Text to vax: Why SMS may be the key to delivering more COVID-19 shots

CareMessage is helping small health clinics stay in touch with patients — and persuade them to come in for vaccinations.

​A health care worker is vaccinated against COVID-19 in December in New York. Community health centers are turning to text messages to urge patients to get a vaccine.

Community health centers are turning to text messages to urge patients to get a vaccine.

Photo: Scott Heins/Getty Images

When PrimeCareHealth in Chicago started signing up patients to receive a COVID-19 vaccine, its staff didn't use fancy apps or AI technology. Instead, the nonprofit relied on an old technology: text messages.

The group, which provides free or low-cost health care, sent its first message about the vaccines in January, using startup CareMessage's service to target patients over 65 with two or more medical conditions. It has now messaged close to 5,000 patients in different groups. The texting service lets customers pick specific groups for mass messages as well as one-on-one messages through which they can receive responses from patients.

"We were thrilled by the response," said Erin Howes, director of quality improvement at PrimeCareHealth, which serves 22,000 low-income patients a year across six clinics, about 50% of whom are Spanish-speaking.

Nonprofit CareMessage, which works with clinics reaching low-income families, people of color and rural populations, offered a text messaging service before the pandemic that helps clinics stay in touch with patients on health care issues or schedule appointments via SMS for chronic conditions like diabetes.

Once the pandemic hit, CareMessage shifted to helping clinics reach patients to get tested for the coronavirus and then to get vaccines. It launched a free version of its product for nonprofits that doesn't require complex integration with other software. At the end of last year, it rolled out a library of messages and surveys that clinics could use to book appointments, create a waitlist or ask patients about their willingness to get a vaccine. It saw a quick uptick in usage and has now sent out more than 3 million vaccine-related messages across 170 providers in about 40 states.

"It's part of our initiative to address increasing vaccine confidence in communities that have a direct impact with COVID," said CareMessage CEO Vineet Singal.

Making an impact

Those with lower incomes, people of color and non-English speaking groups have suffered higher COVID-19 infection rates, while rural populations have had higher death rates — and those groups have had lower vaccination rates than the general population. To address this, the Biden administration has increased the number of community health centers that will distribute vaccines from 250 to over 900 organizations. "Community health centers are a big part of the national strategy to get vaccinations to underserved populations," Singal said. Since those organizations are already delivering health care, they're often more trusted by otherwise underserved communities.

The problem: Many are small nonprofits without the infrastructure to quickly inform, communicate with and track the relevant patients who need or are getting vaccines. Tools like CareMessage have become important for this, providers say.

Despite the proliferation of smartphones, text messaging is still a key way for health clinics to reach certain populations, because they don't use email, are too busy for calls or just prefer to answer text messages later. Some still have feature phones. Others might not know how to use websites to sign up for vaccines. Some patients have limited cell phone minutes for calls, so they don't want to use them setting up an appointment, Howes said. And people in rural areas often have dead zones where they don't get calls but can get text messages later, Singal said.

"It's better than any other tool," said Wes Keyes, executive director at Brother Bill's Helping Hand, a Dallas 501(c)3 food pantry and clinic that serves 10,000 people, about 75% of whom are Latino. "If you give them a phone call, it's more invasive than sending a text." Texts, he said, are more "respectful."

In addition to using it for signing up people for vaccines, Brother Bill's also uses CareMessage to communicate with its clients about events, programs and times when there's extra food or other goods available.

The first time it used CareMessage was at the beginning of the pandemic when an 18-wheeler showed up with frozen food from a group that couldn't use it. Brother Bill's used CareMessage to notify members of the haul, which amounted to 17,000 meals. In about an hour and a half, the meals were all given out. "That was the day we looked at ourselves and said, 'This is the most important tool we have in our entire arsenal,'" Keyes said.

One big benefit for clinics is saving staff time. Another Texas clinic scheduled 900 vaccine appointments via phone calls, which took six people four days, Singal said. Then it did its second batch of 900 using CareMessage, which took two people two days — a 83% reduction in staff time.

"We had a limited number of staff to call constituents for weekly reminders of appointments," Keyes said. "This has been a game changer that's allowed us to have time to talk to people in ways that they're actually interacting with you."

While PrimeCareHealth's electronic health record system can send text messages, it lacks the ability to see who actually read or responded to the messages, and thus how its outreach is performing, Howes said. It also can't filter patients by age or health condition, which is important to reach certain patients.

This direct messaging to individual patients has been used much more during the pandemic, said Orit Mohamed, product manager at CareMessage, which has raised more than $25 million from Y Combinator, Google.org and others. These could be follow-up messages after an appointment to provide information on free transportation, rental assistance or how to access telehealth appointments or how to book a vaccine appointment.

Now that vaccines are more available in the U.S., a key issue for clinics is countering vaccine misinformation. The Texas Association of Charitable Clinics, which works with 70 clinics, are using CareMessage to send out educational or informational texts to patients, said Jody Hopkins, executive director.

Messages coming from local clinics are also important because they come from a trusted local group, Keyes said. Large, government-run operations don't have that level of trust. Many of his patients are waiting to get it from his clinic even if vaccines are already available elsewhere, he said.

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