The adoption of digital solutions in health care has steadily increased in recent years in an effort to ensure uninterrupted and safe patient care amid the COVID-19 pandemic. While the shift has fostered greater adoption of digital solutions and advancements in care, it has also further highlighted social determinants and inequities that factor into the digital divide. Dr. Shruti Singal of First Choice Health and Andrew Tomlinson of the American Health Information Management Association join us to discuss the digital divide – specifically, its root causes, who is most affected and how stakeholders, including health plans and health care providers, are working to bridge it.
Melissa Turner 00:03
Hello, and welcome to Touchpoints, a conversation about care, connection and costs in the US health care system. I’m Melissa Turner. In addition to co-hosting Touchpoints, I am also content director for health care and life sciences at SmartBrief. SmartBrief is a publisher of digital newsletters for professionals and creator of this and other shows in our series of SmartPod podcasts.
Doug Harris 00:24
And I’m Doug Harris. I am a custom content editor for health care and life sciences at SmartBrief, where I create content for payers, providers and other health care stakeholders. In addition to our work hosting Touchpoints and at SmartBrief, Melissa and I are of course also consumers of health care, just like those of you listening. Together, in each Touchpoints episode, we’ll explore the issues that make health care hard for all of us.
Melissa Turner 00:45
We’ll also discuss how health plans, health care providers and their partners in the health care ecosystem can make it easier. Thank you for joining us on the Touchpoints podcast!
Doug Harris 01:08
Wellframe empowers health plans to become trusted advocates for members. Their team believes that health plans are in the best position to lead the charge into the world of digital health management. Let Wellframe be your partner in improving member engagement and outcomes. Learn more at wellframe.com/Touchpoints.
Doug Harris 01:26
Welcome. I'm Doug Harris, your host for this episode of Touchpoints. Today we're discussing a topic that has garnered a greater share of the spotlight in the past few years: the digital divide in health care. Specifically, its root causes, who is most affected, and how stakeholders, including health plans and health care providers, are working to bridge it. Let’s meet our guests. First is Shruti Singal, chief medical officer with First Choice Health, a Seattle-based health plan administrator. Shruti is a leader in commercial medical management whose experience and skills include innovation and strategy, premium medical care, enhancing productivity, and case and utilization management. Welcome, Shruti!
Shruti Singal 02:00
Thank you so much. Glad to be here.
Doug Harris 02:02
Also joining us today is Andrew Tomlinson, director of regulatory affairs for the American Health Information Management Association. Andrew has more than 10 years of health IT policy experience, and he advocates on behalf of AHIMA members about issues at the intersection of technology and health care. Glad to have you with us, Andrew!
Andrew Tomlinson 02:17
Thanks, Doug. Glad to be here.
Doug Harris 02:19
So, let's go ahead and jump into the conversation. The acceleration of digital solutions in health care was born out of a necessity a few years ago to ensure uninterrupted and safe patient care amid the COVID-19 pandemic. This shift has fostered increased adoption of digital tools and advancement and care, but it has also further highlighted social determinants and inequities that factor into the digital divide. Access is one factor, but there are numerous others. Let's talk about some of those now. I'd like to take a bit of a higher-level view to start us off. How would you both define the digital divide? And what do you consider the main drivers behind it? Shruti, let's start with you.
Shruti Singal 02:50
I feel like the beginning of the digital divide for me was the beginning of the pandemic, when all of a sudden, all of the school-age children were asked to be home studying off laptops, they may or may not have had Wi-Fi, they may or may not have had parental help. And that's kind of how I initially thought about the digital divide, which is where we've been thinking about all of those pieces and parts, what had changed at the beginning of the pandemic. And of course, as you mentioned, since then it has really become part of the entire tapestry of the country, whether it's school and what I described, or what you described around health care and all of the different access points. And are we actually thinking about the fact of, do they have access? Do they have access, even the, sort of the what we're considering table stakes? So that's kind of how I think about the digital divide.
Doug Harris 03:48
Great. Thank you, Shruti. Andrew, what would you add to that?
Andrew Tomlinson 03:51
Yeah, I mean, I think that's great, that's perfect, as to how to define the digital divide. My experience with coming into contact with digital divide comes in sort of two places. There's the patient experience, digital divide and when you think about health care and what they're able to access digitally, whether that be internet connection, or being able to have access to a mobile phone or a smartphone, or even the knowledge to use the technology. And then the other side of the digital divide comes from the person that that patient may be getting services from, whether that's a provider, they may not have access to high-speed internet. But it even goes steps further into that, and to, do they have their cybersecurity needs met that keeps patient data safe, that allows them to be able to protect their practice and the patients that come into contact with it? What about in terms of knowledge of privacy? What about being able to offer digital services? And so when I think about digital divide, at least how I've come into contact with it, it also stems from both the people that are experiencing it themselves as they try to seek care or seek the service that they're trying to work towards. But also, what are the limitations for those that they have access to provide that service themselves? Not everybody gets to choose which service provider, whether that be health care or otherwise, they get to go to, based off of their location. And that can be a huge limiting factor on whether it be the quality of education someone's able to experience, like Shruti was talking about with the, you know, Zoom school and whatnot. Or it's about being able to have access to telehealth or audio-video telehealth in a rural area that may not have the cell signals. So it's kind of a complex problem when you think about how it's, it's both ends end up contributing to the same or a larger divide.
Doug Harris 05:23
Right? It seems we're all kind of interconnected, and health care certainly is an aspect of that. You both touched upon who the digital divide affects. That kind of leads into my next question. I wanted to take a closer look at who it actually affects. Who are they, and what are the potential consequences of being caught in that divide? Andrew, let's start this time with you.
Andrew Tomlinson 05:41
I mean, I think the divide impacts everybody, whether or not they're considering themselves to be a part of a group that may be the most impacted by it. I'll use myself as an example. I live in central-west Baltimore. And while I may have more means to get access to either technology, or stable internet, the people or the service providers that are around me, the ones that I'm most able to interact with, may not have the same needs, the same access to it. So in effect, while I don't necessarily fall in the same category -- think about mail service; we have horrible mail in Baltimore -- but it's the product of the system that's around it. So I can find ways around my own digital divide to get the care that I need, and health care. But the others that are around me, they don't have the same ability to do it. So when it's the face of who is the digital divide, it's kind of everybody. Everybody comes into contact with the digital divide in some way or another. But it's about whether or not you have the means to overcome that digital divide. That is really the heart, to me, of that conversation, in and of itself. And that's where the inequities start to be. Whether or not, you know, I'm lucky. I have the ability to move around it. But those that live around me don't. And that's what's most crucial, is figuring out how to bring those that are below my floor up to where I am. So that way that they can have the same access. And I think that's crucial when thinking about who the digital divide impacts.
Doug Harris 07:07
Absolutely. Thank you, Andrew. Shruti, what would you have to add to that?
Shruti Singal 07:10
I mean, I fully agree with Andrew. And, I think, to build upon what he said, I think it's affecting the sickest patients the most. So, you know, the people that need the access, that need the health care, digital divide, really, to me, that's who I think about when I think about who this affects the most, where, is that divide just getting bigger and bigger. Is that gap getting bigger and bigger every day? Because we're not thinking about it enough to figure out how to fix it. And I think, to that point, it's the same discussion around SDOH and just general health care access that we've been having for five, eight, 10 years, maybe more. I mean, I think it's just all one, it should all be one conversation, because it really does belong together. So I think I totally agree, I think the divide affects all of us, I think some of us are able to get around it, some of us can at least get access to help to get around it. And then there's this large, large group that, to me, is the one most affected and tend to be the sickest.
Andrew Tomlinson 08:12
Just if I could add to, I think to the point, is that it's also the ones that tend to be undercounted. So it's hard to know those that aren't even counted in the divide. I think that's a perspective I'd never thought of before but completely right, that the sickest patients are often the ones going undercounted. So then the public health as a whole looks better than it may be.
Doug Harris 08:29
Great points both, there. So you kind of alluded again to my next question. When we talk about the digital divide, the focus often turns to what people or communities are lacking, whether it's, you know, internet services, whether it's transportation, things along those lines. What do you all see as the greatest needs for people and communities, and how can health care providers and plans help deliver those to them? Andrew?
Andrew Tomlinson 08:52
Now that we're in the conversation, I’m sort of rethinking what I had thought about while originally thinking about this question. I'm going to think about it from where I work, primarily, which is the regulatory sphere within the -- you know, dealing with the federal government, how they are implementing laws. And I think a lot of those areas that communities, patients, you know, what they need is, they need regulatory frameworks that push health care further forward. We need permanent telehealth solutions. And I think some of the work the FCC is doing to try to bring the broadband gap down, I think what communities and patients need is help. We're in the situation that we're in, we've experienced it throughout the pandemic. Now, we're into I think almost year three at this point of dealing with this, and we're still struggling with the same problems that we were struggling with before. So, trying to find regulatory frameworks that can give health care a better understanding of how to work forward to identify gaps, solutions to fix those gaps. I mean, that's ultimately what I think they need, is investment and understanding and bringing that data forward to figure out how to move equity conversations forward, out of identifying the problem into figuring out what's the solution -- the Zoom school example, to go back to it. It's such a perfect one because I don't know if we ever fixed any of the problems. Kids just went back to school.
Doug Harris 10:05
Yeah, that's a great point. Shruti what would you add to that?
Shruti Singal 10:07
I mean, probably the step before what Andrew said, because I think that's got to come eventually, is just meeting our patients where they, where they are, I think, you know, for how many years. You know, I'm an ER doc, and people came to me for 20 years. And people came to me, and I think that's the only way of health care delivery we knew. And I think there's more to it than that. And so meeting them where they are and understanding their needs is so important. COVID has changed so much. I know lots of people who don't even want to go to the doctor anymore. It's a scary thing to leave your house to go to the doctor to be around other sick people. It's just being able to give transparency and true information to these groups that may not be getting it all the time. So just keeping that education equitable to them around health care delivery.
Doug Harris 10:58
Great, thank you Shruti.
Doug Harris 11:01
Wellframe empowers health plans to become trusted advocates for members. They believe health plans have the knowledge and resources to support more people across more touch points in their health care journey. Wellframe’s solutions for digital care management and digital customer service empower members and health plan staff to achieve their best in the most wonderfully human way possible. Make sure your members feel confident cared for and supported by their health plan. Don't miss this moment. See how a digital health management strategy would benefit your plan at wellframe.com/touchpoints.
Doug Harris 11:32
Andrew, could you speak a little bit more to the point that Shruti made of meeting people in communities where they are, the importance of that, and how stakeholders can go about accomplishing that?
Andrew Tomlinson 11:43
Yeah, I think meeting patients where they are isn't necessarily just about the physical act of going to where they are, although that is a huge gap. But it is about also meeting them at their knowledge level, their education level, their comfort level, to make sure of that. A majority of people in their interaction with the doctor, they are either used to just sort of being, they go to the doctor, the doctor is the expert. They tell them what to do, they go home. They are not encouraged to be curious, ask questions, understand, better understand their health care. And so some of it is making sure that patients have the ability to feel as if they can have that conversation. And a lot of that is with giving them data. The 21st Century Cures Act is looking to move some of that conversation forward by giving patients more information. So that way, they can review what's happening. They don't have to take notes and don’t have to record it to understand it. But a lot of it is helping them understand exactly what's happening. And it can be scary. It can be, as Shruti has mentioned, it can be difficult when you're dealing with a complex health condition. You're trying to figure out how to manage your condition and go to the doctor, who doesn’t necessarily have time to learn what all of it means. And making sure that you're meeting the patient by helping them understand how to get access to the data, how to understand what it means, so they're not just turning to, you know, Google and just searching random things in there and ending up really confused.
Doug Harris 13:05
Exactly. Great. Thank you, Andrew. I wanted to pivot back a little bit and talk about the previous question that we discussed about what communities or people lack in terms of helping bridge that digital divide. Are there things out there that perhaps are already existing, that maybe we're not taking greater advantage of? Shruti, do you have any ideas on that?
Shruti Singal 13:25
I think that the traditional health care delivery system, sort of like what I was talking about before, it needs to be shaken up. And I think that, if, as we start to look at different channels -- so just like we said, it's not about the physical place, it may not even be about an M.D. or you know, a physician in that space? It's like, what are the other opportunities we have that do co-exist already to help people get the education they need, the health care they need? You know, I think we've done a great job in the last, you know, I'm gonna say five to 10 years, introducing urgent cares. And then retail clinics, right? Going to the CVS or Walgreens to get your care. And then of course, you know, we can't forget telehealth. So I do think that we're getting there. I think it'll be really interesting to see how it all shakes out. Because, you know, the magic word, right, is engagement. Are we actually getting engagement at those levels? And what are we doing to make sure that we're not trying to use peanut butter and cover up one problem with one solution and making sure that we're able to, again, meet them where they need to be. If it's a texting solution, those are available. If it's video, if it's phone, if it's home visits. I think that's another big thing that I think is going to maybe have to come back into one of our channels is doctors and/or nurses, mid-levels, coming into the home and giving health care. So I think it's really about utilizing everything we have at our fingertips.
Doug Harris 14:56
Thank you, Shruti. Andrew, what would you add here?
Andrew Tomlinson 14:58
Now that's a good question because we do talk so much about what's missing and not about what we're not taking advantage of. I don't have a lot to add over, you know, what Shruti already provided. I mean, even myself had never done a virtual visit until like, two weeks ago. I always knew it was there, but I had never really thought about doing it and was always like, “Well, I'll just go see a doctor.” I have, you know, I had a cold at the time. And you know, I've done my COVID testing and it came out negative and so, why am I still not feeling well? And I thought, “Great, I'm gonna have to get in the car, go, they're gonna listen, my lungs, all this stuff,” and then realize they could do a virtual visit. And so I think, you know, what is missing, not to sound like a broken record, is the education piece. Because education also unearths other problems. I love that peanut butter analogy of not just smoothing over everything for one person. But if someone doesn't even know what's available to them, how are they even going to be able to voice what they're unable to access? Or what doesn't work for them? So what's missing is helping to bring that digital education and literacy forward. As odd as it sounds, you know, almost 15 years on from the true advent of the widely utilized smartphone, continuing to understand that you may know how to use the technology, but do you know what services are available to you by doing it?
Doug Harris 16:12
Great. Thank you, Andrew. Appreciate that. We've kind of touched on the role that technology and data can play in helping bridge the digital divide. In what ways are you all seeing health plans and providers leveraging data and technology toward that effort? And what do you see as them doing well, and where are some areas for improvement? Andrew, let's start with you on this one.
Andrew Tomlinson 16:32
Yeah, I think the new sort of data currency for health care -- we're gonna have more of it as the updated electronic health records move out into this space, you know, they're due at the end of the year. And then providers have a majority of next year to implement them. And then attest underneath CMS as well as the broadening definition of electronic health information that's going to be exchanged. There's more data that's going to be available to be able to better identify what -- more data that's also going to be able to be used to do research on. To be able to understand what are trends that are being seen within a provider’s sphere. And data doesn't solve everything, because sometimes data can be used to prove what you're hoping to find anyway. But it's going to be able to help outline trends as it comes to care outcomes. And especially when you think about, you know, does telehealth, something that is widely used for the last few years, but still in its infancy, being able to really determine, are outcomes the same from telehealth visits for certain conditions than they are for others? I mean, I know I've spoken with providers, one that was in a pediatric long-term, post-acute-care facility that was using it to identify those that were in occupational speech therapy, and telehealth operated, and they found out that actually being able to do the first visit inside the child's home led to a better outcome than it did bringing them into the facility to begin with, because then they could see what it was like at home before they started to tailor the treatment. It's those sorts of pieces of information from data that we're going to be able to learn more and better tailor the care. That's going to often drive down costs, because it's going to be potentially cheaper to provide, but also be able to tailor it so that we're not just forcing every case into the same cycle of diagnose, treat, assess, because we're going to be able to identify earlier what the best treatment plans are. I know some of that's aspirational. We're not necessarily there now. But being able to understand more what the data is saying and having more of it to compare against will be able to push us forward to sort of know what could be a potential path forward.
Doug Harris 18:40
Great. Thank you, Andrew. Shruti, what have you seen in your experiences?
Shruti Singal 18:44
You know, it's interesting because we all love to talk about data, including myself. What I've really realized as I've had more access to it -- so being out of clinical medicine and sort of seeing data as a more of a pop health piece -- is we have claims data in a bucket. And then we have electronic health records. So patient health records on the provider side. And what I really hope that's going to happen -- again, probably aspirational -- is when are we gonna get to the point where those can be overlaid? Because that is when we're really going to get the best picture and robust, sort of, full story of what's going on. And then taking that, and then maybe bringing it back to like, the divide, is also being able to use that with outcomes and ZIP codes and being able to take care where it needs to be so that we know -- take, for example, that there's this huge amount of breast cancer in this area, and it's because they're not getting their mammograms. Well, we can't always figure that out with one little set of data. We need things to overlay so that we can go, “Aha, there it is.” And now we know why: It's because of XYZ. So I do think I'm super excited about where this is all gonna go in the next few years so that we can really, really figure out and pinpoint things to the neighborhood, even, about where things are bubbling up.
Doug Harris 20:02
Excellent point. Thank you, Shruti. So, as we've talked about today, obviously, the digital divide is something that it's kind of hard to get your head around and also your arms around. And obviously, it's going to take a collaborative effort to help bridge the gap. How can health care providers and plans work together toward that effort? In what ways can they lend support to each other to improve patient and population health?
Shruti Singal 20:22
I mean, not to sound like a broken record, I may have already answered this. But I think it's the combining of information. No. 1, trust. So, trusting each other to want to be doing the best thing for the patient and the population as a whole. Taking that data, taking that collaboration and creating the ability to give care where it's needed to make sure that we're not overutilizing care where it's not needed, so there's more equity across the country in health care delivery.
Doug Harris 20:55
Thank you, Shruti. Andrew, let's give you the last word on this.
Andrew Tomlinson 20:58
You know, Shruti did already talk about that intersection of the clinical and administrative data. I know something that HHS is looking at, you know, being able to fill in those gaps is a huge place to be able to work together on that. There are initiatives around electronic prior authorization. You know, often understanding how much health care can cost takes a huge barrier of the digital divide. And making it available digitally often removes a barrier from patients to be able to seek care, because cost is usually something that's sort of unknown and scary to the patient itself. And then, you know, part of that is also working together. As we're seeing the traditional roles that are played within health care merge and shift and change, you know, we'll be able to work together on issues like patient identification, patient matching, more data that can be used to help better identify the person that you're standing in front of within the provider facilities, that is the patient that you're expecting to see. And that can help lead to better care, better outcomes. And, you know, we've already talked a little bit about cybersecurity. The health care sector as a whole is under threat. It's not just providers or just payers or just health information networks. And so that is another area of collective work where securing one piece of it often helps secure the rest of the health care sector. It is one unit that works together there. So there are a lot of opportunities coming in areas where we still already are working together as it relates to, you know, using that administrative data and using that electronic health record information to also help inform cost outcomes and help inform those that reimburse for health care understand what's actually happening within the provider facility itself.
Doug Harris 22:36
This has been a very interesting and detailed conversation. Once again, Shruti Singal is chief medical officer of First Choice Health, and Andrew Tomlinson is director of regulatory affairs for the American Health Information Management Association. Thanks so much to both of you for your time and insights today.
Shruti Singal 22:51
Andrew Tomlinson 22:52
Melissa Turner 22:55
Thank you for listening. We hope you enjoyed today's conversation and learned something, too. You can check out SmartBrief’s health care newsletters by going to https://www.smartbrief.com and hitting the blue subscribe button. Be sure to spread the word and subscribe to the Touchpoints podcast. Finally, a huge shout-out to our friends at the Shift.Health Content Network. We'll be back here in a couple of weeks for another episode of Touchpoints.
Doug Harris 23:24
Wellframe empowers health plans to become trusted advocates for members. They believe health plans have the knowledge and resources to support more people across more touchpoints in their health care journey. Wellframe's solutions for digital care management and digital customer service empower members and health plan staff to achieve their best in the most wonderful human way possible. Make sure your members feel confident, cared for and supported by their health plan. Don't miss this moment. See how a digital health management strategy would benefit your plan at wellframe.com/touchpoints.