Name of Innovative Program:
RTM Health, Inc. ("re:Mind")
Name of Innovative Program Lead:
Molly Viscardi, Meghan O'Brien, Dan Bernick
E-mail Address of Innovative Program Lead:
re:Mind is a text message based appointment reminder service for patients discharged from inpatient psychiatric care to facilitate attendance at their first outpatient appointment.Claims data suggest many Philadelphia patients do not attend an outpatient appointment within 7-14 days; national data suggests that 42% of patients discharged from inpatient psychiatric care miss their initial appointment, a number much higher than the average medical referral no-show rate. re:Mind provides a simple, quick, and cost-effective means to increase appointment attendance, targeting the most common reason patients miss their appointments: they forget. By keeping patients connected to care, re:Mind prevents unnecessary re-hospitalizations, reduces “no-shows”, and encourages timely follow-up care.re:Mind provides a cascading intervention, beginning with text message reminders, to increase primary appointment attendance and enable data collection on appointment scheduling and cell phone usage. Discharge planners will spend less than five minutes entering contact and appointment information into the user-friendly, HIPAA-compliant website, which will automatically generate a one-page handout for discharge and two text message reminders, at 7 and 3 days prior to the patient’s appointment. Viewed with claims, re:Mind data can subsequently be used to inform targeted interventions, ensure appropriate levels of care, and allocate resources optimally.
Creativity and Innovation:
re:Mind is the product of an interdisciplinary collaboration, developed by four students from the University of Pennsylvania Schools of Government, Medicine, Nursing, and Social Work. The team won the 2013 National Invitational Public Policy Challenge.Our motto is to "think big, start small." In addition to utilizing popular, low-cost, high-impact technology to increase appointment attendance and better utilize current resources, re:Mind distinguishes itself with output created for analysis. The mentally ill are a transient population, about which it is notoriously hard to collect data. re:Mind will provide details about appointments made by discharging hospitals, which can be compared to claims data to determine patterns, inform policy, enhance understanding of care transitions, and obtain unprecedented information about no-shows. It will also provide information about cell phone usage in this population, which may be used to connect patients with important social services, like the Lifeline Program.
Text-message reminders are a simple, cheap and effective method that is not currently being used in this population, or on a system-wide level for any government program, to our knowledge. In addition to reminders, re:Mind is designed to be integrated with current CBH data collection methods. re:Mind's expansion and development will be an iterative process- allowing identification of target demographics (such as age, cell phone usage, presence of collateral contact, and diagnosis) for additional interventions of higher intensity. For example, patients who respond well to text messages may benefit from a monthly reminder to fill prescriptions. In this manner, all patients will receive an appropriate level of care and resources will be allocated optimally. This innovation provides direction for organizations to target subsets of the population based on the output analytics derived from the re:Mind service.
Over the last eight months, the team has developed a strong working relationship with Community Behavioral Health (CBH), the not-for-profit organization contracted by the Department of Behavioral Health to provide behavioral health coverage for the City’s 526,000 Medicaid recipients. CBH has indicated a commitment to seeing this project to fruition and paying re:Mind a consultant fee during the project launch and subsequent implementation at 14 hospitals.We also have a partnership with the Center for Mental Health Policy and Services Research at the Penn School of Medicine.In addition, the team was recently selected as a Robert Wood Johnson sponsored fellow for the 2014 Social Innovations Lab at the University of Pennsylvania. This forum provides “instruction, mentoring, support and expert guidance to social entrepreneurs in developing viable cross-sector models.” We anticipate that the Lab will help us develop critical relationships and skills to build re:Mind’s organizational capacity and financial sustainability.
re:Mind offers an evidence-based intervention model based on an inexpensive, patient-friendly, minimally-invasive, and easily accessible technology. Text message reminders have been shown to improve care transitions and reduce health care costs, with low opt-out rates by participants. re:Mind can provide a training and implementation plan for system-wide roll-out, guidance for HIPAA compliant web development and data storage, as well as for working with a large government-affiliated organization. The service also enables collection of post-intervention data that will determine effectiveness and facilitate duplication of the innovation. We are interested in expanding to other cities through information sharing or provision of services, to address similar problems related to recidivism and no-shows in this population.
The two primary endpoints for evaluating the intervention will be outpatient follow-up rates and 30-day recidivism rates. Using claims data and outputs generated from the re:Mind website, our success will be measured through decreases in missed initial oupatient appointments (indicated through service use within 30 days) and hospital readmissions (within 30 days of discharge). In addition, we seek to measure re:Mind service utilization through patient opt-in rates for text reminders; decrease in overall hospital readmission for this population through 180-day hospital utilization rates; and satisfaction with the re:Mind service through surveys with discharge planners.There is great potential return from investment in this simple innovation. In Philadelphia, the cost of re-hospitalization for patients who missed their follow-up appointments is roughly $9,429,000 annually. If the city reduces no-shows at a rate similar to the British pilot study that serves as its model, there will be an estimated annual savings of $2,484,000.