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The U.S. health care system is bleeding cash, and the biggest part of that bleed goes toward caring for subgroups of very sick or at-risk patients. Part of the goal of health reform is to engage those populations and keep them well between doctor visits, rather than just keep throwing cash at them.

Enter a new class of digital health startups focused on increasing the health literacy of at-risk patient populations.

CareMessage, a nonprofit, operates a technology platform that allows medical providers to connect with those patients via SMS messages to send things like appointment reminders, personalized information about their health problems, and reminders to check their glucose levels. SMS messages are the communication medium of choice, because unfortunately low-income and elderly people are the most likely to become seriously ill, and many of those people use flip-phones.

San Francisco-based CareMessage has developed a load of custom content about some of the most costly health problems — things like diabetes, high blood pressure, and obesity, the company’s CEO Vineet Singal tells VentureBeat.


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For example, CareMessage’s client providers can use the Heart2Heart and DeCorazón programs, which last a year and cover topics most relevant to hypertensives, such as checking blood pressure, reducing sodium intake, increasing exercise, or properly taking medication. The programs are meant to help support and motivate patients as they make lifestyle changes, CareMessage says.

Sending this type of targeted information to the right people at the right times, it’s thought, can dramatically improve patient follow-ups and disease management.

After incubating under the downy-soft feathers of Y Combinator, CareMessage held its coming out party at YC Demo Day in March 2014.

Since then the startup has raised more than $6 million in new funding, highlighted by a $2.3 million “impact award” from and $1.5 million gift from Bill Ackman and the Pershing Square Foundation. The investments are grants, and the investors do not get equity in the company.

“At, we help entrepreneurs use technology to test out new solutions to big problems,” said director Jacquelline Fuller in a statement. “There are a number of SMS-for-health care apps out there, but none of them is as attuned to the needs of low-income neighbors as CareMessage.”

“Vineet and his team have a strong combination of technical expertise and true empathy for the low-income patients that their platform is built to serve,” Fuller says. “We see huge potential for CareMessage to create real change in the health outcomes of the tens of millions of citizens who are still uninsured.”

CareMessage says it’ll use the cash to reach more than a million patients by the end of 2016. Since launching its product in March, CareMessage says it is working with 80 customers serving over 300,000 patients in 16 states.

One things CareMessage has going for it is a huge addressable market. Health and Human Services says that only 12 percent of U.S. adults have proficient health literacy, and that more than a third — 77 million people — would have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart.

Populations most likely to experience low health literacy, HHS says, are older adults, racial and ethnic minorities, people with less than a high school degree or GED certificate, people with low income levels, non-native speakers of English, and people with compromised health status. Education, language, culture, access to resources, and age are all factors that affect a person’s health literacy skills.

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