Digital Communication is Key to Improving Health Equity

Key takeaways

1. Improving health equity is critical for success in value-based care

2. Addressing health equity reduces costs, enhances productivity and improves the health of everyone

3. Digital engagement provides a cost-effective solution to improve health equity

Definitions

The CDC defines:

• health disparities as preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and environment.
• health equity as the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires ongoing societal efforts to:

‎‎‎‎‎‎             ■ address historical and contemporary injustices,

‎‎‎‎‎‎             ■ overcome economic, social, and other obstacles to health and health care, and

‎‎‎‎‎‎             ■ eliminate preventable health disparities.

Increasing health equity is an economic imperative

In addition to the ethical imperative, the financial cost of not addressing health disparities presents a staggering drain on our economy. The nationwide $451 billion cost of race-based health inequities is about 2 percent of the GDP and a cost of $1,337 per person. This includes the medical costs to care for people with poor health and lost productivity.

Studies estimate that clinical care impacts only 20 percent of county-level variation in health outcomes. Social determinants of health (SDoH) affect as much as 50 percent, so any strategy to improve health outcomes must include SDoH factors.

Digital patient engagement is key to addressing health disparities

Many health disparities are because people are not getting needed care. Digital patient engagement can improve health equity by addressing barriers to healthcare access and empowering individuals to take control of their health. Here's how digital engagement can contribute to improving health equity:

1. Increase access to care: Many rural areas experience significant health disparities. Rural areas have health disparities because they are located far away and have less money. They also engage in more unhealthy behaviors and lack access to specialized healthcare. Additionally, rural areas have few job options for healthcare.

Even individuals in more urban area may struggle to access care because they lack a primary care provider, lack insurance or even transportation.

Digital tools allow people in remote areas to have virtual consultations with doctors, saving them from traveling long distances. This bridges the gap between patients and healthcare services, particularly for those who have difficulty accessing traditional in-person care.

2. Increase health literacy: The National Assessment of Adult Literacy (NAAL) study revealed sobering findings:

This same study shows that current health information is too difficult for average Americans to use to make health decisions. Even people with strong literacy skills can face health literacy challenges, such as when:

• They are not familiar with medical terms or how their bodies work.
• They must interpret numbers or risks to make a health care decision.
• They are diagnosed with a serious illness and are scared or confused.
•  They have complex conditions that require complicated self-care.

Adults over 65, individuals with lower education and without insurance have even lower health literacy than those under 65, compounding efforts to manage their health.

Digital patient engagement platforms provide access to a wealth of personalized health information, resources, and educational materials. Chatbots use simple, easy-to-understand terminology, to educate and empower individuals to make informed decisions about their health and well-being, such as the need and timing for specific preventive care, how to prepare for a procedure and more.

3. Identify and address social determinants of health (SDoH): Social determinants of health impact healthcare access. Therefore, it makes sense to use digital outreach to connect with individuals who are not within healthcare facilities. This allows us to reach them where they are. Screening for barriers using digital technology:

• Respects patient privacy
• Streamlines clinic workflow
• Reduces staffing constraints
• Aligns screening questions where there are resources to help them

It is important to not only capture SDoH data, but also to act on it. This is increasingly important as value-based care models such as ACO REACH incorporate incentives for screening for SDoH needs. 

AllianceChicago used chatbots to proactively reach out to patients overdue to address multiple gaps in care. They educated individuals on the importance of preventive screening. They also created a custom form to allow patients to share SDoH concerns and get help. 58% of patients contacted asked for help and were connected to resources to help them.

4. Increase convenience: As with all populations, inconvenience is an issue. For example, the median wait time for all colonoscopies has been increasing. The wait time for a screening colonoscopy increased significantly from 73.5 days in 2019 to 161 days in 2021 . Similar delays are common between an appointment and a screening mammogram.

Amazon and other digitally native companies have created growing expectations for a convenient retail-like experience. Providers must realize that patients prefer speed, selection, and ease akin to online shopping.

Digital outreach supports convenient scheduling, visit reminders, visit and procedure prep, patient education and more.

5. Reduce stigma: Digital platforms can reduce stigma such as mental health issues or sensitive reproductive health matters. Individuals may be more comfortable to provide information online than to say it to a member of the care team, leading to better health outcomes.

6. Increase awareness of and access to preventive care: Only 8 percent of US adults ages thirty-five and older have received all of their recommended clinical preventive services. Nearly 5 percent of adults did not receive any such services. Most primary care visits are initiated by the patient, who doesn’t know best practices for preventive care nor how to apply the general guidelines to themselves.

Growth in the adoption of analytic platforms has made it easier to identify patients overdue for preventive care. Digital platforms make it cost-effective to reach out to patients to:  

• provide personalized education,
• facilitate easy appointment scheduling and
• then send automated reminders for medical appointments.  

This helps increase preventive care.

AllianceChicago increased childhood wellness and immunizations by 27% for a population under 400% of the Federal Poverty Level using conversational chatbots. They have since expanded to a variety of adult preventive screenings with similar results.

7. Support language preferences: Approximately 8% of the population does not speak English well. Digital platforms can offer content in multiple languages making healthcare information and services more accessible to diverse populations.  

8. Empowerment and self-advocacy: Digital patient engagement encourages individuals to be active participants in their healthcare journey. It promotes self-advocacy and shared decision-making with healthcare providers. This can lead to better treatment adherence and outcomes.

Addressing Barriers to Outreach

Identify who needs preventive and maintenance: One common feature of EHRs is that they can alert that a patient being seen has gaps in care. That is only helpful if the patient is being seen for something else. 

Some EHRS can also generate reports of patients that are do for preventive or maintenance visits. Chronic staffing shortages limit the time staff can spend doing outreach. Adding an integrated digital communication platform proactively automates outreach by the organization.

Smartphone adoption is key to the success of digital outreach. Smart phone adoption is high and continues to grow, even at the lowest income levels as seen in this Pew Research report :

Capture the patient’s mobile number and email address: For automation to work, organizations need to capture mobile phone numbers in the mobile phone field and/or that there be an email address documented. In many organizations, staff often capture a number the patient provides in any phone number field. They may not even capture an email address. 

Organizations must evaluate and clean up phone numbers and email data. Staff training, and monitoring capture rates and providing feedback are best practice.

Broadband access: Broadband has been called a super-determinate of health. In 2022 30 million Americans lacked broadband access. This is expected to improve as The Investing in America Agenda included $42.45 billion to deploy reliable, affordable high speed internet.

Trust: 8 in 10 people won’t answer calls from any unknown numbers. With all the Phishing scams it is critical to follow best practices to build patient trust that digital outreach is legitimate.

Digital technology can help close health equity gaps. More people are using technology and financial incentives like ACO REACH to encourage closing these gaps and manage health.