Health care improvement often refers to the process of making changes to the way health care is delivered by providers.  But actions to improve and reform the health care delivery system can only go so far. As Dr. Don Berwick, Administrator of the Centers for Medicare & Medicaid Services often reminds us, the delivery system doesn’t have much control over the biggest factors that influence a person’s overall health. For example, a doctor doesn’t decide what each of their patients eats, whether every patient takes their medications, or how individuals respond to symptoms of chronic diseases like diabetes. Those health choices rest squarely with the individual.

Beacon Communities Seek New Health Improvement Opportunities

While the Beacon Communities have made significant investments in improving health care delivery in the 17 areas where they operate, they also constantly seek out improvement opportunities that exist outside of the traditional delivery system. For example, they search for new sources of information, new support mechanisms, and new tools that make it easier for individuals  to access the care they need and better manage their own health.

New Diabetes Management Initiative with ADA, CDC, HRSA, Beacon Communities and Voxiva

We are thrilled to be announcing a new initiative with the American Diabetes Association (ADA), two Beacon Communities (New Orleans and Detroit), the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA) and Voxiva (a mobile technology company recently named one of Fast Company‘s ‘World’s 50 Most Innovative Companies’) at the ADA’s 71^st Scientific Sessions

We are coming together with these organizations to implement an innovative, highly-scalable public health activation campaign that offers a new way to take three actions:

• Encourage individuals to engage with and manage their health,
• Help individuals assess their diabetes risk levels, and
• Better connect individuals with the wealth of existing wellness and diabetes care resources available today, to help them manage their diabetes more effectively.

SMS-Based Health Risk Assessment – Connecting Patients to Doctors

The campaign will make a texting-based risk assessment available to anyone with a cell phone, promoting the access number through traditional public health channels.

Here’s how it works:

1. Through their cell phones, individuals will be asked brief questions that assess their risk for diabetes.  The user would answer these questions by sending a text.
2. Based on their responses to this text-based assessment, individuals will be connected with the best possible resources for their needs. This may be an online social forum, a discount for a check-up at a local pharmacy, or the phone number for a local health care provider.

The beauty of using mobile technology in this way is that it allows engagement with a much larger population than the health system can manage on its own, while simultaneously tailoring information and resources to the individual.

Why is Mobile Technology Perfect for Diabetes Management?

There is no better time to act.

Diabetes affects 25.8 million individuals in the United States, over 25 percent of whom are undiagnosed.[1] The epidemic is particularly acute in areas where the two Beacon Communities participating in this program are located: Louisiana has the highest rate of deaths from Diabetes in the United States[2], and Michigan is ranked seventh highest among states for percent of its general population affected. [3]

Ann Albright, PhD, RD, Director of the Centers for Disease Control and Prevention’s Division of Diabetes Translation puts it this way:

“The increasing number of Americans with diabetes or at high risk of developing type 2 diabetes is a significant problem for individuals and for the United States,”

“It is important to use mobile technology and other methods to connect people to effective ways to improve their health. CDC looks forward to working with this innovative project and the potential application to the CDC-led National Diabetes Prevention Program.”

Saving Patients Time and Money, yet Providing Better Diabetes Care

Take an individual in Detroit who has not seen a doctor in the past 10 years because of the perceived financial burden – the ease of the texting process could make him aware of his diabetes risk at the touch of his cell phone, and connect him to potentially life-saving resources he might not have known about. For someone who has a doctor but has been unable to effectively manage their condition, the campaign could prompt him to get back in touch with his doctor and do a follow up visit.

What’s Next for the Campaign?

Over the next two months, colleagues at CDC, ADA, Voxiva, and ONC will help the Detroit and New Orleans Beacon Communities design and deploy this new campaign. The collaboration will include the design of tools and interventions, as well as the development of effective communications that help get the word out about the campaign. All these design elements are being done with an eye toward easy replication and scale across other communities.

How will the Mobile App Work?

The design of our engagement efforts will build on the success of the national Text4Baby Campaign (http://www.text4baby.org/), which is also a partnership between CDC, Voxiva, and others. In designing the diabetes patient activation campaign, we will shift the focus to diabetic patients, add in a customized diabetes risk assessment tool and use the Beacon Communities’ networks to connect individuals with customized resources.

“There will be a massive effort to get the word out about these services,” said Vivian Fonseca, MD, Professor of Medicine and Pharmacology, Tullis, Tulane Alumni Chair in Diabetes and Chief, Section of Endocrinology at Tulane University Health Sciences Center.

“We want to ensure that people who are at risk for diabetes, but who may not have many resources at their disposal, or who may not realize they need to take preventive health measures, can navigate their way to the health resources they need. Type 2 diabetes and its complications are often preventable, but only if people know their risk factors and address those areas where they may be at risk.”

ONC is Looking for Feedback

Also over the next two months, the organizations leading this initiative will be challenging the national innovation community and health care community to get on board.

So we want to ask you is:

With this new opportunity to connect with at-risk diabetic individuals, what are the best resources that can be offered to them?

Is it a gym membership, the latest disease management application, a web-based support group, a free clinic, or something else?

More to Come on other Beacon Community Innovations

This campaign is part of a broad effort in the Beacons to deploy new consumer ehealth tools to help individuals better manage diabetes and other chronic conditions. Projects are underway in Beacon Communities to deploy follow-up reminders, disease management protocols, and interactive monitoring using mobile technology. Look for a forthcoming blog posts on these wider efforts.

Send us your Ideas

Finally, we are announcing this work in part because we intend to collaborate with other experts and partners who can contribute to make the campaign a success. Please contact us with ideas at pierce.graham-jones@hhs.gov.

ADA Press Release, June 25, 2011: American Diabetes Association Advising on the Use of Information Technology to Improve Diabetes Prevention, Management in Beacon Communities

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[1] CDC National Diabetes Fact Sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

[2] http://www.statemaster.com/red/state/LA-Louisiana/hea-health&all=1

[3] http://www.statemaster.com/red/state/MI-Michagan/hea-health&all=1