Stepping Back to Look at the Big Picture
I am deeply saddened by the racism and violence that has left our nation reeling again, just when it seems we were finding a new sense of stability coping in a world gripped by a pandemic. The shocking and widely viewed video showing the death of Mr. George Floyd, an unarmed, handcuffed Black man, illustrates yet again that there is still so much to do to end discrimination, injustice, and inequity in our country and in our world.
That inequity is clear when we examine the impact of the COVID-19 pandemic. There is no question that people of color are disproportionately affected. Deaths related to COVID-19 are much higher for Black and Hispanic people than those that are white or Asian, according a CDC study. Those outcome differences are attributed to social and economic conditions and it’s precisely those factors that also hinder the ability of people to get the resources they need during this public health crisis.
Research shows that social determinants of health play key roles in the devastation caused by COVID-19. Homeless families are at a higher risk for transmission because of tight quarters and a dearth of testing options. The infection rate is three times higher in predominantly Black counties and morbidity is six times higher compared to predominantly white counties. School closures are causing some children who rely on food programs to go without and that, in turn, leads to higher susceptibility for transmission. Studies indicate that people with chronic conditions such as obesity, diabetes, and heart disease are more likely to die from COVID-19, all conditions that are more prevalent in vulnerable populations.
While we are celebrating the lightning fast adoption of telehealth to improve access to health care, we need to be conscious that this, too, could also result in more inequity. A recent Health Affairs article found three overlapping barriers to accessing telehealth–the absence of technology, digital literacy, and reliable internet coverage, all of which disproportionately affect older people of color and those with low socioeconomic status. The differences are stark; more than 30% of US households headed by a person over 65 do not have a desktop or laptop and more than 50% do not have a smartphone.
Leaders from the Washington Health Alliance have facilitated three All-Alliance meetings in the past nine weeks, highlighting conversations with healthcare and business leaders about the profound impact of COVID on our professional and personal lives. During each of these conversations, one or more panelists have predicted that the move to telemedicine will be one of the lasting effects of the pandemic.
For example, during our last webinar, “The Impact of COVID-19: Seeing the Future Through a New Lens,” Washington State Health Care Authority Director Sue Birch identified several programs to expand telemedicine services by making available free equipment like cell phones, laptops, and access to Zoom (application forms are here) available to providers. During that same conversation, Dr. Peter Rutherford, CEO of Confluence Health said they are delivering one-third of their care by telephone, one-third by video and one-third in-person and he has noticed that remote monitoring is resulting in better patient engagement in their care. Dr. Rutherford suggested that schools are learning to educate outside of the classroom by paying attention to student engagement and technology issues. Medical professionals need to do the same for patient care.
In an earlier webinar, “Leadership in a Time of Chaos,” Peter Adler, President of Molina Healthcare, that serves more than 875,000 Medicaid, Exchange marketplace and Medicare dual-eligible individuals in Washington state, discussed technical limitations to remote care delivery and said Molina was taking steps to address it, by making free cell phones available to income-eligible members. For consumers that are not Molina members, the Federal Communications Commission’s Lifeline program provides free or reduced-cost cell phones that are available through several service providers, depending on a person’s zip code. It is recommended to complete an electronic application to expedite approval, since their paper applications are currently in heavy backlog. Information on that program is available at 800.234.9473.
I strongly support the increase usage of telemedicine that makes health care more accessible. At the same time, we must put systems and processes in place to ensure the revolutionary move to this mode of care delivery is available to as many Washingtonians as possible, and not just for those who own a smartphone or computer.
I look forward to seeing how we can make that happen together.
All the best,
Nancy