Inclusive Innovation: Repurposing Technology in Service of Health Equity

Royal TuthillGeneral Manager, Ambulatory and Population Health, GetWellNetwork


At ViVE this year, it was clear that industry leaders are shifting their model from acutely triaging clinical needs and one-off care transitions to broadly engaging the community. Healthcare has never been more aware of and invested in health equity — ensuring that historically underserved and at-risk populations don’t continue to fall through the cracks.

As we leverage advancements in technology to scale our engagement models, we need to be thoughtful about “techquity.” Well-intentioned deployments of technology have unintentionally exacerbated systemic racism and increased disparities in health of underserved communities. 

Balancing these inequities is crucial to both the healthcare industry’s moral imperative and emergent business goals. For perspective, consider:

  • 79% of Black patients were hospitalized for COVID-19 vs. 19% of white patients
  • Only 19% of eligible patients completed an annual wellness visit in 2019, with a 10-11 point lower annual wellness visit utilization for Black and Hispanic populations
  • The United States has the highest maternal mortality rate of any high-resource country, and it’s rising
  • Black women are 3x more likely to die in childbirth than white women 
  • Black babies have 14.1% higher rates of low birth weight and infant mortality than other races/ethnicities

All organizations need to proactively engage mid-risk and low-risk cohorts to prevent them from escalating into high-cost/high-risk situations. Creative digital solutions may be key to improving health equity at a population level. 

Lower the digital barriers

SMS messaging is the most broadly utilized and accessible tech-enabled communication, used daily by 97% of the U.S. population. Let’s compare it to email outreach: 

  • Open rates are 5x higher (98% vs. 20%)
  • Response rates are 8x higher (45% vs. 6%)
  • Response time is 60x higher (90 seconds vs. 90 minutes) 

In fact, 85% of smartphone users prefer mobile messages to emails or calls, and these preferences are reflected in patient communication. HealthITAnswers notes that 70% of smartphone users want to be able to choose between texting and emailing when interacting with providers, and 70% want to receive texts for appointment reminders, confirmations, and pre- and post-visit instructions.

Today’s text solutions enable organizations to screen for risks, triage issues, and route to the appropriate care team — all at scale. They don’t require WiFi, opening access to socially and geographically disadvantaged populations and those in areas with poor connecticity. 

While pushing out batch text campaigns is not hard, delivering SMS with precision and personalization at scale requires a sophisticated back-end to make a simple channel effective. 

‘Available’ isn’t good enough

Simply making services available puts the onus on the patient to seek out and access them, disproportionately favoring those with means and exacerbating health disparities.

An abundance of services are available to help people improve their health and wellness, but the ecosystem is fragmented, complex, and difficult to navigate. We need an intimate understanding of an individual’s personal health context to help them access the right services at the right time. That requires a mix of open communication and data to assess patient needs, as well as a robust library of health journeys. 

Additionally, sophisticated back-end technology, such as AI paired with SMS texting, becomes highly effective. This combination can reliably deliver personalized, scaled engagement. Reaching out to individuals in their preferred format with targeted messages helps screen for risks, triage to services, guide care plan adherence, and gather feedback on customer experience.

‘Content is king’? Context is queen

How can organizations reach dispersed and underserved populations and activate them to return to care? This is where traditional technology like text messaging comes in — with an AI-driven twist.

Context is critical to ensuring we know each person and where they are in their health journey. Communications must leverage the credibility of the provider, system, or health plan. They must be personalized and relevant to the individual. 

Ongoing, contextual messaging builds trust, and getting people connected to the content or services they need helps them to view their provider as a resource they can turn to with health concerns. Further, text outreach can be tracked and generates valuable behavioral, social, and clinical insights. Gaining context can help inform and surface personalized recommendations and resources for patients and guide care teams on next best actions.

For underserved populations, it is also important to ensure communications are at the right reading level, leverage people who are from those communities, and support cultural nuances and multiple languages.

Technology to scale, not to displace humans

The traditional nurse-centered Care Management model is too expensive to scale and lacks the community-based intimacy required to solve for many needs. A new model of staffing and digital enablement leverages technology like AI text-based services and digital care management programs. This is key to improving operational efficiency. Many companies have also successfully invested in community-level teams — non-clinical representatives from the communities they serve — and seen real results, lowering total cost of care and improving outcomes and health equity. 

The combination of enabling technology and the empathetic presence of real people and AI-driven text outreach has been key to unlocking last-mile challenges and establishing trusted relationships.

In summary

Enabling equitable care is about proactively reaching out to those who have been left out. Cross-population holistic care should address SDOH and help deliver personalized care that guides them to content, services, and care tailored to their needs. 

By working to “facilitate health equity across lines of culture, demographics, and systems” as described in the HLTH Foundation’s techquity research with Ipsos, vendors, healthcare organizations, and care staff can help to ensure that all communities receive equal access to care, regardless of the inequities they face. 

Applying technologies like conversational AI, automated care pathways, and intelligent workflows to a trustworthy human element can help engage dormant patients, while also identifying and supporting vulnerable patients and those at rising risk — and that’s progress that’s both innovative and inclusive.