In this episode of Conversations in Healthcare, leaders from Cigna, Henry Ford Health System and eHI discuss how telehealth can help bridge care gaps. Download our new report at right for latest analysis of telehealth’s potential to address healthcare inequities.
Since the start of 2020, the healthcare sector has shown remarkable resilience in providing care for patients throughout the repercussions of the COVID-19 pandemic. One of the most significant shifts for the sector has been the increased use of telehealth services. However, the pandemic has also shined light on health inequity in the United States, especially for African American, Latino and Native American communities.
Recently, Mike Ward, Head of Thought Leadership, Life Sciences and Healthcare at Clarivate spoke with:
- Wanneh Dixon, the director of programs, strategy and development at the eHealth Institute
- Will Lopez, the national medical director of virtual care and senior medical director of behavioral health at Cigna
- Denise White Perkins, the vice chair of academic affairs, associate residency program director, department of family medicine and director of health equity initiatives, office of system diversity equity and inclusion at the Henry Ford Health System, and also clinical social professor at Wayne State University school of medicine, department of family medicine and public health sciences.
Mike Ward: We’ve seen a surge in the use of telehealth services, but that uplift has not been equal across the whole of society. I’d be interested in hearing from each of you, whether the observation resonates with your own experiences.
Denise White Perkins: I believe that the pandemic really shined a light on the inequities that we have, both in our broader society and then within our healthcare delivery as well. We, due to safety precautions at the start of the pandemic, converted the majority of our visits to virtual care, and it became immediately obvious that there were certain segments of the population we were serving that did not have equal access to that care. It ranged from the user end, knowing how to use the technology to set up the visits, all the way to the more upstream issues of having broadband access in their neighborhoods. I think this really did highlight an opportunity that we need to address to improve equity in care.
“I think one of the first steps is just being aware that these disparities exist. It’s very important to look at the data of who is utilizing the services you have available and who is not utilizing the services you have available [and ask,] ‘Who’s being left out?’”
Wanneh Dixon: I think what we’ve seen has really been this glaring relationship between social needs and health needs. We’ve known about social determinants of health, but through this use of telehealth, as Dr. Perkins said, we see the health inequities and we recognize the vulnerable populations. I think within that, we recognize there are more vulnerable populations than we may have categorized before. We have to broaden our definition of who are the vulnerable populations, and also think about what does it mean for access to telehealth? Because there are some other questions that come about in terms of affordability and access to infrastructure. All of these things that healthcare may not be thinking about, but perhaps health IT might be thinking about. There’s this opportunity to marry, if you will, technology with healthcare needs with social needs. That’s really where I’m seeing all the opportunities and the gaps in telehealth services.
Will Lopez: From our perspective at Cigna, we also identified significant disparities for minorities. One of the steps that we have taken is, as we created a coverage policy for telehealth early in the year, we had included telephonic sessions as cover as a benefit, because we recognize due to the health disparities, we need to make sure that those that have no access to technology or broadband have a way to connect with their providers.
Mike Ward: Denise, I’d like to get a little bit more granular. In your experience, what are the groups doing to resolve health inequities that you are seeing and what are the most challenging issues that you are having to deal with?
Denise White Perkins: I think one of the first steps is just being aware that these disparities exist. It’s very important to look at the data of who is utilizing the services you have available and who is not utilizing the services you have available. Who’s being left out? Starting to track, when you look, for example, at utilization of patient portals and utilization of virtual care visits, we’re realizing that older adults, those who don’t have English as their primary language, those who are racial, ethnic minorities or who live in underserved areas, tend to be the groups that are not utilizing this mode of access.
“You end up having those most at risk, most in need of care, also being in a position of being least able to access the telehealth services that we’re providing. It’s really a call to action for us to look at the data, track where there are opportunities and then move towards interventions to address those.”
At the same time, it’s in a sense potentially compounding disparities, because these are also the groups that tend to be at much higher risk for poor outcomes, for the chronic conditions that we’re trying to take care of. You end up having those most at risk, most in need of care, also being in a position of being least able to access the telehealth services that we’re providing. It’s really a call to action for us to look at the data, track where there are opportunities and then move towards interventions to address those.
Mike Ward: What are those interventions or the strategies that you are employing to do that?
Denise White Perkins: Part of it is really making sure that we are engaging our entire healthcare team. There’s a lot that has to happen before you’re at the moment of the patient being in front of the provider on the screen. We’re actually involving our medical assistant, for example, in doing some ‘rooming,’ so to speak, of patients who are scheduled for virtual visits, making sure they have access to the technology, understand how it works, really getting them prepped so that by the time their appointment time comes along, they’re ready to have the quality interaction with the provider. We’re also making it easier just from a user facing point, to engage with the visit. Pushing out direct links to patients’ emails, which makes it easier for them to start the visit, as opposed to having to sign on to a portal, which might be adding another barrier.
We recognize that we have accountability as a healthcare system, but that doesn’t mean we have to have all the answers. We’re working with community partners who are engaged in this area. Our chief technology officer for example, is working with local community groups to advocate for increased access to broadband. We’re doing some research and quality improvement projects to look more closely at opportunities for improvement, especially with the older adult population.
Mike Ward: Wanneh, how does that resonate with you, given the fact that you are, I guess also trying to build those communities?
Wanneh Dixon: Our approach has been, we think about ‘“less is more.’” I think with digital solutions, it’s really important to keep in mind that people need ease of access, they need ease of use, they need affordability, they need a solution that is very familiar to what they’re already used to having in hand. I think one of the mistakes that we made collectively is assuming that with telehealth, we can just turn on a switch and everybody’s going to access the internet and start to see their doctor. That’s not necessarily true. We know that not to be true, because we’ve seen the data and the evidence that shows this as not to be true. Through telehealth, more barriers became more apparent. Yes, it addressed the geographical barriers that people may have, which is a social determinant of health.
“I think one of the mistakes that we made collectively is assuming that with telehealth, we can just turn on a switch and everybody’s going to access the internet and start to see their doctor. That’s not necessarily true.”
It addressed those barriers, but it didn’t address some of the cultural barriers, the linguistic barriers; it didn’t address even the simple device barriers. Even if you have the internet, you may not have a device that can access the telehealth platform. However, it could be the opposite. You may not have the internet, but you may have a device. Then, there’s something that’s lacking.
What eHI’s approach has been is that we’ve developed this framework, where we start from social determinants. That’s where we’ve started our work and we’ve released a number of reports around social determinants of health, around data use. We’ve even released reports on specific populations because it is very important to engage with the community that you are trying to address the needs for, in order to understand what are the unique needs.
I think over the past 18 months, we’ve talked a lot about the inequities for African American, Hispanic/Latino and Native American patients. Within that, there’s also the older population, there’s the population with disabilities. I mean, there’s so many different populations that we can talk about, but through our work and through the reports that we’ve published and through our research, that is how we are educating the public at large and informing, hopefully, some of these policies that we’re advocating for with digital health, through reimbursement policies and such, and access and how doctors can even provide services. All of those things collectively, that’s how we are addressing this. We recognize the importance of partnership and collaboration and communication. That’s really the foundation for our work and our approach in addressing these health inequities.
The above is a partial transcript from this episode. Full episode questions discussed include:
- Despite the surge in telehealth services during the pandemic, the uplift has not been equal across society – how has that resonated with your experiences?
- What are healthcare organizations doing to resolve healthcare inequities and what challenges do we face?
- What are best practices and lessons from eHI, Cigna and Henry Ford Health System?
- Which group of stakeholders would you most like to influence in the pursuit of greater health equity, especially among minority groups, and what would you like them to do?
For additional insights on the role of telehealth in addressing healthcare disparities, download our new report Realizing the potential of telehealth available to the right of this article.