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How to Overcome Flu Vaccination Inequities This Flu Season

Flu vaccines prevent nearly 7.5 million illnesses, 3.7 million doctor visits, 105,000 hospitalizations, and 6,300 deaths annually. For the 2022-23 flu season, 173.37 million Americans received the flu vaccine, with an average savings of $13.66 per vaccine, meaning nearly $2.4 billion was saved from flu vaccinations last season. Conversely, 46% of eligible Americans weren’t vaccinated. Understanding who isn’t getting their flu vaccine and why are fundamental to improve vaccination rates for the 2023-24 season.

When taking a closer look at the 46% of Americans not getting vaccinated, Social Determinants of Health (SDoH) factors such as age, race, and income become evident. Less than 43% of Black, Hispanic, and American Indian/ Alaskan Native adults were vaccinated during the 2021-22 flu season. Flu hospitalization rates were nearly 80% higher among Black adults than White adults from 2009-2022. Adults with incomes less than $35,000 annually had 21% decreased odds of receiving the flu vaccine. Additionally, people aged 18-49 years are nearly 37% less likely to get vaccinated than those aged 65 and older. Understanding why these inequities exist is crucial when designing programs to help overcome them.

Designing Flu Outreach for All

According to a report from the CDC, some of the leading reasons for flu vaccine inequities include lack of accessibility, misinformation, and distrust of the medical system as a whole. Program design that directly targets overcoming these barriers is essential in improving vaccination rates across member populations.  

Lack of Accessibility 

The structures and solutions put in place today primarily serve those who have the upper hand. Many members face accessibility barriers including lack of reliable transportation, disabilities that inhibit access, lack of internet, inflexible work schedules, and language and translation barriers, to name a few. Through no fault of their own, the ability for members facing these challenges to receive vaccinations is nearly impossible due to systems that haven’t been designed in consideration of diverse needs and preferences.

The good news is that health plans can play a huge role in overcoming these barriers. By deploying programs designed with accessibility at the forefront, plans can identify individual barriers, and deliver tailored resources to create access. This begins with a solid understanding of the target audience.

mPulse leverages a combination of both internal and external data sets, which enables a holistic view of member insights and gives plans the ability to craft the most relevant digital touchpoints. By connecting with members through their preferred communication channel, whether it be SMS, email, or IVR, plans can quickly and efficiently identify and overcome individual barriers. With the right message, sent through the right channel, in the right language, with the right resource, plans can begin meeting members where they are to improve flu vaccination rates.

Watch our on-demand webinar to Double Flu Vaccination Rates for Your Health Population »

Misinformation and Knowledge Gaps

While the internet and social networking platforms are a great way to discover and share news and information, they aren’t always reliable. Post-pandemic, perceptions about vaccinations and flu have garnered even more skepticism. It’s more important now than ever to provide members with reliable and relevant information about vaccines.  

By borrowing inspiration from preferred methods of content consumption, i.e. popular social platforms, mPulse educates members in a frictionless, relatable format. Short-form content that is both entertaining and educational is a great way to provide relevant information. In addition to ensuring the content is frictionless and engaging, we also ensure its accessible. Relatable characters that portray diverse populations, and multilingual capabilities are essential to resonating with broader member groups and gaining credibility. Content is sent through each member’s preferred communication channel, making it easy to receive the information they need.

Like the fotonovelas? View another one included in the mPulse Mobile Flu Vaccination Solution here »


Lack of representation in the medical field, in addition to a longstanding history of structural racism and discrimination contribute to the lack of trust many members have toward the medical system. While health plans are a small piece of this larger puzzle, gaining the trust of the members they serve is imperative. Leaning on digital trends for inspiration and support in building trust can allow plans to scale effectively.  

Several positive and meaningful touchpoints over time helps create and sustain member relationships. mPulse works with health plans to deliver empathic messaging that includes relevant and accessible information in each member’s preferred language, through the right channel. When members feel they can rely on their health plan for the care and resources they need most, they’re more likely to trust their plan and feel empowered to act. Simply informing a member they are due for a flu vaccine may come across as abrasive. Our sensitive, culturally relevant messaging incorporates behavioral science techniques, cinematic educational content, and tailored resources, letting the member know their plan understands their needs, and cares about their health. When members feel valued, they’re more likely to trust their plan, and adopt healthier behaviors.

In Conclusion 

Technology has an imperative role in helping overcome health disparities and barriers to flu vaccinations. By leveraging innovative digital trends designed to serve vulnerable populations, health plans can begin broadening accessibility, educating and empowering members, and building trust at scale to improve vaccination rates and inspire healthier outcomes for the populations they serve.

mPulse Mobile designs solutions that identify and overcome barriers to action. Our behavior change model incorporates health equity, behavioral science, and instructional strategy to deliver best-in-class outcomes. To learn more about how our flu vaccination solution can help overcome vaccine hesitancy for your members, contact us.

Celebrating Achievement in Health Equity and Technology Innovation at the Activate Awards

mPulse Mobile recently wrapped up its fifth annual Activate conference with the Activate Awards, which provided yet another celebration of healthcare leadership, innovative program design, and improved health outcomes amidst various health engagement challenges.

The theme of Activate2022, The Power of Behavioral Science to Drive Health Action, was reflected throughout the conference with captivating speaker sessions and expert panel discussions. Networking inspired exciting conversation around innovative technology, behavior change design, and consumer experience, and the Activate Awards surely brought those conversations full circle.

The awards help illuminate health plans, health systems, health service providers, PBMs and other types of healthcare organizations that utilized new strategies or unique tools to activate their consumer populations. The companies highlighted each year typically face barriers with engaging a certain population or driving specific health actions, so they search for innovative solutions to tackle those challenges. 

For example, in 2019, CountyCare saw drastic rates of members losing Medicaid coverage, so the managed care organization (MCO) implemented automated text dialogues and saw their Redetermination rates improve by 3.3 percentage points in just one month, subsequently running away with the Most Improved Consumer Experience award. Last year, CareSource incorporated secure surveys, SMS, and streaming video to significantly impact their hard-to-reach members – they won 2021’s Best Use of Conversational A.I.  

The same story is true for this year’s winners.   

The remaining 3 award categories are Achieving Health Equity, Most Innovative Solution and Most Significant Outcome. Like the teamwork and critical thinking generated from breakout workshops and Q&A during the conference, the awards are a celebration of two companies that partnered together to overcome consumer barriers or gaps in care by building uniquely tailored engagement programs. 

Here are the winners of the 2022 Activate Awards: 

Achieving Health Equity

Program Goal
Increase Colorectal Cancer Screenings

AltaMed Health Services is one of the largest Federally Qualified Health Centers (FQHC) in the United States and provides a range of health services to Latino, multi-ethnic and underserved communities in Southern California. After seeing a steep drop in colorectal cancer screenings during the COVID-19 pandemic, the health center sought a solution that could help patients overcome barriers like language and lack of awareness of services. 

AltaMed partnered with mPulse to deliver multi-lingual, educational health content to patients using mobile fotonovelas tailored to both males and females who had not completed a screening. Patients received and digested vital communication about getting screened, where to find the nearest screening site, and more through culturally sensitive stories delivered in a familiar format.  

A randomized control study found that 63% of patients who responded to the fotonovelas either liked or loved it, and 39% reported it positively impacted their willingness to act. By educating patients with curated content, AltaMed closed a key screening gap, lifted health literacy and perhaps most importantly – made significant progress toward health equity.

Notable Outcome
Patients that viewed the fotonovelas (19%) were more likely to submit a sample for cancer screening than patients in a control group (11%)

Best Use of Conversational A.I.

A Technology-Enabled Health Services Company
Program Goal 
Promote smoking cessation among teen vapers 

This leading health services organization employs over 210,000 employees globally and utilizes technology-enabled solutions to promote consumer wellness and population health. A major public health problem facing young adults, particularly teens, across the U.S. is the use of e-cigarettes, or vaping. The company sought to promote smoking cessation among teen vapers, a cohort still widely understudied, by implementing intelligent conversational solutions and educational content.

They collaborated with mPulse to build a personalized SMS program, lasting 4-6 months, that leveraged Natural Language Understanding (NLU) to deliver automated, interactive text dialogues to a targeted teen population. Individuals were also provided custom-built streaming health videos that offered tips on quitting and even an option to connect with an SMS coach. 

The use of NLU enabled the delivery of automated messaging based on text responses, which helped the organization direct each individual to the appropriate resource. The program yielded an 85% engagement rate, and ultimately 69% of participating teens completed the program. The key result, that 73% of teens in the program set a date to quit vaping, demonstrates the value in utilizing automated text conversations and on-demand content to promote smoking cessation in vulnerable teens.

Notable Outcome 
73% of participating teens set a quit date

Check out a new streaming health course for smoking cessation. »


Most Improved Consumer Experience

CalOptima Health
Program Goal 
Increase Awareness of SNAP benefits (CalFresh)

CalOptima Health is a County Organized Health System that provides health insurance coverage for low-income children, adults, seniors and people with disabilities. As Orange County’s largest health plan, the organization includes a network of over 10,000 primary care doctors and serves over 900,000 Medi-Cal beneficiaries. The health system looked to address a gap they had identified with low-income families enrolling in the state’s food assistance program, CalFresh, federally known as SNAP.

CalOptima and mPulse partnered to launch a two-way texting campaign, which utilized interactive SMS powered by NLU and tailored to 7 different languages. The health plan addressed language barriers by delivering vital information about CalFresh’s food security benefits to underserved families and Medi-Cal members in their preferred language.  

Through automated text workflows, members could respond in their native language with answers like: “I already have CalFresh” or “I want to apply.” The program has continued to expand, having delivered over 5 million messages in 2022 already. Communicating with members according to their preferences about important CalFresh benefits helped CalOptima both improve consumer experience and reduce food insecurity for an at-risk population.  

Notable Outcome 
Over 5 million messages delivered to members in 2022 about CalFresh benefits

Like what you’re reading? Join us next year for Activate2023! Secure your spot now. »

Most Innovative Solution

Program Goal 
Drive members to schedule a diabetic eye exam

Humana is one of the five largest health plans in the country according to member enrollment and has been partnered with mPulse for over 10 years. With more than 20 million members, including over 5 million Medicare members, the plan looked to close a gap with their members scheduling the annual diabetic eye exam.

The plan worked with mPulse to launch an SMS texting campaign to increase awareness around the importance of the eye exam and to drive members to schedule an exam. The program featured A/B testing, in which one half of members was provided a 30-second streaming health video in the initial message while the other half received only text.  

The educational video enabled a learning experience that was easily accessible and familiar, concluding with a URL for members to learn more about scheduling the eye exam. Humana saw a remarkable 270% increase in clicks to schedule an exam when outreach included the streaming video. The test demonstrates that using streaming health content alongside two-way conversational solutions can significantly help activate hard-to-reach members with diabetes.

Notable Outcome 
270% increase in clicks to schedule a diabetic eye exam when outreach included 30-second streaming video

Most Significant Outcome (tie)

A Technology-Enabled Pharmacy Services Company
Program Goal 
Improve member experience and pharmacy engagement

The leading PBM and pharmacy services company is nationally recognized and fills over 1 billion prescriptions annually for millions of healthcare consumers across the country. With a rapidly growing population, the healthcare leader sought a solution to improve pharmacy patient engagement by utilizing a new communication channel for its home delivery pharmacy and prior authorization programs. 

The pharmacy leader partnered with mPulse to roll out more than 50 outbound-dialer Interactive Voice Response (IVR) campaigns. The IVR messages notified members about prior authorization approvals/denials, refill reminders, shipping details and doctor responses.  

Ultimately, over 5.8 million IVR records were exchanged and the outbound dialer launched over 5.1 million total calls. By offering a new avenue for members to complete a healthy action like ordering medications, the pharmacy enterprise initiated meaningful conversations to help enhance member experience, improve self-service capabilities, and close pharmacy engagement gaps.

Notable Outcome 
Reached over 2.2 million members with 55,000+ members giving SMS consent

Most Significant Outcome (tie)

Program Goal 
Improve refill adherence for HIV patients 

MetroPlus Health Plan is a subsidiary of NYC Health & Hospitals, the largest municipal health system in the country. The insurance organization serves a diverse group of over 600,000 New York residents across Medicaid Managed Care, Medicare, D-SNP, MLTC and more plan types. A big challenge for the plan was getting HIV patients to refill medications that are pivotal to managing their condition and avoiding complications.

MetroPlus partnered with mPulse to educate the vulnerable population through interactive text messaging about the importance of medication adherence and reducing their  unmedicated days. Texts were delivered one week apart and provided members with vital resources like phone numbers of a pharmacy or a member of the HIV care team.

The plan measured results based on whether or not a patient completed a refill within 7 days of initial outreach. The program yielded a 69% improvement in medication refills when SMS text reminders were deployed, indicating that text nudges inspire self-efficacy and action within this vulnerable population. Through targeted, mobile intervention, MetroPlus helped positively impact medication adherence for over 1,000 patients living with HIV.

Notable Outcome 
69% improvement in medication refills with mPulse text reminders

Health Challenges in 2023

The 6 winners of this year’s Activate Awards showed that even when a new barrier is identified with engaging a population, healthcare organizations must adapt to adhere to their consumers’ needs. Whether utilizing a new communication channel, adding streaming video or incorporating multiple languages, the awards demonstrate that providing healthcare consumers with tailored, learning experiences can significantly impact how they engage with a program. 

As the needs and preferences of healthcare consumers continue to evolve, so too should the capabilities of the healthcare organizations that serve them. Next year’s awards ceremony will surely exhibit a new string of engagement challenges with complex populations and niche use cases – let’s see what type of healthcare innovation surfaces in 2023! 

The State of Health Disengagement

How do we unlock digital to get more people enrolled, lower costs to serve, and improve health outcomes at scale?

That question sums up a major challenge and business imperative to lift programs and people. To frame up that challenge, three key gaps must be considered for meaningful innovation:

The Health Programs Gap

There’s no shortage of solutions or investment focused on the problem. By 2027, the global corporate health and wellness market is expected to exceed $100 billion.

From health coaches to wellness programs, EAPs to DPPs, 401k to HSA, there’s a lot of shorthand around programs that are too often short on utilization.

By the Numbers

At a time when nearly half of U.S. adults report struggles with mental health or substance abuse, only 5% of employees reach out to their EAP. Plus, 6 in 10 are unaware of wellness programs that offer incentives just to engage.

Meanwhile, better convenience and reduced risk of illness are driving more health consumers to telemedicine for mental health and routine care than ever before.

Bottom Line

You likely have many programs in place to support the rising need for total-person care. The opportunity is now to connect your offerings and streamline the digital path to serving the right ones based on need.

By aligning your human services alongside your digital experience journey, you can start shifting from push-based efforts across disconnected programs to a pull-based model that assesses and adapts to the individual’s needs.

The Health Literacy Gap

Patty Starr at Health Action Council sums it up: “Health literacy is the key to lowering healthcare costs and better education is the key to health literacy.”

By the Numbers

As just a sample of an increasingly global problem, 88% of U.S. adults lack health literacy skills needed to manage their health and prevent disease or other illness. 70% of healthcare costs come from lifestyle choices, and people with lower health literacy report worse outcomes.

Bottom Line

Back up. Nearly 9 in 10 adults lack health literacy? That’s a huge number. And part of the problem is that people don’t know their numbers, from reading nutrition labels and measuring medications to understanding lifestyle factors and personal health history.

So if education drives lifestyle choices and choices drive costs, shouldn’t we invest in better education? Yes. But that’s not the problem. From Dr. Google to a WebMD article (designed to sell ads) to a pamphlet to take home, most health “education” is built to inform not to teach.

We know from adult learning theory that simply telling someone to read, watch or listen is not enough. These are inherently passive ways to impart information. If we want real learning and change to occur, we need to design learning experiences that give us ways to reflect, process and apply what we’re learning.

Across need state or wellbeing dimension, a properly designed digital learning experience can personalize to the individual’s needs and guide them to the right programs. In doing so, it can help us solve the health program gap and the health literacy gap at the same time.

The Latent Health Gap

When we look at health programs and services offered today, we see a spectrum from prevention to intervention.

On one side, wellness and benefits offerings are trying to expand beyond hand raisers to help more people quit smoking, move more, or talk to a health expert to start us down a healthier path.

On the intervention side, disease management, care coordination and a host of point solutions are trying to reach people before major issues occur.

That movement to the middle is by no mistake. The vast majority of people show up in the middle. Except, they don’t show up. That’s the problem.

So now that we’ve covered key gaps behind health disengagement, how can we align with evolving consumer behaviors to lift engagement at scale?

Keep Reading: The Future of Health Literacy

7 Ways to Use Streaming Content in Your Health Communication, Part 2

In part 1 of this blog series, we looked at the power of Fotonovelas, Interactive Content, and Animations to drive action in health consumers. All this content does the same thing: it goes beyond just telling a member or patient that taking an action is important. It teaches someone why it’s important and what can be gained or lost by action or inaction.

There are more types of content that can be used to solve some pervasive health challenges, though. In this post, we’ll tackle four of the top performing content types that can be used to do this: Courses, Expert Led Lessons, Stories, and Self-Assessments.

Courses to Manage Anxiety and Depression

The World Health Organization estimates lost production as the result of anxiety and depression costs the global economy over $1 trillion every year.  And, of course, it isn’t just a productivity issue. Mood disorders make it harder for people to stick with treatment plans, manage chronic conditions, and keep doctor appointments, which can have an overall impact on health and cost of healthcare treatment in the long term.

This makes it an important topic for plans and providers to discuss with their health consumers. Our 5-part course, Living with Anxiety and Depression, taught by author and mindfulness guru, Elisha Goldstein, PhD, teaches self-care strategies for navigating the negativity loop that can serve to keep many of us stuck in negative patterns and behaviors making it a truly powerful learning experience. Healthcare organizations can license the content to provide it any number of ways, including in their own branded content portal.

And anxiety doesn’t just affect adults. According to the CDC, approximately one out of every 10 kids (ages 3-17) have a confirmed anxiety diagnosis. The Parenting Kids with Anxiety course led taught by child psychologist and author, Renee Jain, contains five lessons focused on helping parents help their children transform their feelings of anxiety so they can all find calm, courage, and resilience.

Expert Led Lessons to Empower Consumers

Patients can often feel powerless when they engage in the healthcare system. They leave appointments confused. They have care plans they don’t want or know how to follow. They might not know how to advocate for themselves.

To address this and help them take charge of their care, healthcare organizations can provide expert-led video lessons from trusted experts to educate their members and patients on how to take control of their health. For example, Preparing for a Diagnostic Conversation features Dr. Archelle Georgiou who teaches members how to ensure every health decision is their decision, they leave every interaction feeling heard, and that the decisions made reflect their values and priorities.

These lessons can be embedded online, delivered via SMS messaging, or available on a streaming platform. Giving access to content led by reputable and trusted professionals is the first step to ensuring your members and patients take ownership of their healthcare.

Interactive Stories Encourage Diabetes Eye Exams

Started by Snapchat and copied by Facebook and Instagram, stories are now everywhere. Optimized for mobile delivery, they are auto-advancing snips of videos and images which healthcare plans and providers can take and use on social media as another channel to communicate with their populations or repurpose them for SMS delivered solutions. Our diabetes eye exam story below was promoted to at risk populations and is a great example of how the use of stories can educate.

A quick eye exam can detect early signs of diabetes or pre-diabetes. Because of that, getting members to their eye doctor every year is a priority. To help members really understand why doing so matters to them, we could simply send a text or an email telling them it’s that time, and that might work.

We want to help members really connect to the reality of life with eye disease, though, so to take it a step further and ensure the member or patient really understands the reason behind these exams, you can embedd this video you’re your communication program, and it includes a powerful, easy to follow call-to-action.

Self-Assessment to Determine a Need for Preventive Care Screenings

Increasing regular health screenings is an important goal for every health plan. We have an entire library of assets to help members understand when, why, and how to get the most common health screenings (like mammograms, colonoscopies, eye exams, and more).

Below is an example of a simple interactive self-assessment we provide to help members identify which health screenings are most appropriate for them based on what they tell us. Plans may already know what screenings the member is due for, but by providing this activity, it helps the member connect how their personal characteristics connect to their screening recommendations. Once the member receives their recommendations, we then connect them to additional content to help them better understand how the screening works and what their options may be.

The Bottom Line

Health content in the past has largely been underwhelming where pamphlets, brochures, and information documents were the norm. In today’s environment of social media, streaming content, and digital-first experiences, that won’t work. Healthcare organizations have a wide-open world of rich media experiences they can take and adapt for health education, and it’s imperative they do so! Consumers are not impressed with static (and oftentimes boring) content when the rest of their life is starkly different from that.

These are the top 7 content experiences we’ve seen work, but there are more than just these at healthcare’s disposal. Reach out to us to see what else is available for health outreach!

6 Innovations in Streaming Health Content that Improve Member Experience

The logic behind streaming health content is simple. Just telling someone that it’s time to get a mammogram or renew a prescription isn’t always enough to get them to do it. There are numerous barriers to consider: social determinates of health (SDOH) factors, health beliefs, the health literacy gap, apathy, and more. Sending a well-timed, well-written text message can sometimes do the job, but often we need to go further and help the health consumer understand why taking an action matters and how they are benefiting from it. Or we simply need to get their attention for long enough to even hear us out.  

Streaming health education, when thoughtfully integrated into engagement solutions, can achieve all of these things. It infuses current and innovative types of content into member outreach in new ways. The same way we have seen the biggest brands integrate streaming content into the consumer experience, healthcare can mirror and change the way they interact with their populations and, more importantly, change the way their populations interact with them.  

6 Innovative Best Practices in Streaming Health Content


Innovation 1: Types of Content

The most innovative aspect of content in the last few years just may be the format it’s delivered in. Overall, there are four major content categories we’ve seen work well when brought into healthcare outreach. 


A lot can be said with a well-timed gif, and using humor to capture attention, as gifs usually do, are an effective way to focus the member on a very real issue, such as fall safety in our example above. 

Self-Produced Videos

Self-produced videos are often short, recorded in selfie mode, and have less focus on production value. These qualities make them more personal, fun, and more able to capture attention and connect the creator with the audience.  

Licensable Streaming Content

Spotify, YouTube, Netflix, and more! Streaming is the main delivery method for content today and used by a huge amount of the population. With the option of licensable libraries of streaming health education content now on the market, healthcare organizations can enter the game and have a better chance of meeting members where they are and in the ways they already live their lives. 


Started by Snapchat and copied by Facebook and Instagram, stories are now everywhere. Healthcare can take stories and use social media as another channel to communicate with their populations or repurpose them for SMS delivered solutions. 

Innovation 2: Making the Ask 

Now that you have your content format ready to go, you’ll want clear, robust calls to action embedded within the streaming health experience, which is our second innovative best practice. Think about it this way: all the content delivered quickly falls short if you aren’t ultimately making the ask. 

When crafting your call to action, make sure it is not only closely tied to the content being delivered but it is also specifically based on that recipient’s needs.  

Interested in learning more? Access the guide to get the full version of this content » 

Innovation 3: Integrating Your Content into Your Programs 

When you combine conversational AI capabilities with health content, you can uncover barriers to action through the consumer’s response and in turn deliver bite-sized educational clips to address their specific obstacle. This way, you are not only educating them on why they should take a certain action, but you are delivering tailored content which educates around the specific reason that individual is not complying. And because this is built on conversational AI technology, all of this is done at scale, yet individualized, for your entire population. 


Innovation 4: Creating Surround Sound

Most of the daily lives of health consumers is digital– emails, websites, apps, social media, text messaging, phone calls, streaming content, and more. This makes it easy to apply our fourth innovative technique: create surround sound by producing a digital omnichannel experience. 

In action, it might look like this: If we were heading into winter and you were trying to drive flu vaccinations, you might post an interactive FAQ to your organization’s social media story, send the mini lesson video through email or text message, and have the full vaccine lesson available through your website portal. Your audience would likely run into your content multiple times, which serves to reinforce the educational message and makes it more likely they’ll act on it. 

Innovation 5: Targeting Your Content to Clear Business Goals 

Your streaming health content is only as effective as it is in line with your goal. So, when producing and deploying content, you should tie it to the areas of your business you want to see an impact on—Health Outcomes Surveys (HOS), preventive screenings, diabetes prevention, and gaps in care just to name a few. Plainly, if your content isn’t addressing the action you’re trying to drive, you won’t drive that action. 

Innovation 6: Data, Data, Data 

Metrics regularly tracked still apply, such as text messages delivered, response rate, and completion rate of the desired action. Integrating streaming health content into your outreach, though, broadens the data you have access to for outreach performance and reporting. Now we can look at clickthrough rate to videos or activities, total views, engagement time, pages or lessons viewed per person, average number of course enrollments, average view time per piece of content, and so much more.

Integrating Health Content into Your Engagement Programs 

When healthcare organizations take the innovative approach of creating educational health content (videos, bite-sized content, interactive FAQs, polls, quizzes, and more) and incorporate it in their outreach, we see much longer engagement times, the underlying problem of health literacy improve, and the fostering of better relationships between healthcare organizations and health consumers. 

Our hope is this new frontier of educational health content creates a change in the health literacy of our society as a whole and improves the engagement and investment of individuals in their own health and well-being. 

Interested in even deeper insights into this new way of outreach? Download the guide, 6 Innovations in Streaming Health Content that Improves the Member Experience, to get the full version of this content.

How to Address Changes in Patient Engagement and Motivate Flu Vaccination Fulfillment

Flu season is coming back around and in a post-COVID world, that means changes in how members engage when it comes time to be vaccinated. Lingering perspectives related to vaccine hesitancy may influence members’ reluctance to be vaccinated for flu, despite vaccinations being even more critical to their continued health. Health plans, providers, and pharmacies will have to work that much harder this year to make sure their health consumers are vaccinated and protected against the flu than they have in years past.

Compared with the same time last year, flu vaccination rates are trending down from between 2.0% lower for children 6 months to 17 years, all the way to 17.4% lower

vaccination rates for Hispanic adults, 18+. With the unpredictability of flu severity from season to season, outreach and engagement with members to provide information and identify resources for access to vaccinations is integral to a health plan’s ability to proactively communicate with diverse populations through targeted content.

Annually, unvaccinated individuals will cost the health care system over $10.4 billion and an additional $17.6 Billion in lost worker productivity. Guiding members on the path towards vaccination can help to prevent:

  • 5 million flu related illnesses
  • 7 million flu associated medical visits
  • 105k flu associated hospitalizations, and
  • 3k flu associated deaths

So, what can the healthcare industry do to combat this? With tools like behavioral science, interactive health education, and conversational ai at their disposal, it’s possible to see significant increases in vaccination rates among members. Let’s take a closer look at why.

The Foundation: Science of Human Behavior

Let’s start with the basics for any outreach program we run: behavioral science. In this mega-study conducted by The University of Pennsylvania and Walmart, 22 different behavioral science techniques were put to the test. These 22 varied techniques were embedded into messages delivered through SMS to over 650,000 Walmart pharmacy patients to determine which boosted vaccination rates the highest. Overall, the inclusion of all these techniques increased vaccination rates by an average of 6.7% over a three-month follow-up period.

The most effective technique, however, was the endowment effect which encouraged patients to visit Walmart for a flu vaccine that was reserved specifically for them. By telling a person a particular flu shot is ‘reserved for you’ and already belongs to them, the vaccine becomes a tangible thing of value that they own. That’s Endowment Effect, an emotional bias to put higher value on owned objects. This approach also uses the technique of Loss Aversion, a bias that makes us care nearly twice as much about avoiding loss than receiving an equivalent gain. In this case, if you don’t claim your flu shot, well, you’ll actually be losing something you own.

We use behavioral science in every program we deploy for our clients, but this study specifically and the endowment effect itself was the basis with which we built our flu vaccination solution for the 2022-2023 flu season. What UPenn and Walmart didn’t have, though, was these next few factors that pushes our flu program beyond even this study.

Streaming Health Education for Flu

With so much vaccine hesitancy in our post-COVID world, educating your health consumers about the safety and efficacy of vaccinations is a necessary step, and departing from the mundane pamphlets and brochures of the past by utilizing streaming health content is an extremely effective way to do this.

The content we’ve produced for flu vaccination are a series of Fotonovelas, which are auto-forwarding image-based stories with a visual interface similar to the stories feature on Instagram. Fotonovelas are ultimately a health literacy tool, but at the same time, they make learning fun and easy (80% of learners on our platform report liking or loving the fotonovela content type).

In this specific flu fotonovela below, the characters featured resonate with diverse audiences, the storylines detailed transcend linguistic and cultural barriers to deliver key information, and the tone provides empathy and support on the path towards the desired call to action. The best part: health consumers who view a Fotonovela are 72% more likely to get vaccinated.

2-Way Conversations Uncover Barriers

The ability to have 2-way conversations allows you to gather insights about your members that can inform future communication. What is their sentiment toward the program and plan? Why haven’t they been vaccinated? Have they already been vaccinated, and we just don’t know?

If we know why they haven’t been vaccinated, it allows the plan to respond with education and resources to assist. Are they not sure where to go? Send them the information to their nearest pharmacy. What about if they’re not sure they need a flu vaccination? Send them a Fotonovela to educate them!

Multiple Channels, Multiple Languages

The UPenn and Walmart mega-study tested SMS message, but why stop there? A large part of effective engagement strategy is meeting members where they are. As such, our solution includes SMS, IVR, and email channels. Take the concept of meeting members where they are one step further, and you’ll get the ability to deploy this vaccination solution in both English and Spanish. All of this means reaching more of your population in the way they want to communicate.

Tackle Flu Early and Effectively

The CDC recommends that everyone six months and older, especially people at higher risk, should get a flu vaccine annually to reduce their risk of contracting seasonal flu, alleviate the severity of symptoms and decrease the likelihood of experiencing major health complications if infected. The importance of each individual vaccinating against the flu needs to be communicated to members through targeted, succinct and easily understandable materials, delivered through channels to reach them where they are most apt to respond and be motivated to act. Studies have found that patients who are informed and affectively motivated are also more likely to adhere to their treatment recommendations.

mPulse Mobile’s flu vaccination solution uses proven behavioral science, dynamic content, and an omnichannel approach to overcome common vaccine barriers and get more members vaccinated. With over 15M Flu vaccination touchpoints sent to Medicaid, Medicare and Commercial members by mPulse in last two years using its 2-way Natural Language Understanding platform, we have learned from millions of past vaccine conversations in both Spanish and English. Using behavioral science in a relatable and quick experience and employing Fotonovelas to empower members to act. By listening for vaccine readiness, we can help overcome common barriers and resistance.

For more information on this flu vaccination solution and a live demo, register for our webinar, Double Your Vaccination Rates for Your Health Population.

Shifting the Mindset: How Health Plans Can View Members as Consumers in a Digital-First World

What can health plans learn from the retail industry’s success with consumer engagement?  

A lot, it turns out. Leading retail organizations have been using important digital-first principles for a couple of decades now. This approach has not only transformed the expectations of everyday consumers for all organizations they encounter (including healthcare) but has also driven profits through the roof for these companies.  

Take a moment to think about it. When you sign into Amazon, everything you experience as an end user is seamless and customized. From the presentation of personalized recommendations on your homepage (which is different for every customer) to the fast and easy delivery of your items. It’s all frictionless and crafted for the consumer. 

Where does this leave healthcare? Well, even though health plans are not direct competitors of Amazon (or even in the same industry), their members live in an Amazon world and now have expectations set for this kind of consumer experience across all areas of their lives – food delivery, online retail, and yes, healthcare. The challenge for healthcare organizations now becomes leveling up to those expectations and harnessing these digital-first principles to improve their members’ experiences and inspire healthy behaviors. 

From Members to Consumers: How plans are adopting popular digital trends from leading consumer brands to drive better health outcomes » 

The first step toward that goal is understanding that members are no longer just members. They have become fully-fledged consumers of healthcare services and treating them as such is a critical way for plans to be competitive in a digital-first world. 

Beyond the Consumer Mindset: Implementing a Digital-First Experience 

Simply shifting your view of your members to consumers, however, is not enough. There are significant foundational and technological changes that must be implemented to truly realize this concept and transform the experience. 

  • Using Data to Customize the User Experience – Without data, customizing the experience in this way is impossible. Plans have more data at their disposal than you might think, though. From claims data and satisfaction surveys to engagement data from previous communications programs, it can all be leveraged to customize the experience. This results in tailored tools and resources at every point across their unique journey.  
  • Streaming Health Content – 5% of all Google searches are for health information. That is a lot of people turning to the internet for health education instead of their plan or provider. That also highlights the fact that health literacy is a prevalent issue and a contributing factor to inaction among members. Plans are in a unique position to increase health literacy by providing health education to their consumers with commercial quality streaming health content to sustain engagement, deliver the information that consumer needs at that point in time, and ultimately drive healthier actions at scale. 
  • An Omnichannel Approach – Combining an omnichannel approach with orchestration of resources and channels helps plans reach members in the way they prefer while allowing plan investments to perform with higher results and efficacy. Using a combination of 1 on 1 care coordination, interactive voice response (IVR), mobile web, resource triaging through AI short message service (SMS), multimedia message service (MMS) and rich communication services (RCS) channels are a few examples of digital ways to engage and activate more consumers. 
  • Behavior Science and Conversational AI – Behavior science is a foundational tool for large tech companies to drive specific behaviors in their consumers and ignite growth. It’s healthcare’s time now to take from those lessons and apply them to the health of their members. Health programs and services that seek to understand the intricacies of human behavior and leverage these techniques will significantly increase engagement. 

Want the full version of this content? Access the complete white paper, From Members to Consumers » 

The Members to Consumers White Paper 

By implementing digital trends that drive engagement in the retail landscape, health plans can replicate this success for their population. Leading brands have had to continually stay aligned to trends and keep a high-touch strategy in place to drive sales. Health organizations are in a unique position to leverage consumer insights to refine their strategy, inspire consumers to take action, and lower costs, because unlike Apple or Amazon, health is a necessity. Ensuring your health consumers continually have a positive experience and adopt healthier behaviors based on their individual health needs is critical to drive health outcomes.  

This article gives just a peek into the ways health plans can serve that experience to their members. To get the full version of this content, including case studies from plans who have implemented digital-first techniques, download the white paper, From Members to Consumers: How plans are adopting popular digital trends from leading consumer brands to drive better health outcomes.

Activating Healthcare Consumer Behavior Change: Make it Personal

Key takeaways from our interview with Solome Tibebu

In the last decade, behavioral health has grown from an ancillary service offering to a critical component of health services and care delivery. According to an OPEN MINDS Market Intelligence Report, spending on mental health services totaled $225 billion in 2019, up 52% from 2009. Companies like Talkspace and BetterHelp, founded in 2012 and 2013, recognized this spike and made it their mission to increase the availability and accessibility of mental health services to those struggling to access and navigate care. Behavioral health has continued to evolve, and it is incumbent on all healthcare organizations to adopt new methods of providing care to vulnerable populations. Learning from innovative companies and forward-thinking leaders is vital to building an effective care strategy for the one in five U.S. adults living with a mental illness.  

mPulse sat down with Solome Tibebu, a pioneer in behavioral health technology and innovation, whose passion stems from the care gaps that have existed and still remain in mental healthcare. At the early age of 16 years old, Tibebu started a non-profit online resource, Anxiety in Teens, to offer education and support for teens and young adults who were struggling with anxiety and depression. After ten years, she began working in startups and consulting, continuing to advocate for the role of technology in advancing behavioral healthcare. 

This year in June, Tibebu will be putting on her third annual Going Digital: Behavioral Health Tech summit, a conference where health plans, providers, health systems, employers, investors and startups convene to discuss the evolving landscape of behavioral health. The virtual (for now) event is a great opportunity to share best practices for implementing digital resources and innovative technologies to improve access to mental health services. We are proud to be a sponsor for the second consecutive year, and we look forward to contributing to discussions around how healthcare organizations can implement solutions to tackle barriers and make mental healthcare more accessible for all.

Improving Access through Technology Innovation

COVID-19 created an array of challenges to advancing mental health access, but it also sparked a digital transformation that brought innovation to the center stage. With more consumers staying home, “tech has exploded as a response to the pandemic,” Tibebu prefaces. Technology plays an important role in understanding and addressing the social dynamics that affect each person living with mental illness. Some of the challenges that plague mental health accessibility require more than simple one-way consumer interactions, however. 

Talking about health plans, Tibebu emphasizes, “stigma is a huge barrier even after they’ve procured some kind of solution, so they need to have a strategy around how they’re gonna address stigma, and engagement of the member.” Stigma can produce feelings of worthlessness and lead to social isolation while social determinants of health (SDOH) like transportation access or income level can prevent consumers from seeking care. To tackle barriers like SDOH and stigma, it is necessary to utilize technology to understand consumer needs and preferences. 

Conversational AI and Natural Language Understanding power the capability to deploy behavioral science strategies at scale when communicating with vulnerable populations. For instance, incorporating a strategy like Affect ensures that messaging is based in empathy, increasing motivation to engage with sensitive healthcare outreach. Social Proof is an effective strategy that helps assure consumers that they are not alone and can help reduce social isolation caused by mental health stigma.  

Applying behavioral science and identifying SDOH in conversational outreach enables a deeper understanding of consumers. Once individual preferences are captured, healthcare organizations can efficiently tailor relevant content to each consumer and activate meaningful behavior change. 

Delivering Tailored Content at Scale

Incorporating clinically validated behavior change techniques helps with understanding the needs and preferences of consumers. Tibebu asks, “now all of these payers have implemented their telehealth solution but it’s the next level – how do we get something more customized, personalized to their respective populations?”  

Plans and providers can drive deeper engagement and self-efficacy by adopting tailored engagement strategies that lift utilization of the programs they’ve invested in. Conversational AI enables the orchestration of programs and resource delivery across preferred consumer channels. Natural Language Understanding helps capture important data from consumer responses to help route them to the appropriate digital resource. 

A one-size-fits-all care model fails to meet the needs of each consumer, while customization empowers healthcare organizations to intervene with meaningful content that drives behavior change. “How can you identify the consumer’s need and triage them to the right end solution?” Tibebu reiterates. Certain individuals who prefer a visual learning experience may benefit from a course like Living with Anxiety & Depression, while those who respond better to audio can be directed to a podcast like Mental Health Matters. 

Providing on-demand, curated content can motivate consumers to take control of their health and execute healthier behaviors, leading to improved outcomes and a better consumer experience.

Impacting Beyond Mental Health

We asked Tibebu why personalization in mental healthcare should be important to payers specifically. She responded, “because mental health is at the vortex of all health…for all of these other conditions, expensive conditions, that are impacted as a result of poor mental health.” Consumers who are negatively affected by mental health are more likely to develop chronic conditions, which piles up costs for both the consumer and the organization providing services. This creates an opportunity for plans and providers to adopt innovative solutions that promote well-being through tailored engagement. 

MagellanRx Management serves a complex population and recognized the need to incorporate well-being content for their members who were experiencing loneliness and anxiety from COVID-19. They partnered with mPulse to deploy digital fotonovelas, which use culturally sensitive stories in a comic-strip format to improve health education and activate diverse populations. The program drove impressive outcomes, yielding over a 38% engagement rate and a 90% member satisfaction score. 

We questioned how organizations outside of payers and providers can “step up” to make mental healthcare more accessible. Walmart Wellness is a nationally recognized brand whose goal is to “help customers raise their hand and more easily access their hubs,” Tibebu clarifies. Walmart partnered with mPulse to implement SMS solutions along with streaming health education to drive their customers to the right well-being resources. The program included custom learning plans across several wellness topics and produced significant improvements in customer engagement. 

After chatting with Tibebu, we are reassured that mental healthcare should be the focal point of an effective engagement strategy. Innovative companies can promote mental well-being and health literacy by leveraging technology that personalizes outreach. Educating consumers with tailored content through timely and convenient engagement builds self-efficacy and lasting behavior change.

Learn more about Conversational AI and streaming health education here. 


CareSource Activates Hard-to-Reach Members with Conversational Outreach and Streaming Content

COVID-19 Accelerating Digital Engagement

It is no secret that COVID-19 has changed the way healthcare communication is delivered to consumers. The uncertain nature of the pandemic has forced healthcare organizations to incorporate digital strategies to continuously update their members on important COVID-19 information. Just this year, health plans have had to respond to the new mandate requiring reimbursements for at-home COVID-19 tests.  

Gaps remain in other facets of COVID-19 communication, like driving behavior change to increase vaccinations. Across the country, states are seeing lower vaccination rates among Medicaid beneficiaries. In California, the Department of Health Care Services (DHCS) released a January 2022 report indicating that 81% of the general population had received one dose of a COVID vaccine compared to only 54% of Medi-Cal (California’s Medicaid program) beneficiaries. Significant disparities in vaccination completion such has this have developed in states beyond California as well. 

CareSource, an Ohio-based managed care plan offering insurance coverage to vulnerable populations across five states, recognized a similar disparity in their diverse member population and sought a solution. Traditional methods of engaging members had failed to produce desired results, creating an opportunity to incorporate a new approach in their outreach efforts. The plan partnered with us to implement conversational outreach and streaming health education into their COVID-19 vaccine program strategy.  

Here’s some key takeaways from the program along with strategies that health plans can adopt to drive vaccine engagement.  

Strategies That Personalize Outreach

Delivering vital information about vaccines becomes more difficult when using a one-size-fits-all approach to communicating with vulnerable members. A successful COVID-19 outreach program requires personalized interactions with members to inspire healthier actions. CareSource identified a need to activate hard-to-reach consumers and sought a tool to tailor engagement based of range of factors including health beliefs. 

The plan leveraged our robust technology platform and Natural Language Understanding capabilities, which enabled tailored engagement through 25 SMS workflows, 1 Secure Survey, and 1 streaming video.  

We helped deploy SMS surveys to assess individual vaccine readiness levels, and members were assigned one of three personas based on their responses: Ready, Unsure, and Nonbeliever. Developing personas enables plans to tailor messaging according to personalized interactions with members to inspire healthier actions each member’s preferences and self-reported barriers. Messaging must be intentional and sensitive to inspire paradigm shifts for unvaccinated members or members who have no plans to get vaccinated.

Behavior science informs every communication we send, and this program was no different. An effective behavioral science strategy in the CareSource program was giving members Social Proof, which comes from the Social Determination Theory and suggests that people are motivated by feelings of competence and relatedness. Through the texting channel, members were sent a streaming video, “My Why,” which highlights a diverse range of people explaining their personal reasons for getting vaccinated. Plans can inspire confidence and healthier actions just by making members feel as though they are not alone.

Another behavior science strategy employed in the program was Authority, which is using trusted health experts to improve education, drive health literacy and reduce barriers like misinformation. Using sources like the CDC can ease doubt and motivate members to reconsider personal health beliefs that may contribute to vaccine hesitancy.   

CareSource provided zip code data, which we used to further tailor conversations based on socioeconomic factors. Providing members with personalized, familiar interactions gives the member a voice and drives self-efficacy. 

By incorporating behavioral science and SDOH into their COVID-19 engagement strategy, CareSource was able to tailor conversations and streaming educational content at scale. Social determinants of health (SDOH) can play an integral role in tailoring messaging to each individual inspiring vaccine readiness. 

Innovation That Drives Outcomes

We sent a total of 4 million SMS messages and delivered over 3 million automated dialogues to 664,000 members. The program yielded nearly a 15% engagement rate, an increase from traditional rates of 8-10%. Of the members who received a first dose, 81% reported they would follow through to get a second dose. By the end of the program, 57,000 of the 107,000 “Unsure” members moved into the “Ready” persona. 

Each member response led to additional tailoring, with automated responses covering topics like variants, availability, cost, fear/anxiety, effectiveness, and side effects. Upon conducting 30-day and 90-day reviews of the program, common themes were uncovered within each member persona. Gathering insights from member interactions can help influence future vaccine engagement programs and ensure that each conversation is tailored to drive the best results. 

As companies focus on highly tailored engagement, scalable intelligent capabilities are required.  CareSource has demonstrated the potential for Conversational AI outreach and streaming health education to drive healthier actions and meaningful outcomes.

Closing Diabetes Care Gaps

According to the Centers for Disease Control and Prevention, more than 34 million Americans have diabetes, and 88 million are prediabetic. Despite being one of the most common diseases in the U.S., it is still widely misunderstood. Providing education and resources to help those living with diabetes is critical to improving quality measures, managing diabetes, and preventing poor outcomes. Adherence to diabetes medications alone reduces over 1 million emergency room visits annually, which accounts for approximately $8.3 billion in annual health spending.

Proper management of Diabetes can be shown through data captured from routine blood work, A1c tests, specialist visits, prescription refills, and diabetic eye exam claims. But many members do not know they need to complete these visits, or understand why they are important. By identifying key gaps in care and understanding the barriers stopping members from completing these screenings, we can help members become more empowered advocates in their health journey.

Engaging the hard to reach

You need to meet members where they are. Through implementing a tailored omnichannel approach, you can engage with each member in the ways they prefer, while uncovering their barriers to care. This will help extend your reach, improve engagement at scale, and collect population insights to inform your enterprise strategy.

Each of your members is on a different journey. Addressing the correct gaps and identifying each member’s unique barriers will yield greater self-efficacy.

Tailored Experiences Fill Gaps


Diane is a Type 1 Diabetic who is a new member. Through SMS messaging, we can identify her barriers and provide her with care management to help support her and provide her education on nutrition and resources to help her maintain routine care visits.

“At age 14 I was diagnosed with Type 1. My parents watched over me and took care of me, but when I Iived  alone I didn’t take care of my diabetes. I wasn’t checking my sugars, ate anything I wanted whenever. I didn’t want to be the diabetic girl with her medical bag.” –Diane J. Type 1 Diabetic


Charlotte is also a Type 1 Diabetic whose provided phone number is a landline. Through IVR and email, we can connect her to education on the importance of routine diabetic eye exams with a CTA (call-to-action) to schedule with her optometrist.

“I’ve been a type 1 diabetic for 30 years now and my hypo symptoms have changed. The first thing that happens is my vision starts to become abstract and I have hallucinations, it’s terrifying! I don’t know if this is common or not cause it never used to happen to me during hypos.” -Charlotte L. Type 1 Diabetic

mPulse uses conversational Artificial Intelligence (AI) and Natural Language Understanding to fill gaps in care by overcoming barriers and providing the right support through the right channel to build trust with each of your members. We deliver personalized interactions that inspire health literacy and behavior change over time.

Inspire Behavior Change at Scale

An essential part of building relationships with members is providing more than appointment reminders, test results, and claims status updates. While tests and appointments are strong indicators that the member is receiving recommended routine care, management of Diabetes goes beyond the doctor’s office. Living a healthy lifestyle with Diabetes is just as essential as maintenance visits, especially when it comes to diet, exercise, and mental health. Investing in health and wellbeing resources, programs, and education throughout each member’s health journey drives meaningful behavior change.

“People living with diabetes tend to focus on diet and meds (necessary of course) that I think maybe we forget other important tools in this fight. I have found that stress like an argument, financial worry, depression etc. affects my bs. I’d love to hear some successful stress reducers that can help.” -Joey S. Type 2 Diabetic

The Big Know is mPulse Mobile’s streaming health education capability. Our team of instructional writers and designers produce broadcast-quality content designed to inspire health literacy at scale. We leverage the expertise of nationally recognized health experts to teach video and podcast learning experiences that are proven to engage and educate your members.

In addition to condition-specific content, we offer holistic well-being education that teaches the basics of living your healthiest life, with wide-ranging topics that include building resiliency, HSA planning, eating well, yoga, mental health, and more. Discover our content library by visiting

Our LiveWell Diabetes Podcast is hosted by Dr. Reed Tuckson, Doctor, Health Executive, & Author. In each podcast episode, he hosts a different health expert to discuss specific wellness topics related to managing Diabetes including eating well, movement, and understanding the science behind Type 2 Diabetes.


Listen to the podcast here:


Enroll in mPulse’s Newsletter to be notified when our Diabetes Essentials video series, taught by Ranelle Kirchner, launches in 2022.

Reimagining Health Engagement

mPulse Mobile partners with over 100 leading healthcare organizations and initiates 500+ million omnichannel conversations annually. As the leader in conversational AI for healthcare, we help build relationships with your consumers that go beyond the transaction to inspire self-efficacy and health outcomes at scale.

Case Study: A1c Test Reminders

Client: Anonymous Health Plan

Goals: Encourage and remind Diabetic members to get their monthly A1c Test to lower costs and increase self-efficacy and overall health.

Execution: Leverage SMS messaging to send tailored conversations to Diabetic members overdue for their A1c test.

Outcome: 29% Program Engagement

32% of claims submitted were from previously un-engaged members


Case Study: Insulin Rx Refills

Client: Anonymous Pharmaceutical and Medical Device Company

Goals: Increase conversion rate for diabetes insulin pump reorders.

Execution: Consumers reviewed and confirmed their supply reorder through SMS messaging and prior opt-in.

Outcomes: 11pp increase in reorders after program optimization

ROI of >360%

92% program opt-in


To learn more about mPulse’s solutions and outcomes, contact us at

To learn more about how to prevent and manage Diabetes, visit The American Diabetes Association Website.