Although our increasingly digital healthcare culture offers a wide variety of benefits to many patients, one group is being left behind – the poor. Veenu Aulakh, the executive director of the Center for Care Innovations, a nonprofit in California that works to improve health care for the underserved, notes that new technologies are generally designed for wealthy people who already track their health; however, the poor, who are often faced with more chronic conditions such as diabetes and may be the ones that would benefit the most from these technologies, lack access to them. Ironically, it may be possible to improve overall access to health care for the poor through the use of technology by overcoming the barriers they face, making this an important issue to consider.
Among the many barriers faced by the poor in accessing health care are transportation (whether because of disability, rural residence, or urban residence without a car); the inability to take time off of an hourly job to visit a doctor during business hours; and language (in the case of non-English speakers). Telemedicine and mobile health address these barriers by bringing care directly to the patient, being available to them at all times, and offering translation technology.
For those who do not have access to digital devices, Petaluma Health Center’s network of community health centers in California is trialing a program that provides iPhones on loan to discharged patients to help avoid the complications that might cause them to have to return to the hospital. However, studies have shown that increasing numbers of low-income people do own cell phones – 86% of households making less than $30,000 a year, 70% of homeless people visiting an emergency room, 89% of homeless vets, and 85% of rural households – and those percentages will most likely continue to increase into the future. Text services may be of greater importance to this population than apps, as text is cheaper than data on a phone. Text4Baby, a free text service created by ZERO TO THREE and Voxiva, Inc., provides information to pregnant women and new mothers, from prenatal care through early childhood development. Since its inception in 2010, the service has been utilized by over one million women, more than half of whom have had annual incomes of less than $16,000.
Another program that is in the trial phase is the Prevent diabetes and heart disease prevention program from Omada Health, a free program for individuals on Medicaid or those who are uninsured. Participants are given a digital scale that transmits their weight to counselors each day. In addition to behavior counseling and education, they are provided with a personal health coach and an online peer team. In order to best meet the needs of the underserved population, this particular version of Prevent is bilingual, is presented at a 5th-grade reading level, requires just one hour of internet access per week, and includes educational materials that recognize the particular problems this population faces, such as economic hardship, food access, and safety.
The Affordable Care Act incentivizes saving money by keeping patients healthier before the point of acute care. The catch to targeting the poor, though, is that government insurers, in this new value-based model, must address how to pay for health care that takes place outside of a doctor’s office. It is also a challenge for entrepreneurs to reconcile the lesser profitability of this population, although they may be able to make up for it by sheer volume alone. Certainly economics will play a big role in the viability of expanding digital health to the poor.
In order to help other entrepreneurs who are interested in bringing technology to bear on healthcare access for the poor, the nongovernmental organization (NGO) Aventor was formed. It accomplishes this goal through providing social entrepreneurs with legal, regulatory, reimbursement, and policy assistance free of charge. Organizations like this represent the potential for improving healthcare access among underserved populations through digital technology, a promising trend in health care that will require continued dedicated effort to come to fruition.