People stay healthier when they show up in their doctors™ offices for necessary health check-ups, but it™s sometimes challenging to get them there. Today, one Medicaid program, Delaware Physicians Care, Inc. (DPCI), is using cell phone text messaging to remind members of appointments, let them know if they have missed an appointment and inform them when they should be scheduling tests or additional appointments.

DPCI™s original pilot program, using text messaging to remind members who have diabetes of the need to schedule regular blood tests, was so successful that the health plan recently began a second program, reminding pregnant moms of their prenatal and postnatal appointments.

Once enrolled in the program, pregnant members receive a variety of messages that deliver educational information and appointment reminders to their cell phones. Members who miss their appointments are sent messages to remind them to reschedule.

Providers benefit by having access to a tool that can increase the appointment compliance of their patients, leading to a decrease in no-show rates, said Dr. Stanley Lynch, DPCI chief medical officer. Members benefit not only from having the convenience of appointment reminders, but also from having ready access to information that can help them have improved birth outcomes.

We are extremely excited about the potentially positive impact this program can have on our pregnant members and their expectant children, he continued. Leveraging the success we achieved using text messaging for our members with diabetes, we hope to improve prenatal and postnatal visit compliance in this membership group. This could in turn result in improved pregnancy and birth outcomes, something we strive to achieve every day.

In the 2006 pilot project with diabetes patients, DPCI found that after six months the percentage of patients receiving a necessary test rose from 52.3 percent to 70.5 percent in members receiving text messages. Furthermore, the results were much higher than the 45.4 percent rate for members of a control group of diabetes patients who did not receive text messages.

Diabetes is a disease that touches the lives of tens of millions of Americans, and the number is continuously growing. Knowing how well the patient™s diabetes has been controlled over time is essential to the management of the disease, Dr. Lynch said.

Evidenced-based medical guidelines call for a blood test to provide that information, he explained. The test, called HbA1c, is an easily obtained and commonly available blood test that measures adequacy of glucose control. The maintenance of HbA1c levels in the normal range through tight glucose control has been shown to be a strong predictor of improved healthcare outcomes for patients with diabetes. The blood test results can be used to make necessary adjustments to treatment regimens and lead to better long-term control.

The challenge is that the test should be obtained on a regular-interval basis, as frequently as every three months. This degree of frequency can present a compliance challenge to many patients and their medical providers, Dr. Lynch added.

We wanted to find a way to reach patients in a discreet, yet efficient way. It seemed to me, with all the popularity of text messaging these days, that cell phones might just provide the communications tool we needed, Dr. Lynch said.

We reached out to our members, and we were pleased to discover that many of them had mobile phones, even when they did not have reliable land line phones, he said.

One study by the New Millennium Research Council indicated that more than 60 percent of households with incomes of less than $35,000 have cell phones. In fact, a National Center for Health Statistics survey found that adults living in poverty were more likely than higher income adults to be living in households with only wireless telephones.

In late 2005, Dr. Lynch contacted Medixine Ltd., a company that specializes in multimodal communications software for healthcare and wellness.

We determined that our reminder and alert solution fit his needs exactly, said Dr. Tapio Jokinen, Medixine chief executive officer. DPCI sends reminders to have an HbA1c test as text messages. It also sends patients health tips related to diabetes every month, and congratulates them when they have received the test.

The results convinced us that using new communication technology can significantly enhance compliance with evidenced-based clinical guidelines, eventually leading to improved health outcomes, lower health care costs and better quality of life for our members, said Dr. Lynch.