What innovations drive success in healthcare? Here's a tactic from a leading healthcare organization.

The problem

The Population Health Management team at Sharp Rees-Stealy Medical Centers, a 550-physician medical group in San Diego, knew that intensive outpatient case management is critical when supporting patients, especially those who are chronically ill or recently discharged from the hospital.

But its goals for case management created a resource challenge. “The number of department case managers could not provide the outreach and education hours needed to reach the engagement goal," says Janet Appel, RN, director of population health and health informatics at Sharp Rees-Stealy.

The solution

Sharp Rees-Stealy turned to technology to solve the problem – specifically, texting. It rolled out a new texting platform, customized for each individual medical condition, to keep patients engaged and on track with their health. Plans include diabetes, post-hospital discharge, medication adherence, smoking cessation, weight loss, and healthy living, and patients can enroll using any text-enabled device. They receive anywhere from two texts a week, for healthy living, to three messages a day, for diabetes.

A typical hypertension text might read, "Have you checked your blood pressure in the last 7 days and, if so, what was it?" Whereas a recently discharged patient could be asked, "Do you have any questions about your medications? Do you need help coordinating your follow up appointments?" Although the messages are automated, the texts do include questions specific to each patient. For example, a hypertension patient might be asked, “Are you still taking Lisinopril 20 mg?" to reflect their individual dosage.

The texting program provides two-way communication, with patients able to text back at any time or use the tool to reach out with questions.

Sharp Rees-Stealy has a team of medical assistants, certified nursing assistants, and community health workers monitoring a dashboard for incoming texts. They screen all questions and concerns and escalate them to a registered nurse or the assigned case manager as appropriate, with the patient receiving a response within a half-day (often sooner). And a nurse or SRS pharmacist can send the patient a dedicated message at any time – such as in the case of a missed appointment or prescription refill.

The outcome

Current staff have been able to take on the task of monitoring the dashboard so, without hiring any new employees, Sharp Rees-Stealy has been able to increase its capacity to communicate with patients by 36 percent. And case managers have been able to take on an additional 25-30 patients each because the texting program eliminates timely phone outreach.

Outcomes data are also promising – a recent analysis showed that diabetes patients enrolled in the program showed a greater decrease in HbA1c compared to those receiving case management alone.

“Everybody engages or connects in a different way," says Appel, “So the more innovative ways you can touch people, the greater number of your population will engage with case management. That way, when something does go wrong, you can capture them right away, you're not losing them."

Next steps: Sharp Rees-Stealy is beginning to use texts to screen for food insecurity and other social determinants of health and hopes to expand into behavioral health as well.

Lia Novotny is a contributing writer for athenaInsight.