Wednesday, Jun 14, 2023

On Health Equity, It’s Time For Digital Health To Put Its Money Where Its Mouth Is


Over the past few years, the digital health boom has directed tens of billions of dollars into the development of innovative healthcare models and new technologies. As the market cools, many of these new solutions are being held under a microscope. Do they deliver a great experience? Are they clinically effective? Are they cost effective? These are important questions, but it’s equally important to ensure that innovative healthcare models and new technologies are advancing health equity. 

Health equity, the state in which everyone has a fair and just opportunity to attain their highest level of health, according to the CDC, is often touted as a desired outcome by digital health companies. While many preach about the promise of health equity through technology, few have created solutions and business models focused on delivering results.

Few of our most frequently used digital health tools improve health equity. A new study from HHS’ Office of the National Coordinator for Health IT, for example, found Black and Hispanic individuals are offered and access patient portals at significantly lower rates than white individuals. This trend permeates across other digital health technologies, begging the question: where is the payoff? Are we actually making progress toward a more equitable healthcare system, or are companies using health equity as buzzwords to better position their business? 

While in medical school, I read Nelson Mandela’s book Long Walk to Freedom and I couldn’t help but draw the parallel between the journey of fighting for and working toward transformation, equality, and peace and the U.S. healthcare system. Under the repressive Apartheid regime in South Africa, discriminatory health policies coupled with poor coordination, deprived Black South Africans of quality healthcare.

The U.S. healthcare system, similarly, was not built to serve every population equitably. Rather, it was built upon exclusionary and discriminatory structures, systems, policies and practices that have disadvantaged historically minoritized and marginalized groups and those without the means to access quality healthcare.

Today, billions of dollars are invested and spent on trying to fix and improve systems in the United States, the majority of which are focused on employer sponsored healthcare programs, but we have yet to achieve equity at scale.

Despite new policies and acts implemented to create a more equitable system, major health disparities persist in the U.S. It’s time for the private sector to stop buzzing around the idea of health equity and start actually building toward it. We can do that by first considering where we are falling short, and where those shortcomings are most widespread and impactful. This includes rural America – the small towns, farming communities, tribal lands, and frontier areas that people of every race, ethnicity, and culture call home. 

We can’t build health equity until we fix rural health

Today’s healthcare system at-large fails to properly serve everyone, no matter their race, culture, gender, or where they happen to live. One of the greatest disparities in healthcare today is still largely ignored. In rural communities across the country, geography, socioeconomic status, and other social factors lead to drastically poorer health outcomes and a mortality rate that’s 23% higher than those who live in urban communities. And rural populations of color are at an even greater disadvantage.

We are a wealthy country, with the resources and means to deliver care in a thoughtful, intentional and meaningful way. However, the United States has the worst healthcare system overall among 11 high-income countries, according to research by the Commonwealth Fund. The U.S. zip code you live in is a better predictor of your health outcomes and life expectancy than your genetic code.

Healthcare has seen record investments in new healthcare ideas and concepts in recent years, but very little of that has been focused on rural communities – communities that are home to half as many primary care providers and one-eighth as many specialists per capita when compared to urban communities. 

There’s a deeply entrenched problem of misunderstanding in rural healthcare, of attempting to paint every rural American as the one-in-the-same. The reality is, there are communities within communities in rural America, each with incredible nuances and differences, and each with their own unique healthcare needs. We must give voice to these individual communities by engaging the individuals within them as stakeholders with a critical seat at the table, listening deeply and often to build trust.

By ignoring the needs of rural communities, digital health is ignoring 20% of the population. I believe we cannot truly improve health equity at large without addressing rural health disparities head-on. But we cannot do it with technology alone. 

Technology itself won’t build health equity

The Covid-19 pandemic was a catalyst for healthcare innovation. New digital healthcare companies and products emerged with the promise to create more seamless, efficient and accessible health care. Telehealth was a critical care model that bridged gaps to accessing care when in-person visits were limited. 

However, technology will not solely fix our healthcare system nor eliminate systemic health disparities. Telehealth often relies on high-speed internet connections. Unfortunately, only about 60% of rural residents have such access. Healthcare is deeply personal, and face-to-face interactions with a trusted care provider is important for many people, especially within rural communities. 

People need a healthcare system that can adapt to their unique and varied way of life. Every person with hypertension deserves the same quality of care. The means by which we provide that care, however, will not always be the same.

Rural healthcare is a complex problem to solve, and despite billions of dollars invested into healthcare, no one has made healthcare accessible, affordable, and convenient in America’s rural communities – yet. Reconfiguring models and solutions that have gained traction elsewhere has not worked in America’s small towns, farming communities, and tribal lands.

We will not ever be a country known for providing equitable care until we fix healthcare in rural America. Healthcare companies and innovators need to stop reinventing and disrupting, and start by listening to the needs of the people they serve and delivering on the promise of better health for all people, regardless of where they live. 

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