When it comes to managing health, certain groups, such as the 46.7 million Americans living in poverty, or the more than 59 million people located in rural pockets of the country, face more challenges than others. Patients in this demographic often have little access to healthcare and the tools needed to effectively maintain their health. Individuals living on the borders of poverty are also the most at risk for developing a chronic disease that requires frequent intervention from a physician and regular self-management.
It can also be challenging for urban and rural providers to reach these patients who live somewhat off the grid. And the burden is a heavy one—for patients and on the health care system.
Yet, one of the biggest assets of digital health is rooted in its ability to help reach many different groups of patients, each with unique healthcare needs and life circumstances, who may be otherwise limited from receiving the care they need to be well, such as the underserved patient.
Utilizing Digital Health to Engage those Hardest to Reach
Innovations in digital health have helped to significantly bridge the gap in care for underserved populations for whom traditional models of care aren’t necessarily effective, helping these patients to better manage their health and connect with physicians.
Text messaging, email, health kiosks, telehealth and apps are among the digital tools that have been integrated in the care of underserved patients in an effort to extend access to health care and improve outcomes.
Initiatives like Text4Baby which sends bi-lingual text messages to pregnant women and new mothers educating them on topics ranging from prenatal care to breastfeeding to immunizations to organizations utilizing telehealth, have been successful. Telehealth, which encompasses video, telephone or cable, has been useful for engaging patients in rural locations. For example, a care provider can connect with a farmer in rural Nebraska to remotely monitor his type 2 diabetes. It’s also an effective way for caregivers to educate and exchange information with patients about chronic conditions like hypertension and diabetes–a key to patient’s developing the confidence and skills necessary to self-manage their health.
Digital health will be most impactful for underserved groups when its intelligently integrated, through design, access and operation, to fit the unique lifestyles of the patient population using the technology. “Fitbits aren’t particularly useful if you’re homeless, and the nutrition app won’t mean much to someone who struggles to pay for groceries. Same for emailing your doctor if you don’t have a doctor or reliable Internet access,” explains Barbara Feder Ostrov in a recent NPR story.
When applying digital health to groups in the safety-net, one can’t help but ask, is access to mobile technology realistic for individuals in lower economic brackets?
In a report from the California Health Care Foundation (CHCF), author Jane Sarasohn-Kahn explains, “low-income consumers are harder to reach and to serve in the traditional model of face-to-face care during typical working hours. They are more likely than others to lack stable housing, transportation, and work schedule flexibility. Many lack facility in English, and some are socially isolated. People in the safety-net population tend to have less consistent access to Wi-Fi, which is increasingly becoming a necessity for connecting with education, health, and human services.”
Yet, despite this, the report found “a significant portion of low-income consumers use digital technologies including mobile phones” which has presented a big opportunity for providers and innovators to engage this population.
Another study found that for hard to reach and high-risk groups, “text messaging has proven to be highly effective at getting consumer attention, and more importantly, encouraging consumers to participate in their own health.”
As we transition to value-based care, digital health is poised to make a significant impact in the overall health of our most vulnerable populations, not only in how they are engaged by providers but how they approach their own wellness. Ultimately, the hope is that these populations can do so from a more educated and motivated place.
“We are moving toward a very interesting time in digital health where there’s a lot of opportunity to fix really big problems,” says Andrey Ostrovsky of Care at Hand. “I think the most money is to be made where the largest social inequities exist.”
Where We See a Disconnect
One size rarely fits all these days and this is exceedingly true in healthcare. When using digital health to engage a patient in extraordinary circumstances, such as someone living in poverty or in a rural area with the closest physician’s office or hospital hours away, it’s important to take into account which tools will be most effective.
“There is a disconnect between the problems of those who need the most help and the tech solutions they are being offered,” said Veenu Aulakh, executive director of the Center for Care Innovations, an Oakland, Calif.-based nonprofit that works to improve healthcare for underserved patients.
Perhaps many innovators do not fully know or understand the needs of their audience or the people who would benefit most from their technology. Is it the upper class family already privy to the knowledge and resources necessary to support good health? Or what about the single working mother with a chronic illness who doesn’t have a regular physician or access to information to educate her about her condition?
Technologies that are accessible, useful and that can be tailored to meet the comfort level and needs of the user, will have the most impact and greatest chance of improving health outcomes for underserved patients.
“Health advocates say it’s important to tailor digital health technologies to lower-income people not only to be fair, but because they’re more likely to have chronic illnesses, like diabetes, that are expensive to treat,” said Feder Ostrov.
Leveraging Technology with a Human Touch
“If you tie a coach or human at the other end of a digital health intervention, it increases the likelihood of a user engaging for their own health,” says Stan Berkow of Sense Health.
One study that looked at the effectiveness of health coaching for underserved groups found that most of the individuals in the project “were unfamiliar with the accountability talk that is unique to coaching. They responded favorably to creating specific, measurable, realistic goals, building concrete plans, and identifying their values and strengths.”
We’ve talked about the value of health coaching to improve the outcomes of individuals living with chronic illness. But, digital health’s value to underserved populations, particularly those in the safety-net who suffer a disproportionate number of health issues, we imagine would only be magnified by the integration of a health coach into the process. The conversation has begun,but further research is warranted.
Is there a panacea for how to change the outcomes for those who need the most help? Perhaps not. But the promise digital health holds for these most vulnerable groups is encouraging and will only be enhanced by the shift in our healthcare system.
The CHCF report concludes, “The sooner Medicaid and other plans that cover low-income Americans move to paying for value, the sooner the underserved can be better served by promising digital health technologies.”