The goal of this campaign is to reduce unnecessary ED visits by providing patients who are high ED utilizers (with a visit of any acuity) with alternative resources to manage their health outside of the ED. In this campaign, patients will be randomized to receive one of two types of outreach following discharge aligned with the goal. Outreach may occur via (1) a phone call from a Geisinger Community Health Worker (CHW) or Community Medical Assistant (CMA); current standard practice or (2) an interactive chatbot message providing similar information and questions to those provided by the CHW/CMA. The study team will measure whether ED use differs across patients in different outreach conditions. The study team will also examine whether patients followed through on the message-specific calls to action in the messages differently across conditions.

Inclusion Criteria:

• Geisinger Health Plan insurance or KACO membership
• Any PCP or no PCP
• Visit of any acuity
• 4 or more ED visits in the past 6 months

Exclusion Criteria:

• Institutionalized
• Cannot be contacted via the communication modality being used in the study (i.e., SMS), due to insufficient/missing contact information in the electronic health record or because the patient opted out
• Admitted to hospital
• Eloped from ED
• Left ED without being seen
• Deceased prior to messaging
• Qualifies for more intensive care management due to higher-level category of complexity

Patients will be aware of their own messages but will not be aware of other messages.