Health Equity and the Role of Technology
// By Jane Weber Brubaker //
Healthcare executives from Highmark Health, Virginia Mason, and Bristol Myers Squibb discuss the potential of technology to level the playing field in healthcare.
Technology is a two-edged sword. It can help solve some of healthcare’s thorniest challenges, and it can also create problems, however unintended, particularly in the realm of health disparities. Take mobile devices, for example. They keep us connected — unless you don’t have one. Or what if you have one, but you don’t have access to the internet? When the world shifted to virtual visits to keep patients safe during the pandemic, an entire subsection of the population was left out.
Stacy Hurt, patient engagement consultant
A group of industry innovators took part in a recent panel discussion hosted by Reuters Events™, “Taking Action to Eliminate Disparities and Advance Health Equity.” In this article, we zoom in on technology, one of several topics these leaders covered during their wide-ranging conversation, moderated by patient engagement consultant Stacy Hurt.
Hurt asks the panel, “How can we prevent technology from being a barrier to care? Is there a risk that technology can exacerbate the inequity?”
The panelists, David Holmberg, CEO of Highmark Health; Dr. Gary Kaplan, chairman and CEO of Virginia Mason; and Patti Doykos, executive director of Healthy Equity at Bristol Myers Squibb, shared their perspectives on technology — their challenges, discoveries, and successes, and what they hope to accomplish in the future.
A Permanent Place for Telehealth in Care Delivery?
Hurt had a pressing need for telehealth well before the pandemic hit. Transporting her disabled son to medical appointments was becoming a challenge. But when she asked providers about the availability of telehealth to ease the burden, she was told it couldn’t be done. Once the pandemic hit, she says, “Suddenly, it was done in three months.”
Kaplan says, “We were all dabbling in telehealth and we stood up robust platforms very quickly.”
The panel concurs that it’s time to solidify the place of telehealth in care delivery. Holmberg says, “The pandemic proved that technology could be very effective in getting people care, to extend the capabilities that we had.”
Patti Doykos, Executive Director of Health Equity, Bristol Myers Squibb
Doykos points out that telehealth has greatly expanded access, especially for patients in rural areas who need specialty care. “I think what we have seen is that digital health, telehealth definitely creates opportunities for more healthcare information or access to services, and especially resource-limited settings or rural settings where patients would have to travel very, very far in order to get access to care.”
Improving the Telehealth Experience
Now that telehealth has been widely adopted by providers and patients, the next challenge is improving the experience of telehealth. “Technology can actually be an impediment if it’s not executed properly,” Kaplan says. Some patients, for example, may not have the technical skills to navigate a virtual visit.
Doykos highlights a promising trend in addressing this issue. “We’re seeing that a new kind of community health worker is emerging, which would be a telehealth or digital health community health worker, just to help families and patients who maybe don’t have a lot of digital and telehealth literacy.”
Adding Screen-side Manner to the Med School Curriculum
Medical school training is also making progress in this area. A board member of Dartmouth’s Geisel School of Medicine, Doykos shares, “We’re seeing that medical schools as well now are looking to create capacity and learning on this kind of healthcare delivery so that your ‘screen-side manner’ is good, like bedside manner, and clinicians can learn to use digital and telehealth tools to best serve patients.”
Changing the Regulatory Environment
Telehealth, including video visits, text messaging, telephonic consultations, risks being relegated to a former state, which favors in-person visits to a provider’s office as reimbursable encounters. The panel believes that the changes put in place during the pandemic serve only to validate digital modalities in care delivery, and payment parity is necessary.
Dr. Gary Kaplan, Chairman and CEO, Virginia Mason
“The industry, the profession, I think is on a very steep but very fast-moving learning curve,” Kaplan says, “and I think that if we can allow the regulatory environment to move along with it, we can potentially avoid disadvantaging people.”
There are still barriers to overcome. “I think one of the ways we need to focus on this is to actually work on the regulatory environment to make sure that we have laws in place that allow payment parity, that allow audio-only access,” says Kaplan. “That’s in place today for behavioral health and some patient education services, but there’s actually barriers to audio-only interactions right now in CMS coverage restrictions.”
Responding to Kaplan, Hurt says, “If we don’t leave telephonic as an option, we alienate an entire group of patients. And if we don’t, as you said, make policy changes that keep telephonic access in place, we’re going to leave a ton of patients behind.”
Aligning with Like-Minded Partners
David Holmberg, CEO, Highmark Health
Finding the right technology partners is helping healthcare organizations accelerate digital transformation. One example is Highmark Health’s Living Health model, a partnership with Google Cloud and Verily. The goal is to “deliver a remarkable health experience for patients through a holistic, digitally-enabled, personalized set of solutions,” according to the March 2021 press release announcing the partnership.
“We’re very focused on our partnership with Google,” Holmberg says. “From my perspective, it’s all about partners — whether it’s government and the private sector or within the private sector — finding partners who have similar values and want to make a difference.”
Bristol Myers Squibb (BMS) develops medicines for specialty care, with specific focus on rheumatology, oncology, and immunology. Its grant-supported partnership with Project ECHO (Extension for Community Healthcare Outcomes) aspires to “improve access to quality cancer prevention, screening, treatment, side-effect management, palliative care, and survivorship for underserved populations in the U.S. and around the world,” according to the BMS Foundation website.
Doykos explains that Project ECHO “creates hubs of specialists who then [virtually] connect to community-based providers and provide case-based guidance for their patients.”
Who Should Pay?
Holmberg highlighted the need to build on the technology capabilities the pandemic pushed forward. That requires investment, and the $1.2 trillion bipartisan Infrastructure Investment and Jobs Act passed in November earmarks $65 billion to expand broadband access and make it more affordable.
“We’re all very hopeful that the infrastructure bill, given part of its stated focus of bridging the digital divide, will be very, very helpful there,” Doykos comments.
Kaplan agrees that more is needed. “Even broadband access doesn’t mean that people will have devices to access to the internet and so we’ve got to really be looking hard at this,” he says. “I also would talk about leveraging philanthropy, leveraging other ways to use those with disproportionate wealth to actually help fund access to these technologies to avoid exacerbating inequities.”
Hurt adds that health systems should “take a stake in providing access and a device” if they require a patient to use the patient portal to get test results or other information.
Algorithms and Faulty Assumptions
Virginia Mason uses the concept of an “equity lens” to evaluate proposed changes to processes. “Every team that is working on improving a process has to look through an equity lens prior to moving forward,” says Kaplan. “For example, our transplant team recognized that a dental clearance requirement that was part of the protocol actually prevented over 100 patients from getting on the transplant list where they needed to be.”
Measuring What Matters
The panelists agree that the industry needs to leverage data and analytics to shed light on inequities.
Kaplan notes, “It starts with getting the demographic data we need to understand our patient population, to understand the gaps in care. We need to build an analytics engine so we can capture the data and understand where we are today as well as whether we’re making progress or not. I think that’s critically important whether it’s the LGBTQ community, whether it’s racial inequities, or poverty.”
A fourth panelist, Dr. Penny Wheeler, retired as CEO of Allina Health at the end of 2021. Watch the full panel discussion here.
Jane Weber Brubaker is executive editor of Plain-English Health Care, a division of Plain-English Media. She directs editorial content for eHealthcare Strategy & Trends and Strategic Health Care Marketing, and is past chair of the eHealthcare Leadership Awards. Email her at jane@plainenglishmedia.com.