In this month’s issue, we reconnect with a legacy grant partner, who we first made a grant to over ten years ago. In conversation with CareMessage’s Vineet Singal, we catch-up on where his organization is today, why social determinants of health are a new but vital pillar of CareMessage’s work, and what excites him about the future of tech and health equity.

We also introduce you to our newest team member, Blessitt Bryant!

The Rx Foundation is now a team of three! We are thrilled to introduce our newest team member, Blessitt Bryant.

Blessitt joins the Rx Foundation as our Strategic Communications Manager from a decade-long career in the nonprofit advocacy space, leading online movements that spur real, quantifiable action. Blessitt has served in senior digital communication and strategy roles at the AFL-CIO and the Service Employees International Union, and has led political organizing projects focused on racial justice for high-profile clients such as the Los Angeles Black Worker Center, NAACP, Movement 4 Black Lives, and NBC Universal.

As a Black, queer, nonbinary person with cerebral palsy, Blessitt’s commitment to social justice extends beyond the office—they are also a social media influencer changing the definition of beauty by showing that being comfortable in your skin is always in style. A Midwest native, Blessitt can often be found promenading the streets in one of their favorite capes, dusters, or kimonos.

At Rx Foundation, Blessitt will lead our communications strategy, which includes amplifying the impact of the extraordinary leaders, organizations, and networks we support. In addition to digital communications, they will also develop workshops, trainings, and resources to help strengthen the communications capacity of the entire Rx network.

Please join us in warmly welcoming Blessitt to our team!

CareMessage – a patient engagement tool used by over 400 health care organizations across the country – is on a mission to leverage technology to improve health equity.

Recognizing that the U.S. healthcare system continues to leave low-income communities and communities of color behind, CareMessage started in 2012 to improve health equity for historically marginalized patients and communities. Today they reach 1 out of every 7 community health centers nationally and are focused on three main pillars to achieve their vision: (1) increasing access to care, (2) improving clinical outcomes, and (3) addressing the social drivers of health.

One example of their impact is best highlighted in a case study on Alliance Medical Center’s use of CareMessage. In 2021, as preventive health screening rates sharply declined from the impact of the COVID-19 pandemic, the Center used CareMessage to meet their goals for cervical cancer screenings, childhood immunizations, and even number of patients with controlled hypertension. Alliance was able to target specific groups of patients and send customized messages to them with a clear call to action. The results were impressive, as Alliance met their goals for patients to make visits for their missed preventive screenings. CareMessage engaged patients to drive preventive care visits and address health disparities. In the case study, Alliance reported 39 patients moving from uncontrolled hypertension status to controlled.

Independent academic centers conducted additional studies that highlight how using CareMessage for patient engagement resulted in health outcomes, such as increased colorectal cancer screening rates in underserved populations,  improvements in food security status, physical activity, and depression scores for people who access food banks, and better hemoglobin A1c levels for patients with diabetes. CareMessage is increasingly interested in how clinics can leverage their technology to address the social determinants of health in clinical settings.

The Rx Foundation first connected with CareMessage in 2015 through a grant to support the adaptation and implementation of a mobile health platform that integrates patient health education programs with clinically-proven Patient Reported Outcome tools for a state department of health.

We recently reconnected with their team to learn more about how their platform has developed, and their impact has scaled. Below are excerpts from our conversation with Vineet Singal, Co-Founder and CEO of CareMessage. Our biggest takeaway is the importance of messaging – not just the tools we use to communicate about health but how we reach people, and in what way. Throughout our interview, Singal raises several important lessons learned about accessibility, equity, and innovation that many in the health care space – whether practitioner or community-based organization – can appreciate.

(Rx:) Before CareMessage, you were a part of a nationwide initiative at the Stanford Graduate School to register over 115,000 new bone marrow donors from underrepresented communities using social media. That intrigued me because it seems like tech and health were always an interest of yours. What initially drew you to that intersection, and what do you carry with you from that experience into your work at CareMessage today?

(Singal, CareMessage:) That’s a blast from the past! When I was an undergrad, I was pre-med at Stanford and very involved at the public service center on campus. At the time, Jennifer Aaker, a professor on campus, was recruiting a team of undergraduate and graduate students to help lead an initiative based on her book The Dragonfly Effect, which talks about using social media to drive social change. The initiative was to use individual stories of people looking for a bone marrow transplant in order to register more people on the bone marrow registry. This program was designed to amplify the stories of people going through cancer and other other conditions, especially folks from communities that were traditionally underrepresented in the bone marrow registry such as those of South Asian descent. It was just an incredible experience to work with those individuals and their families and to see the power of personal stories create broader social change. Through our collective efforts, we registered over 115,000 people at Stanford and other universities.

That was an incredible experience and one that I’m really proud of. I not only learned what it’s like to both lead a team towards an important goal, but also saw the power of technology and amplifying important messages and communications. When it’s used in the right way, it can have such significant applications in terms of reaching people on a big scale.

(Rx:) You first connected with the Rx Foundation over ten years ago. What are you all up to today?

(Singal, CareMessage:) We just completed our five year strategic plan! Our goal is to improve health equity for five million people from low-income and historically marginalized backgrounds each year, by 2028. We’re focused on three pillars to make that vision a reality: (1) access to care, (2) clinical quality, and (3) social drivers of health.

Those ambitious goals require us to have access to outcomes data at a level of scale that we have never really had before. Previously, we focused on partnering with academic medical centers and others to demonstrate improvements in target metrics in studies, randomized controlled trials, or evaluations. But we really want to hold ourselves to a much higher bar of outcomes evaluation at a scale much larger than individual studies because of the diverse populations we serve.

(Rx:) Can you elaborate on why the social determinants of health are such an important pillar of your organization?

(Singal, CareMessage:) It actually wasn’t something that we envisioned when we first started CareMessage. But what changed for us was witnessing the utilization of our platform during the pandemic. In total, we helped facilitate somewhere around 100 million messages that were COVID-19 related between our partners and our patients. 

A significant portion of the messages were on food access, housing and rental assistance. These types of messages were utilized somewhat prior to the pandemic, but it really grew significantly from 2020 to 2022 as these became the focus. That’s when we really started to think about the application of CareMessage and how we can help clinics identify patients with specific social needs. We also thought carefully about the role we can play in connecting patients to resources. That was exciting for us to imagine in terms of what the platform could do!

We also recognized the level of impact you can have on somebody’s health. Health interventions are going to be extremely limited if all you’re focusing on is the clinical needs. So much of the health related challenges emerge from needs that are not traditionally clinical – like food access or air quality, having an A/C unit in your home, whether you have transportation to attend doctors appointments. All of these different things have an impact on people’s ability to achieve optimal health. We’re really excited about the role we can play in this space.

There’s so much more I think we can do in building more capabilities that are exclusively focused on helping clinics identify social determinants of health needs closer to when they actually occur too. In many partners’ clinical settings, they’re not collecting data on social determinants of health at the same rate or at the same frequency as patients are experiencing those needs. Collecting that information is goal number one. Goal number two is how to connect patients to resources virtually and close that gap. How do we help ensure that that patient received that particular resource, or got the help they needed? How do we help them do that?

(Rx:) Can you tell us more about the different partnerships you have and how CareMessage is being leveraged across all of these different entities towards the shared greater vision of health equity?  

(Singal, CareMessage:) In order to be successful, we know that we have to partner with a variety of different types of organizations for different use cases and applications. For instance, we partner with Epic, NextGen, and athenahealth so we can get the data that we need for patients served by FQHCs, free and even tribal health clinics, that use these EHR systems. As an example, our latest integration allows clinic staff at FQHCs and other sites to create interventions for different patient cohorts. CareMessage automates the segmentation of patient populations and creates follow-up actions based on the clinical data in the EHR, our data analysis and messaging capabilities. This looks like messaging patients who have diabetes who have not come in for an appointment and don’t have one scheduled to prompt them to come back in for care – or clinical staff using hemoglobin A1c values in EHRs to enroll patients into health education programs. These interventions have been proven to work, and once set up require zero staff effort to maintain. 

We partner with other organizations to help us think through recommendations for communication and messaging to large scale populations. For example, during the COVID-19 pandemic, we had an advisory board to help inform the messaging that we recommended to our clinics around vaccine hesitancy. Many of our clinics look to us not just as a tool to drive messaging but also as an expert on what to message. That’s a really critical part of the service that we provide too – how to deliver a message in 100 and 60 characters. How do you create ongoing conversations? How do you use the right tone? What messaging is the right frequency? What time of day, and what day of the week is optimal? 

We also partner with organizations outside of what you’d typically think of as “healthcare” organizations. For instance, we work with Vot-ER, a nonpartisan, nonprofit organization working to integrate civic engagement into healthcare. This partnership is really important because we know that voting is a social determinant of health. Political access and power is a social determinant of health – and it has a huge impact on people’s ability to have a say in their own outcomes. Encouraging people to vote in a nonpartisan way is exciting.

(Rx:) You’re providing some expertise around how to message, which I think in this world of misinformation and disinformation that is really important. It’s also about figuring out what message resonates with communities, while paying attention to literacy levels.

(Singal, CareMessage:) I’m glad you brought that up. 100% of our messaging is at 6th grade reading level or below, 80% is at 4th grade reading level or below. That’s one of several things we do to make sure our messages are accessible. We also consider what devices patients are using to make sure they are readable (e.g. smartphone versus flip phone), and what languages people need to receive messages in. 

We’ve been very fortunate to have supporters and funders like Johnson & Johnson who funded our language expansion efforts a couple years ago so we could grow from two languages (English and Spanish) to over 61 languages that CareMessage now supports. It’s a huge upgrade in terms of equitable access. It allows us to reach over 99% of the target population that we want to serve. 

When we think about social drivers of health, like food insecurity and deserts, we also consider the other factors that might be impacting people’s ability to live healthy lives. So how do we kind of account for that in the communication that we’re sending? That’s a big part of why CareMessage exists, and why we’re so focused on this population exclusively. Unlike a lot of other platforms that provide messaging capabilities, we are able to tailor our approach to populations that are served by safety-net providers.

(Rx:) What excites you about the future of CareMessage?

(Singal, CareMessage:) We’re sort of a tech company inside of a nonprofit. We’re fully not-for-profit, but at our essence, we are a technology company in terms of building products and being at the cutting edge of technology. What really excites me is the fact that we are in a unique position to leverage the latest technology for health equity.

In 2013, when we first started, it was cloud computing and being able to do application-to-person messaging. Now we’re looking at what’s possible with generative A.I. Obviously, there’s so much harm that can come from using A.I. improperly but we’re taking an ethical approach that lets us make an impact while also mitigating a lot of the issues facing A.I. today. We are seeing that just in some of the early work that we’re doing. I think that’s what’s most exciting to me is the fact that we are in such a good position to just leverage what’s possible through technology to actually solve real problems and have real impact versus just building technology for the sake of building technology.

(Rx:) That’s a beautiful way to end because I think it naturally brings us back to where you started with your early interest in the intersection of health and technology and how you can leverage tech for health equity.

With the help of philanthropy, CareMessage recently established a $2.2M impact fund to bring their messaging tool to other safety net health care organizations, like Federally Qualified Health Centers and free and charitable clinics across the country. Historically, CareMessage has been able to leverage grants and philanthropic dollars to assist over 114 safety-net healthcare organizations in adopting their tool. 

Today, CareMessage is excited about the role philanthropy can play in helping their own organization innovate, invest in data infrastructure and test out applications of generative A.I. towards their five year goal of reaching 5 million people by 2028.