel says.

“We’ve also seen a decrease in hospital readmissions for the post-discharge texting program,” she adds.

The texting tool has helped the case management program grow faster than it would have without it. And while it’s not for everyone, many people, including seniors, do like it, Appel says.

Texting also has saved the case management program in costs of heart disease and diabetes populations, although there is no way of putting an actual dollar amount to that part of the overall savings. “We can’t say texting saves millions of dollars, but we can say that because of our diabetes program, we save millions of dollars,” Appel explains.

Appel and a colleague devised the texting idea while attending a conference. “We were at a population health conference in Philadelphia four or five years ago, and the whole conference was about outreach and engaging populations as they grow,” Appel recalls. “We met this new company that was using mobile technology to connect with patients.”

This strategy appeared to be an engagement solution that could work with a large case management population.

“We were very much interested in assisting and engaging people,” says Christine Tedeschi, MS, RN, CDE, CCM, manager of ambulatory disease management programs at Sharp Rees-Stealy Medical Centers.

At the same time, Appel and Tedeschi were given the task of engaging 5% of the health system’s population in some kind of case management program. There were 180,000 total patients at that time, so 5% would be 9,000 patients, Tedeschi says.

The actual percentage of people enrolled in case management has not yet reached the target, although the population continues to grow and is just shy of 4%.

“We’ve been able to engage several thousand people over the years, using the technology,” Appel says. “We see a 30% increase in patients we can care for because of the mobile technology.”

The program has grown from 30 to 37 case managers. Nurse and social worker case managers lead the multidisciplinary teams, which also include community health workers, medical assistants, and project managers.

“We have limited resources, as everyone does, and limited money to spend,” Appel says. “We were looking at how to expand the care we give using technology, and both Chris and I liked the mobile technology solution. That’s how the whole thing started.”

Each case manager can increase his or her caseload by about 30% with the texting program, Appel says.

The program works by delivering patients interactive messages for up to 26 weeks. Each message is designed to help the person adapt successfully to lifestyle changes and self-care behaviors.

“Instead of case managers outreaching and talking to patients, these scheduled interactive messages are delivered through technology, and patients can interact by text or calling us,” Appel says. “So, we can address their needs without using staff to personally outreach to every person who is using the program.”

When patients receive a text message, they can respond through a centralized messaging center at which staff review all incoming messages and route them to RN case managers, Tedeschi explains.

For example, a patient with diabetes who is having a problem with low blood sugar can send a note or question via text. The patient receives an immediate response from either the RN case manager or another licensed professional, she says.

“We have a medical assistant monitoring the dashboard of all texting going back and forth,” Appel says. “She reads the text and either answers it herself when it’s something like, ‘What time is my doctor’s visit tomorrow?’ or she can provide the question to a nurse.”

The supportive text messages are evidence-based, following nationally recognized criteria for the condition being addressed, Tedeschi says.

“For instance, one of the messages that comes through for general health is that high blood pressure increases the risk of having a stroke and you can reduce risk by being active and healthy eating,” she explains. “Then, at the end, it says, ‘Easy, right?’ with a smiley face. It’s very personal and engaging.”

Text messages also are motivational and inspirational. “For the diabetes program, one message is, ‘Put your sneakers by the door before you go to sleep, so you are ready for your morning walk,’” Appel says.

Patients receive tips and specific curriculum information on how to improve their health, including strategies for selecting healthier foods at the grocery store, Tedeschi notes.

The text message medical information sticks to simple strategies, such as “Think FAST” to identify strokes.

“Think FAST is F for face drooping; A — arm weakness; S — speech difficulty, and T— time to call 911,” Appel says. “The message says, ‘Help save a friend’s life or your own. Learn to recognize the warning signs of a stroke.’”

In addition to these kinds of simple messages, the technology delivers quizzes to patients and specific medical instructions and reminders to improve treatment adherence.

“Patients have the opportunity to set up text reminders for medication, blood glucose testing, taking their blood pressure, or doing other activities,” Tedeschi says. “They can set up text reminders when they register for the program.” The case management program also sends out reminders about blood draws and doctor appointments.

So far, the program has been popular with enrolled patients, Appel says.

“People like the flexibility of being able to choose the text messages they receive and the curriculum they’re receiving,” she says. “We have testimonials from patients and for our staff and staff members who love the idea of being able to communicate directly with patients through a text message, because that’s so timely.”