Connecting patients to public benefits works better with texts than paper flyers, Penn research finds

Text messages are more effective than paper flyers to help emergency department (ED) patients apply for public benefits programs, like Supplemental Nutrition Assistance Program (SNAP), Property Tax and Rent Rebate Program (PTRR), or Low Income Home Energy Assistance Program (LIHEAP). A quarter of eligible ED patients who received a text message referring them to a public benefits navigator called, and 18 percent enrolled in at least one benefit. On the other hand, no patients that received the information on paper called or enrolled, according to a study published this month in JAMA Health Forum by researchers at the Perelman School of Medicine at the University of Pennsylvania and Accelerate Health Equity.

“Patients are understandably focused on their medical care while in the ED, and information about other programs that could benefit them are not going to be top of mind, especially if it's just another piece of paper on top of their discharge and follow up instructions, which are commonly also printed papers,” said study author, Austin Kilaru, MD, MSHP, an assistant professor of Emergency Medicine. “But if we text them even one day afterwards, then they have the brain space to look into these helpful resources.”

Text messaging as a post-discharge tool

Prior studies have shown that text messaging after ED discharge can promote medication adherence, monitor symptoms, and improve attendance to follow-up appointments. Text messaging has also been shown to improve healthy behaviors, like exercising, losing weight, and reducing substance use.

For this study, researchers used electronic health records to identify patients at two Philadelphia EDs who were less likely to have a severe illness and who were actively enrolled in Medicare or Medicaid insurance. Patients who did not live in Philadelphia or have access to a cell phone, who were intoxicated, in police custody, or were likely to be admitted were excluded from the study.

160 participants were enrolled in the study and completed an online survey to determine eligibility for benefit programs. During their time in the ED when they were not receiving medical care, a research coordinator told them about the different assistance resources that they qualified for and were given flyers with the phone number of a Philadelphia nonprofit hotline staffed by benefits navigators. Half of the participants received a series of automated text messages on day one,

three, seven and fourteen after ED discharge. The text messages included a short prompt and the hotline phone number. Participants could opt-out of text messages and the study at any time.

Of the 79 participants enrolled in text messages, 20 (25 percent) called to explore benefits within 14 days, and 11 (18 percent) enrolled in at least one benefit, compared with zero calls in the control group. After 30 days, 24 participants (18 percent) in the text message group had called the benefits hotline, while just two participants in the control group had called – after receiving a follow-up survey on day 14 via text message.

“The success of the text messages confirms that we should use different strategies to improve communication after a person leaves the hospital,” said Kilaru “The barrier is sometimes awareness that benefits exist, but it can also be the friction that prevents people from taking the next step. We can use an ED visit as an opportunity to find people who are eligible for benefits but not enrolled and support that next step.”

Putting benefits within reach

Every year, it is estimated that Philadelphians are eligible for around $450 million dollars in federal and state benefits that they do not apply for. These benefits include support for food, housing, healthcare, economic support, and others that can make a significant impact on well-being, upward mobility, and financial stability. There are many reasons for the discrepancy between available benefits and lack of claims including lack of awareness about benefit programs and eligibility criteria, complicated application processes, and social stigma about accepting public benefits.

EDs are uniquely positioned to help address these unmet needs, as they often serve patients who don’t otherwise have health care providers, and are also more likely to have less engagement with social services. EDs also already screen patients for some health-related social needs, like access to transportation, exposure to violence, and housing and food insecurity, and some health systems collaborate with social service organizations to help individuals manage some health-related needs.

“This isn’t about replacing human support—it’s about making that support easier to reach,” said Kilaru. “When health systems pair existing community resources with simple digital tools, we can and help more patients actually access the assistance they qualify for.”

This research was supported by the National Institutes of Health (NCT05654220).