Memorandum utilizes intelligent mobile messaging to advance health literacy, patient care and chronic disease management for all populations

Issue Area: Chronic Disease Prevention & Care

Memorandum - How It Works

The Idea

Medication adherence has been described as “the holy grail of primary care” for clinicians, healthcare systems, and other stakeholders, such as payers and insurance providers. 50% of patients in the United States either forget to take their medication or take the wrong dose. This increases preventable disease progression and otherwise-avoidable emergency room visits due to medical complications. As a result, 125,000 Americans die annually due to poor medication adherence. Furthermore, medication nonadherence is likely to increase as the U.S. population ages and as patients take more medications to treat chronic conditions such as diabetes and cardiovascular disease.

Worldwide, over 75% of all deaths are due to chronic, or noncommunicable, diseases. Annually, thirty-eight million people die from chronic illness, such as cardiovascular disease and diabetes, that could have been better controlled through more effective primary care. The World Health Organization argues that the rapid rise in chronic disease has also impeded poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. The high costs of chronic disease management, which often includes lengthy and expensive treatment, is forcing millions of people into poverty each year and choking socioeconomic development.

Poor medication adherence results in up to 69% of medication-related hospital admissions in the United States, at a cost of roughly $100 billion per year. Total potential savings from adherence and related disease management could reach $290 billion annually, 13% of total U.S. health spending. Furthermore, the passage of the Affordable Care Act and subsequent physician payment changes provides an incentivize for hospitals and insurance companies to reduce readmissions and cost overruns. New performance measures that reward quality based on the attainment of treatment targets such as blood pressure and low-density lipoprotein (LDL) levels or outcomes such as 1-year mortality after hospitalization for conditions like heart attacks reinforces the importance of longitudinal medication adherence.

Literature indicates that initial investments in interventions to enhance adherence are fully recovered within a few years and recurrent costs are fully covered by savings. These “cost-saving interventions” are firmly linked to the prevention of disease relapses, crises and/or complications. From a societal point of view, most interventions aimed at enhancing adherence have been shown to result in cost-savings, due to the improvement in patients’ quality of life and avoided indirect costs.


Our inaugural service, PillPal, is an automated web-based application that helps patients rememberwhen and how much to take of each of their prescription medications using a text-messaging service that is free to users.

While filling patient prescriptions, providers, usually a nurse, medical assistant, or pharmacist, would enter the patient's medication, dosage, and cell phone number into the application or pull the data from existing electronic health records. The application’s automated server sends patients customized text message reminders, at the exact time they should be taking their medication, with the drug name and correct dosage.

Current features include:

  1. Email Verification – E-mail registration for the application is based on a whitelist model. The server will only recognize and register emails with approved domain addresses (e.g., which ensures that only authorized providers have the capability to input medication information at the point of data entry.
  2. Language Support – Current support for both English and Spanish-speaking patients. Hindi support is in development.
  3. Back-end Data Encryption – When providers input patient information, all of the data is encrypted prior to being sent to the server to ensure HIPAA compliancy. The data is encrypted using a private RSA key stored on the server-end. Decryption at the client-end using AES is initiated in the case that Twilio, the text messaging application programming interface, sends a call to the server to retrieve patient information for notification purposes. This assures that no loopholes in encryption of patient information are present.
  4. Twilio SMS Integration – Elderly patients, who are the most likely to have trouble remembering their medications, are the least likely to have and use smartphone-based medication reminder apps, much less take the time to input the information for each medication in a phone themselves. Utilizing SMS-based messaging with personalized pill photos from the hospital allows any patient, with any kind of cell phone, to receive automated reminders and maintain peace of mind about their medication schedule.

Platform Features in Development:

  • Appointment attendance – Patient pre-appointment information and appointment reminders based on the already-developed Memorandum messaging infrastructure.
  • Immunization Record Management – automated immunization record storage and reminders for newborns and children.
  • Health literacy – messaging platform to help patients better understand their condition, the significance of their test results, and simplify medical jargon.
  • Patient engagement – messaging platform to guide patients through chronic disease management, including reminders for collection of data such as blood glucose, conducting self-exams at home, and postoperative monitoring.
  • Actionable data collection and visualization – SMS-based real-time patient survey and data collection platform with visualized analytics that allow providers to remotely monitor patient health, understand the factors that motivate patients to change their behaviors, evaluate the effectiveness of treatments, and develop personalized, evidence-based options for managing care.

Primary Users

  • Hospitals: Hospitals and clinics purchase the platform to improve patient chronic disease management, minimize readmissions, and personalize patient care.
  • Health Insurance Companies: Insurance companies have a financial incentive to maintain a healthy patient pool and can subsidize the use of the platform as part of a patient treatment plan.
  • Pharmaceutical Companies: Pharmaceutical companies can use the mobile messaging platform to automate the process of collecting clinical trial survey data from select patients outside of the clinical setting.
  • Public Hospitals, Community Health Centers, and Non-governmental Organizations:These customers receive the platform pro bono or at a heavily subsidized price in an effort to improve health equity for underserved populations both locally and globally.

Ultimately, patients are the ones receiving mobile messages as means of not only extending care outside of their stay in a clinical setting but also aiding them in engaging in self-care. By bridging the communication gap between physicians and patients, our platform has the potential to instigate a behavioral change within patients in terms of medication adherence. Using a simple and effective solution that doesn’t cost patients any monetary fee, we present patients with the opportunity to avoid adverse outcomes and improve overall quality of life.


  • Manav Sevak, Data Management & Software Partnerships

  • Nisarg Patel, Product Design & Business Partnerships

  • Kunaal Naik, Back-end Developer & Software Development

  • Kurt Carpenter, Principal Software Engineer

  • Sam Marder, Principal Software Engineer

  • ManjinderKandola, Clinical Representative

The Other Finalists:

  • BlueLight: Improved mobile 911 that shares your precise location, picture, and medical conditions with dispatch for faster emergency response.
  • bluField, Inc: In danger? Instantly broadcast your exact indoor/outdoor location to 911 using your city’s BTLE beacon network and the tourism app, Stroll.
  • CareIT *: A virtual Doctor's office, a medical services marketplace, your online medical home. The perfect complement to high deductible health insurance policies.
  • Community Health TV*: Video-based healthcare programming that educates and empowers minority audiences.
  • Concrn: the compassionate response network. We connect peer responders to people in need of support.
  • HabitatMap, Inc: AirBeam, a wearable air monitor that maps, graphs & crowdsources your pollution exposures in real-time.
  • Knock Software: building better tools to engage citizen advocates and cities around bike infrastructure. Where, when and why are people riding bikes?
  • Memorandum: intelligent mobile messaging to advance health literacy, patient care and chronic disease management for all populations
  • Walk[YourCity] Park and Walk: Banish parking pains. Enjoy your city on foot. Park-and-walk for a happier, healthier community!
  • WeWalk, Inc: gamifying fitness and encourages kids to learn about their city.

* These two of the finalists were also selected as finalists for funding with our investment partner Jumpstart Foundry.

Ten finalists from across the country!

Cities - Join Us!

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  • Help spread the word about the MCIC opportunity to local entrepreneurial and technology communities (e.g., universities, developer groups, accelerators, co-working offices, startup community, etc.).
  • Serve as a judge to review the submitted idea entries and prototypes.
  • Provide relevant publicly available data to support the development of the technology, if available from the City and State.


  • Work with winner(s) in developing/testing the solution during first year of solution development (if needed).

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