Reducing Health Disparity is One Way to Ensure Racial Equity

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Uncovering the potential of telemedicine to bridge the socioeconomic gaps in healthcare 

By Jennifer Kent

I have spent nearly two decades working in public health and advocating for quality access to health care for all. While leading the nation’s second largest public health program providing health care services to 13M+ people in California, I have witnessed all kinds of public health issues, but nothing as complex as the impact that COVID-19 is having and will likely continue to have on health care delivery. 

COVID-19 has revealed the cognitive dissonance that exists between safety net health programs and state budgets. Since I worked for Governor Schwarzenegger in 2008 when the Great Recession left California with a $60 billion shortfall, I have seen this firsthand. Now, as we are still witnessing the human and economic impact of this public health crisis, I’m worried about the healthcare safety net for marginalized and underserved communities — typically those that are low-income, uninsured, or undocumented populations. When times are good, fewer people need to use Medicaid for health coverage. But when our economy plummets, like now, people turn to their state Medicaid and safety net programs to provide critical health coverage. 

But, even in the midst of this crisis, we can and should find ways to pivot and move forward through innovation. I see an opportunity where we can learn and shift to support new emerging needs through telemedicine. The acceleration of its adoption during this time may uncover its potential. 

Most crises often hit those on society’s margins the hardest. COVID-19 is no exception, especially as it relates to health care. Marginalized communities are the most vulnerable, suffering disproportionately for a number of reasons including inability to work from home because of the nature of their job or live in multi-generational homes or they live in remote rural areas. Poverty is a powerful determinant of population health, and low-income populations are often suffering a disproportionate impact from chronic health conditions such as obesity, diabetes and heart disease, which exacerbate the severity of COVID-19. These vulnerable communities often have the least access to the information, resources, and even the basic care they need to stay healthy and safe. The pandemic has led to a heightened escalation of these preexisting health inequities, creating an even larger gap in access to quality health care. 

Though devastating, what the pandemic has brought to light is the value of telemedicine. Before COVID-19, many Americans did not consider telemedicine as a mainstream option for care. However, according to the American College of Physicians (ACP), telemedicine was already on the rise before COVID-19, reporting that 42 percent of their members offer e-consultations. Telemedicine has also been shown to reduce cost and unnecessary hospital visits. According to a 2019 American Journal of 

Emergency Medicine study, patients realized net cost savings per telemedicine visit ranging from $19–$121 per visit and diverted myriad costly and unnecessary visits to the emergency room. 

As of 2018, roughly 50 percent of U.S. hospitals have a telemedicine program. COVID-19 has been responsible for the recent exponential growth in the use of telemedicine, increasing more in 2 months than the past 10 years. This could signal that real and tangible possibilities exist by way of telemedicine to improve the health care delivery system even for marginalized communities. 

As the gaps in health care widen during this time and access continues to be challenging for some populations, telemedicine may provide an emerging light, a disrupter with the potential to fundamentally alter our health care system to support growth and future needs. 

Telemedicine can overcome barriers to health services for different populations. It can be a viable way to provide care for those in rural areas, for example, where access to care is limited by distance between patient and provider. For lower income families, telemedicine could provide a more efficient and cost-effective way to access care by reducing the need for transportation to and from a doctor or hospital, fragmentation of care due to gaps in time between appointments, or lack of available providers. 

Still, the biggest hurdle in closing the health care delivery gap for these communities requires that a strong doctor-patient relationship be the foundation for high-quality care. According to the Robert Woods Johnson Foundation’s 2016 Right Place, Right Time Initiative, trust and respect were patients’ primary concern, even more than the quality of the health care they received. How can the potential benefits of telemedicine be realized when shrouded by a lack of trust? Telemedicine should support, not replace, traditional care delivery, continuing to care for patients’ in-person care, while still providing the flexibility and convenience of seeing patients remotely for follow up visits, check-ups, and education when appropriate or necessary. Importantly, telemedicine can act as a bridge upon which health care providers can build trust with patients who have traditionally been underserved by our current health care system. 

Telemedicine should not be viewed as a panacea. There are many barriers to broad adoption ranging from reimbursement to cultural considerations to limited Internet access. According to the FCC, as of 2019, there remained 34 million Americans that lack access to adequate broadband services. For vulnerable populations, it is important that one of the lessons of COVID-19 is greater support and acceptance of telemedicine in our health care delivery system coupled with an increased investment in sufficient infrastructure. 

As availability and adoption of telehealth expands, the opportunity to deliver high- quality and innovative telehealth services to a much broader population. Telehealth could be a valve that releases a portion of the pressure from our health care delivery system so that more of our residents, regardless of social location, may realize its benefits.

Jennifer Kent is CEO of the Kent Group and Former Director of the California Department of Health Care Services.

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