Wellness Copilot: Automate Diabetes Care and Scale Population Health

The Unsustainable Equation in Community Health

Diabetes is a major public health challenge in the U.S., affecting over 38 million people of all ages and contributing to nearly 100,000 deaths. At safety-net organizations, such as Federally Qualified Health Centers (FQHCs), the volume of patients with diabetes continues to rise, with the latest data showing over three million patients with diabetes seen in 2024. Effectively managing blood glucose is crucial for reducing the risk of serious complications for patients with diabetes like vision loss, heart disease, and kidney damage.

However, you also face a shrinking healthcare workforce.

This creates an unsustainable equation: fewer clinicians caring for more patients with increasingly complex needs. The result is predictable: rising provider burnout, increased operational costs, and a widening of the very health inequities you work so hard to close. This constant focus on managing high-risk chronic disease leaves little time to even address the 1 in 3 adults with pre-diabetes.

Introducing Wellness Copilot: A New Approach to Population Health

To solve this, your care team doesn't need another complicated tool. You need a way to scale your impact without scaling your workload.

CareMessage’s Wellness Copilot for Diabetes is an intelligent solution designed specifically for the safety-net. It leverages technology to automate the complex work of identifying, engaging, and supporting entire patient populations with, or at-risk of, diabetes to meet short-term and long-term health goals.

How It Works: An Automated Workflow for Better Outcomes

The Wellness Copilot acts as an intelligent partner, integrating directly with your EHR to drive a powerful, automated workflow.

Step 1: Smart Patient Segmentation

The system automatically analyzes your clinical, appointment, and demographic data to create patient cohorts based on need: Pre-diabetes, Controlled Diabetes, and Uncontrolled Diabetes. This means your team can focus on the why, not the who.

Step 2: Recommended Next Best Action

The Wellness Copilot intelligently recommends a specific health goal for each cohort, whether it's a short-term goal like attending a quarterly check-up or a long-term one like A1c reduction.

Step 3: Automated, Conversational Engagement

Based on the goal, each patient is enrolled in a conversational text-messaging flow designed to guide them toward their outcome. These messaging flows are crafted to guide the patient toward their target outcome by using our evidence-based approach to behavior change and patented sequential messaging technology.

Evidence You Can Trust

This isn't a vision for the future, it’s available today. Leveraging EHR data, patient-reported information, and artificial intelligence (AI), the Wellness Copilot can handle thousands of unique patient conversations simultaneously.

Our approach is validated by rigorous research:

• A1c Reduction: Our diabetes coaching has been clinically proven to help patients reduce their A1c levels.
• As Effective as a Human Coach: A recent study with Stanford University showed our automated intervention was as effective as a human coach at increasing physical activity.
• A Single Message is not Enough: CareMessage-powered studies have proven sequential messaging outperforms single-message engagement. 

At CareMessage, we blend rigorous outcomes validation with human-centered design to deliver solutions that work seamlessly for Safety-Net Organizations. The simplistic messaging of other platforms is not “good enough” for your patients.

Deep Integration for OCHIN Members

This powerful automation is first available to OCHIN members as a deeply integrated solution to scale population health improvements. The Wellness Copilot works in tandem with Epic, using real-time data to support your quality goals and logging all patient engagement back into Epic via Communication Logs. This ensures your entire team has a complete, unified view of the patient journey.

The Future of Population Health at Your Fingertips

At a time of limited resources and funding uncertainty, the Wellness Copilot ensures you can support your entire patient population without compromise.

Diabetes is just the beginning. We are actively developing Copilots for other critical areas including:

• Annual Wellness Visits
• Colorectal Cancer Screenings
• And more coming soon!

By building the most robust intervention recommendation engine, guided by insights from over half a billion patient interactions, CareMessage is helping providers and patients achieve better health goals, together.

Join the 1 in 7 FQHCs Who Trust CareMessage

Are you ready to improve your population health outcomes and empower your team? Get in touch and let’s partner to create healthier communities.