The COVID-19 pandemic set the stage for a slew of conversations about health equity and access.
“I read a book, probably a lot of you have read it, Charles Dickens’ A Tale of Two Cities. It starts by saying, ‘It was the best of times, it was the worst of times,’” Abner Mason, prilosec and protonix founder and CEO of ConsejoSano, said during a HIMSS19 panel, moderated by MobiHealthNews.
“One of the weird things about COVID was it really has been that way. Poor people got poorer and sicker, and died at higher rates. Well off people actually did OK. The high-end real estate is booming, and, if you look at the stock market, a lot of people have done very well. Against that backdrop we have the disparate impact of COVID and the whole conversation around racial equity and racial justice that happened in 2020.”
Patients who have less resources may be less likely to access healthcare for a variety of factors including taking time off of work and childcare.
“I think overall we have this view in America, and maybe it’s tied to the founding of the company and how Americans think that somehow if you are low income or poor it’s your fault. That’s not true. But when it comes to healthcare, we have this view that people aren’t going to invest in their own healthcare.
“What we found is that they serve mostly Medicaid populations across the whole country. Low-income people want to improve their health, they want their kids to be healthy. They want their kids to grow up to be healthy. They struggle, because, if you need to go to the doctors, etc.,” said Mason.
Today clinicians are increasingly looking to use technology to help gain further insights into a patient’s social determinants of health. Madhur Garg, medical director of radiation oncology at Montefiore Health system, noted that his hospital has begun to use a screening tool to help gather holistic insights about a patient’s life.
“From the provider’s perspective, when it comes to SDoH, I think incorporating them into general care, to address them upfront, and know that a patient might have trouble coming in because of childcare issues or the job …. I think it improves compliance to a significant degree, because that is what we were seeing before we established a program to screen these patients upfront,” Garg said.
Telehealth has long been hailed as a way to improve access to care for patients. However, Mason noted that, historically, low-income folks have been left out of access to these tools.
“Before the pandemic, very few low income people – the folks on Medicaid – had access to virtual care, because it wasn’t reimbursed. The truth is – we should all be truthful –telemedicine and a lot of virtual care was built for higher income people, and it certainly wasn’t used for low-income people,” Mason said.
However, the COVID-19 pandemic prompted policy changes, which enabled more individuals to get the service reimbursed.
“Where, along comes COVID, and all of a sudden no one can get into care, so regulations changed overnight. A lot of the clients we had – federal qualified health centers (FQHC) are people who serve low income people. For the first time, they were able to get reimbursed for virtual visits. From a policy position, we shouldn’t go back,” Mason said.
“It’s a shame that it took a pandemic to provide low-income people with innovations and healthcare that higher income people had had for 10, 15 years and didn’t even want to use.”
Mason said that allowing patients to seek care across state lines is another way to open up access to appropriate care for patients.
“If you are in Wyoming, and you speak Vietnamese, and there is no doctor who culturally and linguistically understands you in Wyoming, but there is one in Denver, you ought to be able to talk to the doctor in Denver. That’s one of the things that technology can do for us today, but policy prevents that today.”
Garg said that, while CMS policy changes came quickly during COVID-19, going forward there needs to be structured changes.
But policy changes aren’t always patient-centered, said Mason. He gave the example of using a telephone call versus a video visit.
“Here is the thing that is happening now: Policymakers are saying we think that telehealth, meaning using a phone, shouldn’t be reimbursed the same as video visits. What happens in healthcare is whatever you reimburse higher is what everyone is going to do, but what we have found and there is lots of data for this,” Mason said.
“People prefer the phone, and lower-income people, because of broadband and other issues, only use phones. We are saying to the patient, the way that you prefer to communicate – are willing to communicate – we aren’t going to encourage that. We are penalizing the system for engaging you the way you want to engage. That’s crazy. It should be turned on its head.”
Going forward, Garg said, addressing issues early on can help boost a patient’s health in the long term.
“If this is addressed proactively by taking care of living conditions, or taking care of some of the education and awareness needed, it in the long run is going to improve healthcare,” Garg said. “Telemedicine is a great tool. I see that as a great supplement of care.”
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