While new technologies are bringing a host of changes to the health care ecosystem, digital tools have largely failed to address equity, said Maia Hightower, CEO and cofounder of Equality AI.
Hightower, speaking at AHIP’s recent Consumer Experience & Digital Health Forum, said that in her experience, patient portals are primarily used by affluent members, rather than those who do not speak fluent English or face other challenges.
“But when a digital technology is designed with health equity by intention, it truly can make a difference,” Hightower said. “We need to make sure we’re measuring how that intervention impacts each of our subpopulations. When we see a disparity, we need to make targeted, culturally appropriate interventions … and sometimes these interventions are not technology interventions.”
Michael Crawford, assistant vice president for strategy and innovation at Howard University’s Office of Health Affairs, recommended five criteria when evaluating technologies:
- Does it increase access?
- Does it enhance patient and family engagement?
- Is it affordable for the population you’re seeking to engage and help?
- Is it helping to advance health literacy?
- Does it improve the patient experience?
“If the technology is not designed for the needs of the users, you’ll see a quick churn,” Crawford said.
Digital determinants of health
While digital tools can improve the care experience for some members, they can also create digital determinants of health where other members are disconnected because they can’t afford mobile phone plans, face language barriers or for other reasons can’t use the tools that would help them optimize their health.
These include technologies that allow members to self-monitor metrics like blood pressure and glucose levels, so that people who can’t routinely go to a doctor can still contribute their data and understand if they’re achieving outcomes. “The question then becomes who has access to those technologies and are they accessible equitably,” said Rachel Harrington, assistant VP for health equity sciences at the National Committee for Quality Assurance. “As we’re seeing technology change the delivery of care, can we track and understand, through stratification and additional tools, who is benefiting and who is not.”
Plans may need to think outside the box to improve access for these members, such as providing them with smartphones, offering Starlink hubs in communities and making sure educational materials are available even when the member is offline, panelists and audience members noted. Harrington recommended plans look who is not adopting their digital tools and find out why so they can “address the digital divide.”
Letting go of assumptions
But while insurers often assume all members want to use the latest apps and technologies, panelists and audience members noted there are also populations that don’t want to go digital due to resistance to learning new technologies, trust issues or privacy concerns.
“For some populations, getting on the phone with them is the most equitable way to reach out,” said Pooja Mittal, chief health equity officer with Health Net. Because there is no video feed, they don’t feel pressure to clean the house.
Rather than guessing what members want, plans can benefit from going into the community to speak to members directly and see what things are actually like where they live. Hightower told attendees she gained invaluable insights from taking a mobile bus to different Latino communities to distribute vaccines and ensure providers in those areas had priority access.
By connecting with member communities, listening to their needs and intentionally building equity into new technologies, plans can move the needle on the digital divide and ensure members have the best available tools to improve their lives.