Healthcare accessibility has become a bit of a buzz term as of late. Like most buzz terms, the definition can easily get lost in the mire and requires a bit of unpacking. Contrary to what the name implies, it doesn’t simply refer to a person’s proximity to a doctor or whether a health system accepts a specific insurance plan.
By definition, healthcare accessibility refers to the way social and economic conditions (aka “social determinants of health” or “SDoH”) impact a patient’s ability to obtain health services. While healthcare disparities are often viewed through the race and ethnicity lenses, they include many other social factors that lead to preventable differences in disease burdens experienced by socially disadvantaged populations.
COVID-19 and the Reality of Healthcare Disparity
While these disparities have been understood for more than 20 years, the COVID-19 pandemic highlighted them and stressed the urgent work needed to bridge the gap. A 2020 Peterson-KFF study showed that people of color had three times as many premature excess deaths per 100,000 in the United States compared to white and Asian populations.
These higher rates reflect increased risks of exposure to the virus as the populations were more likely to be in work or home situations with increased risks. Additionally, higher rates of underlying health conditions and cultural/situational barriers to treatment and testing further exacerbated this disparity.
Healthcare disparity factors include:
- Socioeconomic status: A combination of income, employment status, and education level creates financial barriers to healthcare.
- Age: A large portion of the population is aging and, thus, more susceptible to communicable and musculoskeletal disease.
- Geography: Some neighborhoods or regions host fewer resources such as healthcare providers or grocers with fresh foods and may be less safe and with lower quality schools.
- Language or culture: Residents who primarily speak a foreign language and are not fluent in English or those from a different culture may struggle to find providers who can effectively communicate with them.
- Gender, sexual identity, and orientation: Women and individuals within the LGBTQIA community frequently face greater healthcare burdens.
- Disability: People with disabilities are at greater risk for health disparities.
- Citizenship: Non-US citizens and those without legal immigrant status may be more reluctant to seek health services.
- Insurance status: Individuals who are uninsured, underinsured, or on Medicaid face limitations to health services.
These disparity drivers to accessible, quality care are multidimensional and can affect a person’s health outcomes, leading to a chasm of inequity.
The Impact of Cost or Insurance Status
In the US, employer-provided health insurance is tied to full-time employment. Those who work multiple part-time jobs or are in nontraditional fields (or those unable to work) face barriers to getting insured.
The CDC’s 2019 National Health Interview Survey notes that 30.4% of Hispanic adults were uninsured due to eligibility reasons. Among uninsured adults ages 18–64, affordability was the most common reason. Furthermore, 21.4% of Hispanic adults needed but avoided seeking medical care at some point during 2018–2019 due to cost. Forgoing needed care, especially for chronic issues, can result in more acute incidents of care and hospitalizations.
The health system needs to be more adaptable, responsive, and resilient. And that means using nontraditional means to reach patient populations such as new technology and different channels and locations. The pandemic showed us this is possible with positive experiences in telehealth.
This requires setting up new systems and thinking about care and solutions in new ways. And it also needs to be done with security in mind; cyberattacks are a true threat, and patients need to know their healthcare data is secure.
Case Study: Diabetes Management
At Maven Wave / Atos, we are looking at new ways of providing personalized care. One way we’ve accomplished this is through new diabetes management models. An estimated one in 10 adults in the US have Type 2 diabetes, and a shocking one in three are pre-diabetic. Decades of research show that diabetes disproportionately affects racial and ethnic minorities and low-income adult populations in the U.S.
What helps combat diabetes? The answer: Preventative and regular health checkups, which unfortunately are often skipped due to financial issues and the time, energy, and reliable transportation needed to get to the healthcare provider.
Addressing the Complexities of Diabetes Treatment
With diabetes, care does not rely on drug therapy alone. Behavior and lifestyle management are critical parts of treating diabetes, including medical nutritional therapy, physical activity, and psychosocial care. In the best of circumstances, patients see their doctors for diabetes management every three to six months. But for those with transportation or insurance challenges, the wait can be even longer. That negatively impacts behavior modification and lifestyle changes, which require learning and building new habits.
Patients don’t know what behaviors to choose — that’s why they need professional help. They need a real-time feedback loop that takes into account their personal situations.
Developing an Accessible Approach to Care
With this in mind, Maven Wave / Atos built a platform to support virtual and automated interventions. The system is personalized and adapts to the individual, giving recommendations in real-time. Patients provide data passively through wearables like a Fitbit fitness tracker.
The data then flows to the cloud with Internet of Things (IoT) technology, and a machine learning algorithm analyzes patient behavior and its impact on their health. Next, the system sends the patient personalized messages on the platform that is accessible via smartphone, which most people can access. And to keep things secure, all data is stored and analyzed in a HIPAA-compliant environment.
This trial has taught us that managing a chronic condition this way is cost-effective and aids in value-based health. The program is impactful and high-quality, and it provides healthcare directly to the people who need it most. Furthermore, this type of system allows providers to engage with their patients more effectively to improve health outcomes. Technology enables new ways to provide care, but it’s the marriage of technology and patient-centered care that brings the significant promise of healthier lives to all patients.
To learn more about how cloud technology enables accessible healthcare, watch our on-demand session from Google Cloud Next ‘21 featuring our Healthcare Practice Lead Gretchen Peters.
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