By Dr. William Payne
Innovation and progress in healthcare move slowly. COVID-19 vaccine development has been the exception in a discovery process and implementation that often takes 15 to 20 years. Disruption today comes mainly from healthcare startups, not major institutions. But despite deep knowledge of digital technology, healthcare entrepreneurs face the same challenges in regulation and growth as incumbents. Enter a critical missing ingredient: health equity.
Healthcare innovation cannot be transformative without reaching the populations with the most to gain from better health. Linking technology and wellness requires access to care and patient engagement. The premise here is simple: If the healthcare profession can attract more patients who are historically left out and keep them engaged in managing their health, those patients will achieve better outcomes. The test for technology solutions is whether they bridge this digital and physical gap.
Action on this critical front will cut to the core of health issues such as cardiovascular disease and diabetes. These and many other conditions are disproportionate threats to people of color. Blacks are twice as likely as whites to die from diabetes, and heart disease is 30% more likely to be fatal. Reducing the number of Black people diagnosed with hypertension or diabetes to the majority benchmark would improve millions of lives and prevent thousands of deaths every year.
Patient engagement, activation and action can make a significant difference in managing these chronic conditions. Connecting the dots in their care will reveal the form that healthcare transformation must take.
‘Pain Points’ in Health Tech: The View From the Clinic
Digital technology can play a cornerstone role in health equity. The first part of progress in this area lies with the tech startups themselves, which must recognize and address their limitations. For instance, the thrust of much of today’s innovation follows a path from the tech world to the healthcare world instead of the healthcare world to the tech world. Solutions searching for a problem are destined to fail and have only a marginal impact.
Healthcare professionals involved in disruptive technology can, from the very start, provide valuable intelligence and reduce friction in transactions such as refilling prescriptions. Here, we can see analogies in financial services. While much of the innovation today comes from financial and consumer technology companies, fintech startups often have next to no experience dealing with health regulators and compliance demands, as traditional bankers do.
And while much disruption in healthcare revolves around the tech-centric paradigm of finding consumer or business “pain points,” healthcare diagnoses defy one-size-fits-all solutions. Medical professionals, first and foremost, must create a safe environment for patients that can provide them with the best outcomes. The tricks and tools that work well for tech disruptors may not fully bridge the gap between innovation and safety.
Finally, a great idea that originates from a startup may not scale very well, either from a financial or sustainability standpoint. An innovation that can’t scale will not make an immediate impact. It will not reach those who need it to manage chronic disease and will not change the lives of Black patients at risk.
COVID’s First Lesson: Focus on Access to Care
Engagement begins with providing patients with information and knowledge in a consumable way that they can utilize readily and easily. But that brings with it a host of questions: What’s the best way to do that? How do you communicate that? Who’s the right person to express it? And how do you create interaction between a patient and service provider to deliver a better experience?
Here, it helps to grasp one of the most fundamental issues: access to care. The pandemic has brought this concern home. Vaccination has been highly effective at preventing COVID-19 related hospitalization and death. Attention to outreach and logistics in the Black community has helped narrow the initial gap in vaccine acceptance. Still, in COVID-19 cases for which race is known, hospitalization among Blacks has been 2.4 times the white rate. This health disparity certainly has cost thousands of lives.
Medical professionals must also be made aware of disparities they might otherwise miss. They may not know, for example, that Black patients with diabetes have a higher amputation rate than white patients. Data analysis can play an essential role in remediating these knowledge gaps. Even among doctors who recognize serious conditions among their patients on an anecdotal level, data-driven insights about patients will paint a clearer picture.
The Value of Equity in Value-Based Care
Value-based care can also be very beneficial in improving health equity because it is not driven by a patient’s insurance but by quality. Instead, it offers a financial incentive to provide patients with preventative care. Any population with shared characteristics, such as disease, ethnicity, or gender, could benefit from this approach. The focus can then shift to delivering services that uniquely help them live their best lives. This is where burgeoning technologies such as telehealth have an important role to play.
Let’s be clear: Equity means using all that we can learn about the whole person through data; extending our collective reach via technology; and offering better access, treatment and outcomes by way of enhanced education and engagement. That’s the big challenge. Hospitals and health systems can leverage their power and potential in this cause, as both an economic engine and a community platform to voice issues relevant to their community.
The good news here is that we are taking great strides forward. Where we can collect the right information—from social determinants of health to socioeconomic status—we will have better answers to the question of how we are faring with different populations.
Value-based care should, in theory, level the playing field. Tech disruptors can give us new tools to process data and employ a range of innovations, from machine learning to virtual health platforms. And the vision that ties it all together—providing health equity for underserved populations, including Blacks—will require the input, energy and commitment of medical professionals to create an ecosystem of trust and a new era of healing and wellness.
Dr. William Payne is a founding member of Black Directors Health Equity Agenda, a Chicago-area orthopaedic surgeon and co-founder of the telehealth platform MyOwnDoctor. The Black Directors Health Equity Agenda comprises board directors and senior leaders who are working to eradicate the health disparities and inequities that threaten the individual and collective prosperity of Black families. Learn more at bdhea.org.
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