Written By: Cecilia Corral, Co-founder, VP of Product at CareMessage

In the spring of 2016, my co-founder and I were sitting in our San Francisco office, thinking about what we wanted the future of CareMessage to be. When you are starting any company, half the battle is staying alive and the other half is dreaming big. So we dreamed big: “Impact Public Health at a National Scale”.

Fast forward to March of 2020 and a global pandemic hit like nothing we could’ve ever imagined.

A lot of what happened in the first two weeks of March 2020 is a blur. Almost overnight, outreach, our mass-messaging feature, shot up in utilization at almost 10x the volume it would normally support. We had to gather data, analyze it, and turn around insights for our customers as close to real-time as possible. Things were changing quickly as cities and states adopted stay-at-home orders, mask mandates, and social distancing. Meanwhile, the Federally Qualified Health Centers (FQHCs) and Free Clinics we serve were having to rapidly adopt new telehealth technologies they were not ready for. I sat at home and watched it all unfold through our platform.

Utilization of our outreach (one:many) messaging feature from March 2020–March 2021

What Happened?

One of my favorite side projects at CareMessage is digging into data, and more specifically understanding messaging trends. Looking back at the last year, I wanted to share some insights on the top four message categories we saw and their impact on underserved patient populations. These are insights from our expansion to serve over 8 million underserved patients across the United States and two U.S. territories.

Top four messaging categories — March 2020–March 2021

• COVID-19 (17.5M messages) — No surprise here. COVID-19 was here to stay and our clinics and their staff experienced it all. Federally Qualified Health Centers (FQHCs) and Free Clinics worked tirelessly to deliver trustworthy information to their patients at a time where many news sources could not be trusted.
• Clinical Quality (5.9M messages) — Chronic conditions, behavioral health, cancer screenings, etc. didn’t go away when COVID showed up. If anything, it was even more important for patients to manage these conditions to prevent the onset of severe COVID symptoms. Our clinics tried to balance the urgent needs with the standards of care.
• Telehealth (5.4M messages) — Telehealth was a very new technology to FQHCs and Free Clinics. We saw them undergo a complete transformation by both offering telehealth and getting their patients adjusted to a new way of receiving healthcare.
• Social Determinants of Health (2.6M messages) — Never before had we seen so many of our customers prioritize the non-healthcare needs of their patients. Case management, food, housing, and financial assistance were all extremely important, but 2020 also brought to the forefront the census, voting rights, and racial equity.

Let’s dig into these categories further!

COVID-19

March 2020 started full of uncertainty, and the first trend we saw was information around the symptoms of COVID-19 (1.6M messages). This information was critical to preventing exposure for clinic staff who were facing a number of PPE shortages. At the same time, shelter-in-place orders were starting (783k messages) and clinics were scrambling to redefine what appointment availability looked like for them (1.5M messages). As we went into the summer, incorrect information about testing availability was shared nationwide, listing FQHCs as testing sites ahead of their access to COVID testing. This placed FQHCs in a difficult position, at times having to share information that contradicted what was listed on the national HRSA website. By the summer, FQHCs became a core component of our national testing strategy (5.9M messages) — something which was critical for the working class patients they serve — and to date have tested over 10 million patients.

The fall brought a glimmer of hope as organizations prepared for possible vaccines, and we hit the ground running in 2021 by powering messaging — over 4 million and counting — around vaccine confidence and vaccine scheduling.

Top 10 COVID Topics

Telehealth

The use of telehealth was not common for FQHCs and Free Clinics. As cities started to go into lockdown and PPE was in short supply, clinics adapted to a new way of delivering care. Although underserved patient populations have access to mobile phones, a number of other barriers come into play that prevents their access to what we all think of when we hear telehealth: video conferencing appointments. Many patients at FQHCs and Free Clinics had trouble downloading mobile apps, signing up for patient portals, and getting access to reliable wifi to support a video call. Instead, our clinics also offered “telehealth” in the form of phone calls with no video conferencing.

At CareMessage, we also provided a number of videos in English and Spanish to educate patients about telehealth, teach them how to use the most common platforms, and help them be better prepared for a video call.

Five million telehealth messages later, we’ve seen the majority of this messaging move over to our standard appointment reminder feature where we can embed instructions alongside regular appointment reminders.

Top 10 Telehealth Topics

Clinical Quality

COVID-19 hit patients with underlying conditions the hardest. It, therefore, became critical for our clinics to keep these top of mind. A large number of our clinics sent out supportive messages to help patients overcome the stress of the pandemic (384k) and overall address behavioral health (166k). In the fall, clinics used flu vaccinations (2.1 Million) as a testing ground for COVID vaccine procedures.

Top 10 Clinical Quality Topics

Social Determinants of Health

As an organization serving exclusively underserved populations, social determinants of health (SDoH) have always been a core design consideration when delivering healthcare. It was incredible to see our clinics rally behind the needs of their patients to help them overcome the challenges that came with job loss and corresponding loss of income and often healthcare. We quickly saw a large and sustained volume of messages tied to food resources (662k). However, 2020 was also a year of another important SDoH: advocacy. In the summer, customers sent messages tied to racial justice and protests (218k). In the fall, messaging shifted to promoting the completion of the census (354k) as well as voter registration (459k).

Top 10 Social Determinants of Health Topics

What Comes Next?

A lot of COVID-19-related uncertainty remains for us and for our customers. With a fully remote team, we have felt the impact on our U.S.-based team members as well as those based in Brazil and India. The utilization of CareMessage over the last year really put our infrastructure to the test, and I am happy to report we had virtually no downtime as we scaled to meet the demands of hundreds of existing and new customers, and millions of new patients. The rollout of the COVID-19 vaccine has given us a bit of hope that a new normal is near, but one thing is clear: COVID-19 has changed healthcare forever.

We remain optimistic about the ways telehealth can enable more access for patients who can’t always travel or take time off from work to receive care. We are hopeful for improvements in payment models that will incentivize and reward the clinics that go above and beyond to treat all the needs a patient may have. Lastly, as an organization, we have been re-energized to believe in the power of technology to improve healthcare outcomes for the patient populations who need it the most.

Here’s to more messaging and continuing to impact public health!