The inequities in access to healthcare and resources are well documented and can have a negative effect on patient outcomes.
Those disparities have been amplified by the pandemic. Many leaders and public health experts were unaware at the pandemic's start that the virus disproportionately affected black Americans due to inadequate data reporting, lack of testing sites in their communities and lack of access to reliable Wi-Fi and data plans for telehealth.
But health systems have long known about the risks associated with underserved communities and have relied on technology to collect data and mobilize response to broaden access to care. Here, six health system executives outline their efforts and the most promising opportunities for the future.
Thomas Dean Sequist, MD. Chief Patient Experience and Equity Officer at Mass General Brigham (Boston): We should think about technology in two ways with regard to health disparities. First, as we adopt new technologies, we must ensure that we do not leave communities or specific patient populations behind because they cannot access the technology or it was not designed to meet their needs. In other words, first principle is do not contribute to the problem. Second, we should implement technology to address the gaps in care that we know contribute to disparities. We are using text messaging and mobile phones to reach our multilingual patient population to provide real-time education on COVID, including infection control principles as well as information regarding food and housing resources.
Pablo Bravo Vial. System Vice President of Community Health for CommonSpirit Health (Chicago): Technology can help us break down barriers and inequities when we're designing programs to address the social determinants of health. However, it's only one piece of the solution. Technology can work well for community health if it's part of a collaborative, community-led effort. For example, we're building community networks to electronically refer people to the social services they need. In the past, the process for making referrals was inefficient. We'd have to call or fax some of the agencies we work with. Bringing all of our community partners into a network creates a seamless experience for patients.
While the platform that we're using is critical, of course, the project is only possible with the support and participation of other health providers, government and public health agencies, businesses, payers, schools, foundations, and an array of community-based organizations that provide services to people who are struggling.
Stephen K. Klasko, MD. President of Thomas Jefferson University and CEO of Jefferson Health (Philadelphia): Jefferson Health pioneered faculty-only, all specialty telehealth in 2014. Now, however, the challenge is to extend it to a variety of chronic illnesses that address social determinants of health.
Telehealth for cancer: The Telehealth Task Force of Sidney Kimmel Cancer Center at Jefferson addresses access and digital literacy needs that may limit use of telehealth by cancer patients. Funded by philanthropy, it provides device and/or data service when needed, assistance with getting an email address and logging on to the patient portal and individualized assistance. During the COVID-19 shutdown, Jefferson helped more than 300 cancer patients since March who have subsequently successfully completed a first telehealth visit.
Philadelphia is rapidly improving the overall survival rate from cancer of African-Americans – one of the most tragic racial disparities in outcomes in America. But to use digital tools, our social workers have been counseling cancer patients about data plans. What we've learned: access to the internet is now critical to healthcare. While most people have smartphones, fewer can afford data plans. We believe governments should see connectivity as a public health necessity, a utility, and bring it to all individuals, just as we historically brought electricity and clean water to homes.
Telehealth for medically supervised diets: Food support is key to recovery and prevention plans for heart disease, diabetes and cancer. Jefferson Health has a five-year $3.2 million NIH grant to assess the cost effectiveness of telehealth-delivered nutrition planning, and for delivering medically appropriate meals. Our ultimate goal is to prove that integration of telehealth for medically supervised diets should be routinely covered by insurance, thus addressing significant disparities in access to food and education for vulnerable populations.
John Bosco. Senior Vice President and CIO of Northwell Health (New York City): Screening questions around social determinants of health have been built into our electronic records to help identify patients in need of services to support their health and well-being (e.g. economic instability, food insecurity, legal assistance, housing insecurities, and etc.). During the COVID-19 pandemic, questions were also incorporated into a patient engagement chatbox application (Conversa) to gather similar information from patients seen in the emergency department and discharged back into the community.
The information collected is transmitted to social workers and care navigators as needed and appropriate, and also used in conjunction with a commercial platform (NowPow) which matches the patient's needs with available community services and resources. Our care management organization has recently deployed an AI-based system to identify patients at high risk for admission to a hospital or readmission to the hospital; this system (JVion) was specifically selected because it incorporates commercially available consumer-level data to understand the broader social context and risks patients may have beyond just their medical conditions.
Finally, all the collected SDoH information is being used in conjunction with a machine learning company (PIECES) to develop a 'Social Vulnerability Index' that can be used to more tersely identify levels of patient risk and help prioritize interventions and optimize the use of resources. These data will also be rolled up to develop a 'Community Vulnerability Index' to enable Northwell to prioritize and focus on specific community needs in an efficient and focused manner.
Bechara Choucair, MD. Chief Health Officer at Kaiser Permanente (Oakland, Calif.): Kaiser Permanente has had a long-standing commitment to identify and reduce health outcome disparities — such as hypertension and diabetes management — among our members. However, we know that to address health inequities we must also address the nonmedical factors that influence people's health, including basic social needs such as housing and food security, transportation access and reliable child care, to name a few.
For example, our Food For Life campaign, launched last year and expanded in April amid the COVID-19 pandemic, uses text messaging to help Californians access the CalFresh (Supplemental Nutrition Assistance Program) benefits they may not know they're eligible for. Through an interactive texting process we're able to walk people through the process of applying for benefits, the complicated nature of which frequently deters people from completing the process.
In a survey Kaiser Permanente conducted last year, 68 percent of those surveyed reported they experienced at least one unmet social need in the past year, and 97 percent of respondents said they want their providers to address their social needs during medical visits. To this end, we developed the Thrive Local program centered around a continually updated resource database and platform that health care providers can use to match Kaiser Permanente members with programs and resources within their communities that meet their specific social needs.
Todd Czartoski, MD. Chief Medical Technology Officer of Providence (Renton, Wash.): Providence has a longstanding tradition of caring for the poor and vulnerable in our communities. Our values explicitly call us to 'speak the truth with courage' and 'stand in solidarity with the most vulnerable, working to remove the causes of oppression and promoting justice for all.'
We leverage technology to help us realize this vision in several ways:
1. Telehealth expands access to care that may not be available in all communities, specifically by providing equal access to care for those who need it.
2. Virtual care minimizes travel time as well as time away from work, which disproportionately impacts hourly workers and people who don’t have employer sick time benefits.
3. Video and phone visits to our mental and behavioral health concierge services give our employees and their dependents same-day or next day appointments to licensed mental health providers.
4. Our app Circle provides education to new and expectant mothers and parents to ensure access to the latest peer reviewed expertise and literature.