Multi-Channel Messaging

Messaging is a powerful and essential engagement tool. It often makes more sense to use it instead of distributing an app.

SMS is not secure, so that makes it more challenging to integrate. Even so, messaging providers are using creative ways to get around HIPAA, such as secure links embedded in messages and getting patients to consent to SMS as a potentially higher-risk communication channel.

I’m a big fan of SMS integration from various services. Google uses SMS effectively for two-part authentication. AT&T also does a good job with SMS for surveys and payment notifications. I might get annoyed if more companies start doing it, but, for now, I’m happy with it.

I was particular interested in the recent news that Medicaid would be using SafeLink Health Solutions in 20 states as a mobile provider. That’s a massive contract for a new offering like SafeLink, even if the two companies behind it have long track records. SafeLink is a partnership between Voxiva (Text4Baby) and prepaid wireless vendor TracFone. Did I miss another announcement where SafeLink did a pilot for Medicaid to show that SafeLink works and is cost effective?

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What’s fascinating to me is that SafeLink is a full mobile solution for low-income patients, “full” meaning it’s hardware plus mobile services. The SafeLink service includes a free cell phone, text messaging (apparently no limit, at least according to the site), 250 minutes of talk, free calls to Medicaid member services, and Voxiva messaging.

I like the idea of giving hardware. I talked to a health system a few years ago about doing this, but I wonder about how much patients want it. Giving phones and services comes with logistical challenges, but TracFone is probably an ideal partner to help make it happen.

As I said, my biggest question is how big is the market of members looking for a cell phone from Medicaid, even if the phones won’t have a Medicaid logo on them. According to Pew, 91 percent of adults have a mobile phone and 86 percent of adults with an annual income below $30,000 have a phone. With those numbers in mind, it’s probably a decent chunk of Medicaid members that don’t have a cell phone.

What would be really cool is if SafeLink or Medicaid enabled members with phones from Medicaid to get extra minutes or mobile services based on engagement metrics. Why not give extra minutes or credits to someone who responds to a multiple choice wellness quiz? It doesn’t even have to be specific for that person — the questions could be based on foods or activity recommendations. Getting people to think about health is always a good thing, even if they don’t get the answers right. What they get right and wrong, if you had that aggregate data, would also be interesting to drive health campaign decisions.

What I also wonder about is if members have or if TracFone offers phones that have multiple SIM cards. Non-contract, prepaid wireless is much more common overseas, and many of the phones allow you to have multiple SIM cards. I always thought it would be cool if Medicaid funded one of those cards and used it for health-related messaging. It keeps the hardware slightly more independent from Medicaid and still allows the user to have a personal number and service. I don’t know if this was explored or used in the SafeLink-Medicaid project.

All of the posts I’ve written on messaging in healthcare have been mostly focused on SMS. Messaging in healthcare needs to be much broader than one communication channel.

  • Push. Push and app-based messaging is probably the closest to SMS. I’ve shut off almost all push notifications, but it’s a good way to reach some smartphone users and has additional security benefits.
  • E-mail. I worked with a psychiatrist who delivered daily e-mail reminders with a basic link to a question about mood. His e-mail open and clicks rates were fantastic. I get daily e-mails for calendar and CRM even though I can look up the info in an app if I really want to take that extra step.
  • Voice. Ringadoc shows there is still a need for voice interactions, even if those interactions are asynchronous and/or transcribed. I don’t think voice — whether it is one way or IVR — is going away any time soon.
  • Fax. Of course it’s healthcare, so you can’t forget fax, though fax is really just a workaround for HIPAA. But fax isn’t really relevant for patient messaging.
  • Social channels. Facebook messaging or Twitter direct messaging are both individual messaging services. Those are much further down the list.

I prefer SMS and e-mail, depending on the type of service. I can’t stand IVR and I’ve grown tired of Push. The point is that it’s all personal preference. If we have the algorithms and logic for when to send messages and what messages to send, we should look at messaging more broadly and adapt services to meet individual preference, even if some are less secure.

Are any organizations thinking about messaging more holistically?

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Travis Good is an MD/MBA involved with health IT startups. More about me.

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