Covid-19, Health Disparities and Technology

Never has health care and health care disparities been in the spotlight as much as in June of 2020. With only 90 days of Covid-19 experience, the US has launched an arsenal of resources to combat the virus it knew little or nothing about. Putting aside the “should have/would have” of a few more weeks of knowledge, the US health care system has been stretched to its limit either from over use, preparedness or financial constraints that have applied enormous pressure on an already fragile system.

Covid-19 has shined the light on the broken connections in a health care “system” that is not. It has highlighted where racial disparities have caused infection and death in communities. It has shown us that we can and must do better.

The recent tragic events with the murder of George Floyd, Ahmaud Arbery and the countless other deaths of unarmed African Americans has also made the US and the world aware of the disparities in life experiences from the Black and Brown communities. Numerous studies indicate that the socio-economic status and even the geography of Black and Brown communities increases disease, reduces the chances for healthy pregnancies and reduces longevity. Covid-19 rates of infection and mortality are just another example of this negative impact.

The tools to help repair this long-standing disparity and to effectively fight new diseases such as Covid-19 are available and are being tested. Technology, that is already in use can if used effectively, address these issues using a focused population health approach. These few examples from lessons learned in the field could be implemented across regions to better serve consumers and to help not only flatten the curve of Covid-19 infections, but also begin to bridge the gap in health care quality delivery to the Black and Brown Communities.

  1. Telemedicine- Long overdue is the use of this modality in 21st century care delivery. Virtually the last business in the world to operate solely with face to face visits and hands on care, Covid-19 has catapulted telemedicine to the forefront of care delivery. The combination of electronic health record technology and the availability of previously untapped telemedicine software now made a reimbursable event has effectively launched a new form of health care delivery.
  2. Patient Portals and Secure Messaging- With the ability of labs to report results electronically to the physician office EHR and thus the patient portal, an influx of interest in accessing the portal that has been readily available in almost all offices but severely underused is increasingly a tool for better education, information and interaction between patients and providers. The use of this tool in a Public health notice and advisory is and will be a key to improved outcomes.
  3. Data analytics- A core component of data analysis to determine the impact of health care disparities on populations is the collection of race, ethnicity and social information to help provide correlations for outcomes. Demographics that are commonly collected in electronic health records since the early 2000s could be tapped into for further research. The lack of racial/ethnic information on Covid-19 lab results collected from patients in parking lots is an example of how unprepared Public Health entities that are not currently sharing information from within county to the state level can be corrected to create a cohesive analytic field.
  4. Interoperability- Despite substantial effort and funds to building a national “information highway”, little has been accomplished to collect information effectively and rapidly on a regional basis as has been highlighted by the Covid-19 crisis. Covid-19 testing and tracing has underscored the US inability to correctly account for one single test result per patient and report that result rapidly to a central entity without error. Without this capability, due to a myriad of issues related to patient identifiers, insurance coverage, county public health and lack of interoperability from one disparate EHR to another, it is clear that the US will continue to struggle with a population health approach to disease.
  5. Public Health Policy- Without recognition of the racial and socio-economic disparities inherent in a system that relies on a combination of private sector health insurance and public sector Medicaid and Medicare, improved technology or care delivery will not flow to all members of our society. If only the wealthy, with their cell phones, laptops, broadband and transportation have access to tools for care delivery, the US will never see improvements across the broad demographics that make up our country.

By focusing on the five key areas noted above and improving the use of technology, adapting to new technologies and creating comprehensive and inclusive health care policy changes, we can achieve improvements in care for all members of our communities no matter the age, sex or race.

The Purpose of the Health Care Organization

As we welcome the 2020s, it is an important time to revisit the purpose of the health care organization and its mission for serving the community.

What is the mission?

In general terms, a health system exists to perform the full spectrum of care: primary and specialty care, acute care, rehabilitation or step-down care, preventative medicine, disease management, and occasionally teaching to maximize care to the community they serve.  Systems tailor themselves – restrict their scope – to local conditions and cyclic management programs. They depend upon payment plans to fund operations, and they succeed or fail based on their depth of leadership, systems and processes for providing care appropriate for their patient population.

In 2020 health care systems will face an ever-changing patient population in age, health, and behavior. The question becomes how to organize to optimize wellness and to continually improve the quality of care delivered despite the random variations caused by the changing mix of people and payers.

The decisions for creating a dynamic mission in 2020 are straightforward:

  • determine the scope of care (what’s important, not the entire spectrum),
  • decide on coverage (geographic footprint),
  • identify the payer mix and the resulting projections for income to fund the scope and coverage, and
  • decide who’s in (patients and plan members – they’re different) and how to engage them.
  • determine the technical and business resources toward supporting the mission

As an example, Patient engagement is communications, education, ease of access, rapid response, and satisfaction – not the simplistic patient portal. Population health management is not simple data reporting, but data analytics and clinical interventions to support the community needs. The combination of trained staff, inspired leadership, competent technology and appropriately funded resources will drive a successful mission.

The mission is, in a word, “wellness.” To keep improving patient health and outcomes in a seemingly random world.