An Interview with CareMessage Chief Medical Officer, Tracy Angelocci, MD

Tracy Angelocci, MD, a longstanding customer and super-user of CareMessage, joined us in July as our first-ever full time Chief Medical Officer!

Dr. Angelocci, an Internist and Pediatrician, most recently served for more than 10 years as the Chief Medical Information Officer (CMIO) at Lone Star Circle of Care, one of the largest Federally Qualified Health Centers in Texas, serving nearly 100,000 patients in 55 clinics locations spanning 6 counties. She has a unique career track that has covered both the vendor and clinician sides of healthcare information technology. Dr. Angelocci combines her history of senior-level electronic medical record software design with avid experimentation in data-driven clinical practice transformation to manage population health more effectively.

Dr. Angelocci gave us a view into her past accomplishments and future plans by answering some questions, below.

• In your previous role at Lone Star Circle of Care, you were a CareMessage customer. Why was CareMessage a good fit for the needs of your center?

The breadth of features that CareMessage offered was key for us. Our EHR offered only one-way, campaign-style messaging- no response texting. No reporting or outcomes-tracking was available.

We initially rolled out CareMessage for our Population Health team, which is responsible for managing our performance on value-based contracts. That team became a heavy user of CareMessage Outreach campaigns and Messenger to close care gaps. Most of our patient outreach employs response-based questions that help an engaged patient take the next step without having to schedule an appointment or call us (both of which can be perceived as barriers). For example, an outreach for breast cancer screening might allow the patient to simply type back ‘YES’ to have an order for a mammogram placed by the team.

Our call center experienced a spike in call volume during COVID, which persisted for months, even after the COVID vaccine first became available. We were able to exclusively use CareMessage to offer and schedule all vaccine appointments, removing a significant burden from other departments.

Our referral team was the next on board. Once a referral is processed internally, if the first call to the patient is unanswered, the appointment scheduling details are texted to the patient.,

Last year we began a system-wide process redesign project. As part of that, most clinic managers developed at least one quality improvement project that involved texting.

Most recently, we finally switched our appointment reminders from our EHR’s solution to CareMessage, which gave us more features and represented a significant cost savings. With CareMessage, because we were not paying per message for appointment reminders, we had more flexibility to send multiple reminders and respond to patients, which positively impacted our no-show rates.

• What do you think sets CareMessage apart from other patient engagement and activation platforms?

Because CareMessage is a mission-driven, non-profit company, the focus is really on what solves the most problems for safety-net healthcare organizations- not on maximizing sales or profit. The specific focus on safety-net organizations and their patients makes the CareMessage product and the library of content very relevant for the needs of these patients.

In terms of content, I think there’s a great balance between enabling customization and having out-of-the-box content available (that, importantly, has been designed with literacy and cultural sensitivity in mind). The combination of ready-to-go content with an incredibly intuitive user interface lets you get up and running on day one.

The CareMessage pricing model- which allows for a flat fee based on number of patients, as opposed to charging per text or per feature- allows customers to realize an incredible return on investment.

• What are you most excited about in your new role?

CareMessage is invested in making sure that clients see real outcomes from their messaging campaigns, and I’m excited to get involved in this. I’m looking forward to further study of theories of behavior change, and applying these to our messaging. CareMessage has already been creating individualized content based on demographic variables, and I am interested in exploring and expanding on this work. We have the opportunity to test and research response rates to find even more effective patient engagement strategies.

• Looking forward- what are some shifts or trends in healthcare that you think will impact CareMessage customers the most?

FQHCs have been measuring clinical outcomes for a long time and are passionate about health equity, but as they take on more value-based contracts, their performance on associated metrics affects their financial bottom line. We know that patient engagement and retention are key to improving health outcomes. A flexible communication platform that extends care beyond the visit will be crucial.

And, of course, there is recent national attention on the Social Determinants of Health. FQHCs and free/charitable clinics have always understood the impact that social, environmental, and economic factors have on health. While these organizations have employed community health workers and referred patients to community-based organizations for years, there is a new emphasis from payers and grant makers to quantify that work.. So while addressing SDoH is in our DNA, there is opportunity to create new workflow processes, standardized data collection, technologies, and interfaces — to both collect the needs data and then formally track referrals through to their endpoint. And there’s a lot riding on this — we need to quantify the workload and trace it to favorable outcomes so that payers and policymakers see the benefit of investing in upstream work that has historically been uncompensated.

• What would you like the future of patient engagement and activation to look like?

I think the key will be personalization. We need to understand where an individual is in regard to change readiness, including their beliefs on perceived importance, health risk, and barriers to change. Then we need to employ an evidence-based, tailored approach to engagement that meets them where they are. This personalized communication strategy should be coupled with a new approach to health and wellness delivery that happens as much outside of the walls of a clinic as inside.

• How do you maintain a work-life balance?

There’s a quote that says “There’s no such thing as work-life balance; it is all life. The balance has to be within you.”

It’s a challenge and I haven’t always had that balance. For me, it started with the gradual realization that I am the only person who is responsible — and able — to make that happen for me. It became more than a priority — it became a personal value that I won’t compromise.

Thank you, and welcome again, Dr. Angelocci!