Virtual care could be the great equalizer: three case examples

There are practical ways to apply digital care solutions to improve health for all.

The difficulties associated with the pandemic affect the mental and physical health of various populations differently.

Younger generations, women and people with children at home face higher rates of depression and anxiety, while black and Hispanic adults fare worse than white adults on all measures health. Technology, especially virtual care, could prove to be the great equalizer and improve the quality of care for all populations, if used correctly.

The best virtual care programs solve health access issues for medically underserved communities, resulting in significant improvements in disease control and treatment plan adherence. Seniors transitioning from hospital care to home care, for example, could benefit from personal emergency response systems that allow them to reach a healthcare specialist at the touch of a button. This could reduce readmissions and allow older people to stay safely in their homes, improving their quality of life.

Teleintake services for low-income populations with substance use disorders or mental health conditions can extend the reach of emergency department (ED) personnel to make referrals for ongoing care, which which could save lives.

While the complexity of this work cannot be overstated, especially for populations with (justifiably) low levels of trust in the health system, several success stories from leading provider organizations and health plans indicate practical ways to apply digital care solutions to improve health for all.

Here are three lessons learned.

1. Map regional resources that could serve as partners for virtual access.

In early 2022, the US Department of Health and Human Services (HHS) awarded $55 million to community health centers to expand access to telehealth and digital technologies. Since the start of the pandemic, the use of virtual care in community health centers has increased by 6,000%, according to HHS. More programs like this are essential to solving the digital divide.

While access to smartphones is high even among vulnerable populations, most low-income populations find digital health apps difficult to use. A recent study found that for these populations, the idea of ​​digital health apps is appealing, but the data entry is often too cumbersome to make using these apps worthwhile.

Community service agencies, recreation centers and faith-based organizations could help bridge the gap between usability and the value of digital health, including for virtual care, by providing on-site support, education and presence. friendly person to turn to when questions arise. It could also help address broadband access issues that pose barriers to using telehealth for 45% of respondents who have used telehealth at least once.

2. Investigate ways to leverage care managers for digital chronic care management education.

Self-management of chronic conditions such as diabetes and heart disease requires not only access to medical care, but also savvy consumer engagement approaches, understandable education, and next-level behavior modification tools. Many digital solutions tick these boxes.

However, digital chronic disease management must incorporate sensitivities to cultural, social and economic barriers. This is an area where a care management team can build engagement by providing insight and support to engage populations who may be reluctant or have barriers to trying a new health approach.

Language preferences can be handled with technology. For example, even before the pandemic, clinicians at Massachusetts General Hospital feared that telehealth would disenfranchise large portions of the population, especially those with limited English proficiency.

When COVID-19 emerged, they worked to increase access to virtual care and technology for these patients. They provided interpreters who could facilitate the process of connecting with a virtual provider to receive timely care and address privacy concerns of immigrant patients. They also provided training to patients on virtual platforms and technologies in multiple languages.

“We really had to put ourselves in the shoes of the patient and go through all the workflows to make sure the language and health literacy needs were taken into account,” lead author Esteban A. Barreto, PhD, MA, director of the Massachusetts General Community Health and Equity Assessment, said in a statement.

3. Use digital mechanisms to strengthen existing health relationships.

MetroPlus Health Plan in New York used text messaging to boost telehealth enrollment rates during the height of the pandemic. The health plan, which serves more than 550,000 members — 72% of whom are covered by Medicaid, a notoriously hard-to-reach population — launched its virtual care program during the pandemic and in less than three months, engaged nearly 7 000 members in telehealth. MetroPlus did this by communicating with members through the digital tool they use most – their smartphone – using interactive voice response calls and text messages to drive telehealth enrollment.

At Advocate Aurora Health, care managers used a digital solution to monitor COVID-19 patients discharged from the ER or an inpatient stay to ensure a safe recovery at home. The awareness made possible by this technology allowed nurses to know when a patient’s condition has worsened and they should return to in-person care. For those living in social isolation, the patient experience has been particularly remarkable. Comments such as “I didn’t feel so alone” validated the approach even beyond its clinical utility.

Another opportunity to strengthen existing healthcare relationships is through the use of automated questionnaires that help identify SDoH at the point of care. Some patients are more willing to share information regarding SDoH through a digital mechanism rather than in a personal encounter. Automated questionnaires can help providers get the necessary information about the real-life challenges their patients face without appearing intrusive. Providers can then offer compassionate support and resources to improve health outcomes.

Through the sensitive application of virtual care and digital technologies to improve access for the most vulnerable, providers and health plans can close gaps in care and support. This evidence shows that, properly applied, these tools can improve outcomes and engagement while reducing healthcare costs.

Carrie Nelson, MD, MS, FAAFP, is chief medical officer, Amwell.


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