Health Equity in Action Summit – Addressing Digital Health Equity

Health Equity in Action Summit – Addressing Digital Health Equity

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All right, next up is our digital health panel. We have with us our moderator is Walkitria Smith, Dr. Smith. As a physician and community health advocate, Dr. Smith has been dedicated to reducing health disparities through education, primary care and preventative medicine. Her commitment to helping others live, excuse me, helping others live an optimal life has propelled her to founding Chastain MD, which is dedicated to personalized care and to serving in her role as Chief Digital Medical Officer at Morehouse School of Medicine, one of our co-conveners here today. So without further ado, I'll turn it over to Dr. Smith and her inspiring panelists.

Thank you. You guys need a coffee break. You're a little tired with your claps this morning. It's been a long day? What's happening now? Yeah, I think so, maybe? Officially almost happening. Well, good. Good late morning to everyone. It is my sincere pleasure to be here to moderate this panel with my distinguished panelists today. Again, I'm Dr. Smith, the Chief Digital Health

Officer at Morehouse School of Medicine and this is a a panel that's near and dear to my heart as a person who has as a clinician that really believes in how innovation, technology should be at the forefront of bridging the gaps as it relates to health equity. So without further ado, I'm gonna let my panelists give a little splurge about themselves. I'm gonna let ladies go first. So Ebony, do you want us to get things started? Hi, sure. Yeah, thank you so much for that warm welcome.

We're excited to do this panel. I am Dr. Ebony Respress. I am a health equity lead at Google Health. I work across different pieces of our organization to help embed health equity in our work. Prior to joining Google, I'm a social epidemiologist by training and got my, um, have been doing a lot of health equity research both in the government space and in academic medicine, specifically at Morehouse School of Medicine. We're here to help spearhead the health equity tracker, which is kind of where I got my foray into mixing health equity and tech and so really excited about this conversation today.

Great, and I'm having Abner Mason, I'm Founder and CEO for SameSky Health. SameSky Health is a health equity technology platform company. Specifically what we do is help identify gaps in care and disparities. We work with everybody but we have a deep expertise with underserved multicultural low income populations. Our our clients are health plans in the Medicaid,

Medicare Advantage and exchange lines of business. The plans hire us to help them to build a better relationship with their members so that they can, in the first instance, collect the necessary information from their members, particularly around race, ethnicity, and language, sexual orientation, gender identity and social determinants of health data. Plans in the past have not been very good at this. It's really a blind spot in our whole health care system. And at this point, because of some regulatory changes, we'll talk about plans are kind of the tip of the spear in starting to collect that data. And I think that data is essential if we're going to reduce disparities, we have to be able to measure what the disparities are, and then target solutions and that's what we're doing.

Good morning, everybody. My name is Mario Anglada. I'm CEO and Founder of Hoy Health. At Hoy Health, we provide direct primary care in the community. We follow a physical digital hybrid, where community health workers go into the home set up a host of different devices that can capture 19 different biometrics. Telemedicine a provider into that encounter, to establish care at home at the lowest cost possible. We do that

with a surround sound team of what's called a virtual digital medical home. So one primary care physician surrounded by a number of sub-specialists appointing that primary care as the lead. At the same time we have health coaches that are matched on age, sex, language and ethnicity. To really drive primary care engagement. Our goal is to inflict access and

cost into the health care system and we're doing it across the US, Mexico, Dominican Republic and Puerto Rico today. My first question was going to be for the panel but you've kind of already discussed it. You know when we talk about digital medicine. That encompasses so many different things, so many different platforms. You think about telemedicine, remote patient monitoring. Anything that involves technology and

bridging those gaps. So anything else outside of what you've already kind of talked about your own organizations as it relates to platforms that help provide care to patients? Can you discuss any specific things that you think would be additive? Oh, sorry. So we build everything with three things in mind, when we build. First a third grade education level. It has to get to that level of cultural and educational threshold. Second thing that we build is we build it with a cash pay consumer in mind. Because if ultimately, you don't have a

payment modality supported by Medicare, Medicaid, private insurance, we want to make sure that you're able to pay it on your own with a family support system. And the third thing that we built is we built it to a specification where it had to work with every stakeholder in the healthcare system. Because we do a really specific job, you guys do an incredible job today. And what we wanted to do was to make our tools available to all of you. And our client base includes federally qualified health centers, hospitals, state governments, and all the stakeholders see the value in what we do. Because what we're

trying to do is, and I think somebody brought in the panel before, we put the engineer and the patient first. So we start with what the patient needs, and then work backwards. And that for us has shown a lot of member engagement. We do that in as

many languages as we can. 21 languages currently. And the dynamic for us is that if you're going to get the tools into the hands of the patient, there's two things that have to happen. Number one, it has to be very easy to use. And number two, it

has to be supportive of their digital challenges. One of the things that we do is our members get free cell phones, why? Because a lot of the challenges that we're trying to solve are digitally oriented. And if you don't have data, and you don't have communication capabilities, we're back at square one. So those are three elements that we've seen that are important when creating digital tools. And I just add to that, that really dovetails with what Mario is saying. What we found, and we work in the government programs again. So half of Americans get their coverage either through

Medicaid, Medicare Advantage or Exchange. So about half the country, the rest, most of the rest is commercial, they get it through an employer. But what we have found to be the case is that people prefer to communicate via text message. If you try to if you try to send mail to people, you may as well forget. US mail is not going to happen. Even email and no one

answers their phone now in day. I challenge you, but if a strange number comes up you're not going to answer it. America communicates via text messaging, but we've got to make sure of is that we're building tools. And I love what you're doing. I think that previous panel mentioned that we have got to meet patients and health plan members where they are. And that means

what we found is text messaging. But the thing I want to emphasize is that policy in our country policy has not kept up with the way people live and the way they they interact with each other today, it's very hard for health plans to use text messaging to engage their members. Now think about that. Medicaid plans can't use the main the modality that members prefer overwhelmingly ten to one. It's because of old outdated legislation. I won't get into it, but happy to if you want to know more. Very boring. Okay, we've got to make sure

that coming out of this, that we are that we get everyone aligned around the kind of policy changes we need. If we don't meet patients and members, health members where they are, then all of the good work we're doing is just not going to have the kind of success we want. And for Google, we're really looking to embed health equity in all of our products across the board. But we're really

focusing on both consumers and caregivers. Meaning like health care providers of many sorts. And so thinking about how we can provide tools that help both people who are seeking care, access the care that they need, that they're looking for, and that will help support their needs in a streamlined way through like Google search. Also thinking about like the health

information and making sure that they have quality information that is accurate, and surfacing that information in a way that is available and accessible to different people like through YouTube and but also thinking about our tools for clinicians. So we have Google, for clinicians that really is thinking about how we can address health equity needs of our patients of the communities that they serve. Thinking about also data tools and how we are utilizing patient data, collectively in collaboration with health equity data overall.

So make sure that we're making decisions that will not only reduce bias in spaces, but can also advance the equity lens overall. So you definitely work for Google. because every time I get ready to go to Google, it knows exactly what I'm getting ready for the search bar. So I was just about to put in my search bar, and ask you about data. And as it relates to data. It's such a big thing right now. It is monetary, you know, monetary

values associated with data. And I think that one of the things that we have to have a discussion about in the space and places is our responsibility with what we do with data, especially with people of color, and those who've been most impacted about research and is already has some angst as it relates to their, how they intersect and interact with healthcare systems. So Google, what are you doing with the patient data? From a Google standpoint? Yeah, thank you. Um, so you know, at Google, and hopefully,

in a space where we're talking about health equity in digital spaces, we are thinking about data privacy, from the onset, right? Thinking about ensuring that the, that the people who entrust us with their data can trust us with their data, right? And so that is the first piece of what we're trying to make sure that we're doing that we're being ethical in the use of our data, and that we are emphasizing the community and emphasizing their needs, above the monetization, right? of things. And there's a lot of perceptions around, you know, the data that Google collects. And what we do with that data. You'd be surprised the amount of data we don't collect, actually, for privacy reasons. But the data that we do collect, we make sure that we do it in an ethical way, and that people are aware of what we plan to do with their data. For example, if you're many people in the room right now might be wearing a wearable device like a Fitbit, for example. I'm thinking about, you know, how we could use, leverage Fitbit data. We have a tool,

Fitbit device connect, to be able to connect your Fitbit data to your clinical record in a way to be able to think about how we can use that biometric data to improve your health and improve the health of people like yourself or across communities. But making sure that we are transparent about what we're doing with that data, making sure that we are ethical in our analysis of that data and making sure that we have the right experts, including people, you know, from community advisory board and those things. Who, you know, live and breathe this their experience every day. To be to be able to make decisions around data in the most ethical way possible, and to be able to advance health equity, because we we all know, without data, you know, people will forget that problems exist, or we'll be able to ignore some problems. But if we have the country data, and we are moving towards, you know, a space where we are collecting the data we need, and being able to disaggregate things by different demographic profiles that are important is ultimately you know, what we want to do, but we need to first start with trust, and data privacy and addressing data privacy to be able to have people to be comfortable with So I'm gonna pivot a little bit. So we're in this space in place,

sharing that data. because this allows us to have connectivity, right? That allows us to understand what each of us can bring to the table and how we can drive this to the populations. So Abner, I kind of think about you as the middleman, so to speak, the master connector. What, how do you think, what things need to be done? What innovation could be done to drive patients towards these platforms, towards these these products that are out there? Sure. So I think, first, I just want to say that I think this is a moment of enormous opportunity in our country. We have for a long time known that disparities exist across our healthcare system. But we, it was hard to really attack it. Because we

didn't have metrics or data, we couldn't quantify where the disparities are. Now, for the first time the regulators at the federal level and at the state level. I want to give a shout out to CMS and to NCQA. They have come together with state regulators. And for the first time, and this is amazing, in our nation's history. We're going to start to collect race, ethnicity and language data. Health plans, in particular on

the tip of the spear here. They're required to now in the Medicaid space and Medicare Advantage, as well as sexual orientation, gender identity and social determinants of health data. I mean, you can't, you can't have a trusted patient relationship if you don't know a person's gender identity, for example. But here's the thing. You can't know that unless the person tells you. That's self reported data. And we have got

to get to the point where people are trusting the healthcare system enough that they'll self report and then we can build the kind of customized, personalized relationships that build trust. And that's my answer to your question, how do we get people to try new platforms and new solutions? We've got to stop treating them in this one size fits all approach. Like everybody's the same, because we're not. Even people of color. We're different. We got different life histories,

different levels of trust for the health system, different experiences, the social determinants of health impact us uniquely. So we've got to start to do what I love what you were just talking about Google, Google is personalizing, so does Netflix. So does Amazon, everybody except healthcare treats me like I'm a unique person. But when I go to the doctor, it's like, I'm a generic number. And so what we've got to

do is build trust, and that requires personalization. And we have the tools to do it, we just gotta have the will to do it. And this moment that we're in, we should take advantage of and lean into it. Some of you may not know it, but this is unique in our nation's history. Just think we're going to be able to track and quantify disparities across race, ethnicity, language, eventually sexual orientation, gender identity. That's the beginning of addressing disparities so we can measure it, because if you can't measure something in our culture, you don't really make progress on improving it.

And I was I was in a meeting recently, a few weeks ago, and one of the things that came up was social determinants of health, social determinants of health. You know, drill it, drill it, drill it, but yet, in this meeting, they, in order to meet the quality measures. They said, okay, the persons blood pressure was this, we're going to have them come back in two weeks. With the nurse, for nurse visit, to meet those quality measures. So we've talked about the data. And we know the data,

and we're talking about social determinants of health. We're getting this information and we hear from this information that the person doesn't have transportation. They don't have funds to pay for elder care, they can't take off work. And

then we are telling them, from Abner's you know, creating that connectivity, let them know, okay, these options are out there for us. But we're not always putting into real time play in a clinical setting. So Mario, since you've been on the frontlines to actually provide these innovations in a meaningful way to that patient population, how do you feel like digital health has impacted patient care? Quite dramatically, from the perspective of you have to step back. If I'm a low income consumer in the Bronx, in New

York, and I have an appointment at the free clinic, right? I'm gonna go there, I'm gonna spend maybe two, maybe three hours, if I'm lucky, right? That means I just missed two of my jobs. So if you are a person that is challenged economically, your first and natural tendency is survival, right? I'm going to take care of my my family. And then this comes after. So what we do and what we're trying to do is we're trying to get that conversation to happen, wherever you're at, and you're at, in most cases equals a home. You come, you take care of the kids, you watch the novella, if that's what you like. And then after the fact, you're ready to have a discussion about health. Now, systems have to adapt to that. We operate on a 24/7

environment. Why? Because our members might not be able to come from eight to 5pm. We love it if they could, but that's not a reality for us. So technology, in my humble opinion, can bridge

that gap. In order to get trust, which is a second portion of the discussion, which is critically important. What you need to do is very simple. You have to be honest, transparent, and transfer value. That's the key. The last point is transfer the value. I'm receiving this information, you're allowing me to receive this information. What's the benefit that you are

getting for it? And we're really explicit with our community and telling them listen, unless we know what's happening, we really can't help you. This data, you own you control. You tell us to delete, we delete. You tell us to share with all the system, we share with all the system. So the opportunity, I believe, is as technology becomes ubiquitous, you've probably already heard announcements from T Mobile, and that you're gonna be able to text from areas that have no cell phone coverage. Think about the opportunity in rural health. If I can capture a

biometric and I can communicate to Abner's team via text message, game changer. So what we're trying to do is we're trying to put solutions into the hands at the level with the challenges that they're facing today. And understanding that those are built for very vulnerable populations. In our

approach, the reason why we started internationally, was because the group that we started working with, which was the Latino community, have ideas for us and we take care of our families in Mexico, Puerto Rico, Dominican Republic. By virtue of the nuclear group, we care more about them than us, in many instances that happens across many other ethnic groups. So what we said is, let's create a continuum of care where what you're doing here helps you but it also helps somebody somewhere else. And those dynamics, at least for us have shown that when you present it in that way, transparent, direct, very simplified, third grade education level. People act

fairly well without engagement. And our health outcomes show that we've been able to get people to glycemic control 72% of patients within 90 days in the community setting. 400% under the poverty line, 53% with behavioral health issues. So it's not that it can't be done, it's that it has to be done highly specific for a subpopulation, and that's really hard, we don't expect everybody to be able to do that. But what

we want as a company is to make our solutions available to everybody. That's why we work with every modality, if that explains it. So I'm gonna, I'm gonna hone in on something that you said, and we're gonna bring it back. So third grade education level. And you know, what, we're going to talk about COVID, and a little bit, but with the implosion of COVID, you had every telemedicine platform known to man. You know, has come come from there prior, we started telemedicine program prior to COVID. And so, once COVID hit, we were being inundated with other various platforms. And then there was the RPM that was

coming down the line because of the the funding that came with with it. And so one of the things that I found in this was doing multiple various of demos was okay. Hey, this is the product, and this is what we do. And when I tried to have the conversation like, this isn't third grade level, right? It wasn't always received or it didn't, the light didn't come along for them. So Google, I don't know if you know, when

we're gonna go. How do you from a Google standpoint, ensure that health equity is at the forefront and thought about and embedded across every platform that you guys bring out as it relates to health and health innovation? Yeah, so firstly, doing that by having the right expertise in the room, right? So, you know, being honest and transparent about the places where you have what you need, and where you need to go out and get it right. So the health equity team at Google is relatively new. And but we, you know, are a mighty small force, and we embed across all of the product areas at Google. And, you know, being able to think about health equity at the start of like product roadmap. So not waiting until, you know, we get to the end. But thinking about it from

the onset is the first step in that process. And then secondly, really getting into the community. Right, we talked about a third grade reading level, right? And we think about that is the baseline for what most people we anticipate, would be able to, to consume. But what is happening is that the literacy rate across the US and elsewhere, is reducing. So are we even reaching people, if we're, you know, talking to them at a third grade level, and part of what needs to happen is like overall user research to really garner and understand perspectives of the people who will be using these and who will benefit from these health equity tools. But by talking to them

by, you know, listening to them, and then actioning, on the suggestions that they make, because, you know, they always say the people with the problems also have a solution, right. And so we have to be open to listening to those solutions. So I'm gonna brought it up in terms of COVID. Because all of this kind of, again, telemedicine, technology, it's been here. But I think with COVID, it really helped

highlight some of the social determinants of health, some of the access issues that we talked about. One of the things that Abner he brought up was prior, you know, prior to COVID, each state, which is still the same and it had their own rules, right. So in Georgia, we were kind of in the gray area as a relate to telemedicine. For Medicaid in order for you to do telemedicine you had to be from a presenting site. Which doesn't always make sense, because they have to go to another clinic to present to this clinic to be seen. And once COVID hit, the

floodgates open in a good way, right? So all of those payer, those parity laws kind of went away. And now we're in this that that interesting space, where we're trying to figure out from a legislation side what things should go with things could stay. As it relates to COVID, social determinants of health, everything, all the lessons learned. How was your organization able to start, to Mario, able to facilitate care in that environment and some of the lessons learned. That was for us, at least the pandemic accelerated the adoption curve, I would say for about five years, right? Healthcare for all the right reasons is very slow to change.

Which is a positive and a very negative depending on your view of it. So when the pandemic came, what it did is did an immediate mindset shift, right? I can't go anywhere. Let me experiment. And that experiment was really successful in our opinion. And my opinion is informed by partners like we work with the Mayo Clinic as an example. Where they showed us their results of patients that at with digital technology tools in the home, were able to be transitioned into the home in a shorter length of stay, and had better health outcomes. Close to

100% of the time. So the dynamics that the pandemic did was it allowed him to reset to recalibrate and let me try something new. And that's one of the things that I think that if we all are committed to health equity, we have to strive for incremental growth, not perfection. And that's really, really challenging when you're working with instruct large institutional partners that have for all the right reasons, again, a very slow and methodical approach to development. Companies like Abner's like ours have

solutions. But we move at an accelerated pace. So many of the dynamics that at least in our opinion, COVID allowed us was to get into the front of the discussion, jump a couple of steps ahead. And then let's see if it works. As probably everybody can attest to it has worked. Now the question is what happens now? If you follow the money, money dictates modality in the US healthcare system? It's really simple, right? So I would urge us that have the ability to influence those policymakers to make sure that we look at telemedicine as a alternative of care. It's not a different type of care, it's a

care in a different manner at a different location. And ultimately, if you look at it that way, and your goal is hashtag Health Equity and Inclusion, going to somebody's home and providing services to them where they're at is, by definition, health equity and inclusion. Absolutely. And I think one of the things that most people

fear, and I don't know if this is a financial situation is that we have a very litigious society, right? And I'm a clinician, so I believe that there are certain things I can't do via telemedicine. But as a clinician, I know what needs to be brought into the clinic, I need to touch hands and what things I can leverage technology for. And so I think that's part of the reason that as you relay, talk about the money, and the drive is because we live in a litigious society. And there's so many things, we talk about data, you know, blood pressure, RPM, well, who's monitored 24 24/7? This person's blood pressure spikes to 200 over 100, who's going to be liable for the outcome. But what I, as we all kind of talk about, we know that

there's going to be zebras or things, isolate things that happen and we have to take our wins, we take our wins. But we found during this pandemic state that it has worked. It allowed people to have some level of care, and in some cases, better care. And so what I want to pivot to again, talk about the policy talk about the money. How can we, and this is for Abner, how can we address the intersectionality of health equity and get into health equity and racial equity because, again, all the COVID talked about people of color, African Americans men, you know, most likely to get COVID to have the worst outcomes. How, I want to talk about that piece,

because I think that's important. Sure, so following up on Mario's comment, and yours, I think, one quick story when COVID first hit, we had a lot of our F QHC. Partners, not you for a minute, someone wasn't an FQHC here, federally qualified health centers, this is where low income people go to get their care. They reached out to us and

said, hey, you know, our revenue has gone from whatever it was to zero because no one's coming in because of COVID. And if these clinics closed, they may not never open again, this is a key part of the social fabric, the safety net, help us get help us deal with this. And we were like, well, have you ever done tellement telemedicine or, you know, phone visits? And they said no, because in California where we are we serve the whole country. But we're headquartered California, you couldn't get reimbursed if you were an FQHC for a telephone for telemedicine visit or video visit for that matter. And so, but they changed the rules that you say it overnight, boom, after like 10 years of not being able to low income people couldn't have access to these newer technologies. Now they could overnight, but the clinics had never done it and the patients had never done it. So we've reached out to the patients in

the way that we do building trust. And we generated about 50,000 tellemed, telle, tellemed, phone visits in the first four months of the pandemic. So here's the point. When we asked people do you want a video visit or phone visit nine to 10 to 1 they said a phone, Not our choice, but that was their choice. Now a lot of doctors will say what that's not as robust of a visit as a video visit. And some doctors used to

say they didn't even want video visit had to be in person, in person, video and phone. Now doctors are increasingly the AMA is here, and Aletha Maybank, who's a great leader over there is in the house. So she's going to be coming up next. She's doing incredible work here. But the AMA, doctors are saying, Okay, we were willing to do virtual visits as your point is well taken. But here's the thing, if patients will only talk to a doctor via the phone, and the choice is no conversation with the doctor, or what the doctor prefers, I think we ought to let the patient rule here. We ought to say, we shouldn't perfect be the enemy of the good. And a conversation

with the doctor is better than no conversation with the doctor. So I want to just make that point, let's not let the perfect be the enemy of the good. And then secondly, these policies that were in place before, and they waive them so that now people can choose how they want to communicate with their healthcare provider. It's the patient's choice, we should not let policy swing back to where poor people can't use low income people can't use telemedicine or virtual care, or that we let policy and even money dictate how patients communicate. I think we're much better off if we lean into from a policy policy perspective, prioritizing what patients want, we will end up with better health care, I would argue even cheaper health care if we let patients, give them a choice instead of dictating to them because the truth is, we can dictate all we want, but they're not going to do it right. So let's let

patients you know, let's prioritize what they want. Well, I want to take a few questions for the audience before we do wrap up this session. Thank you for talking about digital equity. I think there's a structural inequities in our system. And of course, there's a

digital structural inequities that will perpetuate the digital divide further if we don't address the infrastructure, right, the gadgets quality broadband access in other words I hope you heard me. So we have structural inequities in our system and an infrastructure inequities will be perpetuated, and the digital inequities will be perpetual, unless we have that infrastructure is bridge. So everybody has same infrastructure to access quality digital health care. So that's one thing. Second thing you talked about, during the pandemic at the beginning of the pandemic, the telephone calls and video calls were not allowed, but it was later approved. Actually, I'm Dr. Ravi Kohli. I'm a psychiatrist in

Pittsburgh for past 30 years and the president of AAPI American Association of Physicians of Indian Origin. And the bill that allowed phone calls to be reimbursed was originated by our physician, Dr. Kishore Chela from West Virginia, who is the chair of Board of Medicine there, and worked with Dr. Sen, Senator Manchin to pass that bill, allowing all the doctors to be reimbursed at the same price and same cost for phone calls. So that's one of our accomplishment as AAPI. And thank you. And talking about data. And again, I want to echo

the same thing I said earlier. So data is Science and Information is technology and knowledge is economies. But we need to go beyond that to wisdom, communities and societies. So our decisions have been made based on wisdom, not just data, information and technology. So if we transferred there, we can not only can't see our care, but Community Care has to reach the same level. And that's where that is possible. If we put that like you said, equity should be in the beginning of the design, not at the last meeting as a marketing tool. So that's just my pitch. Thank you.

One, one comment on that point. The inequities in digital engagement happen as a function historically of, I don't want to have a phone call with a doctor. I'd rather have a video call but I don't have the data to have the video conference. So you accustom as a consumer to your limitations. And that limitation in certain instances is text message and others it's voice. Now, one of the things that we're doing and we encourage others that work in this space to do is to build the infrastructure into your business model. We offer cell

phones, and we offer the data, why because that built into the business model takes away a huge break for these particular consumers. So there are ways sir to be able to do that there is innovate addition that can happen not only in how what you're doing but also in the business model that you're trying to pursue in order to be able to do things like that. So a data point to reinforce the point that you're bringing, but there are alternate ways to be able to solve problems.

Mark Alexander 100, Black Men of America, I like to follow up on a point that you made Mr. Mason, regarding the ability for us to gather information on race, ethnicity and other important information from marginalized communities. Are there safeguards in place to protect that ability, because we all know that there are forces in this country that don't want that type of data collected, and they don't want the the terrible things that are happening to marginalized people exposed or publicized or studied or researched. So it as the political winds change in this country, is there any are there safeguards in place that will protect our ability to collect this type of data in the future? Our experiences is yes, that this is, strangely enough, one area where there is bipartisan support across the federal administration, between administrations and certainly at the state levels. If you look across the country, and the accreditation organizations like NCQA, there has been that's what I mean by this is a moment of opportunity, we rarely see all of the forces align, to say, this is the right thing to do.

We should have collected race and ethnicity and language and SOGI in sexual orientation, gender identity, and SDOH that we should have done it 100 years ago. That's the truth, we should have. We are late to the game, you cannot provide high quality health care if you don't know the basic things about people.

And you certainly can't target programs and resources to close disparities that you can't measure because you don't know what's working and what isn't working from what. So it's high time we did this what we have found, interestingly enough, and we are engaging millions of, of members directly. People are not ashamed of who they are. They're not ashamed of their race or their ethnicity or sexual orientation. Yes, they have a concern to make sure that it's going to be used to help them not to hurt them. But that's part of the communication that we do. And this is healthcare. And people. As long as you

explain, as you say, transparently, why you're collecting this information. What we found is that people want their doctor to know their race, or their preferred language, or their sexual orientation. They want the doctor to know there's no food in the refrigerator. Why are you talking to me about diabetes, when I have no food in the frigerator, you've got to help me, I think the previous panel said, You've got to help me deal with the fact there's no food refrigerator before you really get me excited about, you know, the diabetes drug. So patients and members, they want to have that kind of relationship, they just haven't had a chance to. Now the system is starting to require it the healthcare system, I think it's a good thing. I don't think, I love

your question, and we need to be thoughtful about it. But this is not the time for I think it's a time for us to lean into saying we need our system to actively, you know, collect this information and start to use it to create a better healthcare experience for people that's more personalized, and customized because otherwise we're never going to deliver high quality care. And to talk more about your question, you know, with, you know, when we move towards where EMRs were required, right? We everybody has experience with EMR. So we have the health information exchange that is supposed to help make sure that there is some continuity and care where each EMR can talk to each other. So they go to the hospital, the patient and the ambulatory physician might know what's going on. There are some things that are coming down the pipe, I want to say in 2023 as it relates to API. So we've been building various remote patient

monitoring. And one of the things even though I pay for this company to build a real patient monitoring, that technically is their data, right, we have to pay them for the API for us to get our own data. Come 2023, as a clinician and in a lot of these healthcare systems, when these these technologies that collect this data, we will be able to have access to it from the healthcare system without having to pay while that monetary tax from from that standpoint, I think that there is a lot of value for me as a clinician, because I don't have to jump through hoops to get the information I need to provide quality care. I think in fact and from the Mississippi Delta.

Community health centers in Mississippi inserting remote patient monitoring to telehealth is great. I was with some providers last week that said of course the reimbursement rates have changed significantly, since I guess most recently, but I'm really curious about the biomarker data that you're collecting. And how is it actually uploading into the EHR system. So what's the end? I want to know what the app is? Or the is the healer? What are you using? Because on the back side, for the most part, these organizations are having to have an intermediary there with the community health worker, or somebody that's having to decipher the date on the backside to put it in the system. So it sounds like you've

mastered that. And I need your name and number because I know a lot of people that want to talk to you. So I can answer some of that question. So we capture first party data on a mobile app, that mobile app is included in the devices we offer our members. That information is stored in a HIPAA hi tech compliant environment through an electronic medical record that has both HL seven and fire connectivity. So depending on who your partner is, ma'am, it could be a download of a flat file that is imported into Epic.

Or it could be a connection point into prognosis, ie clinical works, or any of the systems. All the systems by mandate must interconnect, right. And that's one important thing. The dynamic that really happens is that the onus of the

interconnectivity happens on both sides of the equation. When we go to our hospital partners say, hey, we want to connect to you. They're like, Oh, wow, there's an expense. And when we have to do it, then we have to have an expense. So the dynamic of the Health Information Exchange being that conduit that was being mentioned in 2023, is going to really radically changed those connectivity points. Because it doesn't

matter if you're connected to the healthcare system in a payer modality that is or the commercial, Medicare or Medicaid, that information will transmit. But that's something that's in the works right now, historically, there are vested interest in keeping silos as we all know, right? Those are slowly coming down, I think they should have come down a lot quicker, but they're all Bluetooth enabled no connectivity, and it's one tap process. We can talk I think Dominic Mac would be a good person for you.

We have about a minute and a half left. So I want to wrap things up, I just want to get our final thoughts as it relates to this topic. For my panelists. Thank you for your time. But what are the some of the take home points as that you want to mention to kind of to end things as we need to do and think about as it relates to innovation and technology and health equity? Ladies, okay. All right. Um, so I think the final thought is just thinking about the digital determinants of health and really thinking about how we put in have available to people across the country, no matter whether they're in a rural area, or urban area. Having them be able to access the information that they need to make the best decisions about their health, and having clinicians be able to have the information and data that they need about their patient population, from the voice of their patient populations, and make the decisions that they need to make. And that's how we close the digital divide.

I would just say, I think that we all need to embrace the idea that remote patient monitoring, I would call it remote patient care, which includes everything we've talked about, is going to be a part of healthcare in a big way. And that going forward, it's you can't put the genie back in the bottle. And so we need to make sure that that that as more and more of this remote patient care becomes part of healthcare, that that that marginalized and low income and multicultural and other people who've just struggled to connect to health care that they're not left out. So I know it's going to come up in the next section on Dr. Bennett, may continue to talk about it. But I just want

to put a plug in for some of the work that she's done at AMA, a lot of the solutions that are going to be part of that remote patient care or private sector solutions, like me and Mario. In fact, almost all of them are and are almost all you know, backed by venture capital. And we need to have more entrepreneurs and founders who look like us. Because if we don't start to see this through a health equity lens and through the lens that you and I see it through, we're going to we're going to reinforce existing health inequities as opposed to technology solving some of these problems, and you're gonna hear more about that later. But I think it's really important for

us to think about, I would encourage you, you know, we need policy. But we also need capital. This is a big challenge for us. My thought is, health happens between the visits. And that's the maximum that everybody learns in medicine, but we've never done anything about it. Now, for the first time, technology has gotten us to a place where that can actually happen. So my two cents or my suggestion would be be open to partnerships be open to working together. This is not a zero sum

game. If there's no patient engagement nobody is going to make any money. If there is a patient that's engaged better health outcomes, a whole host of positivity flows through the system. So one of the things that we make ourselves available is to partner with everybody, whoever wants to work with us. If there is a need, we'll work with them. And I would ask that

there's reciprocity in looking at new models of care, knowing that perfection is great, but the reality is another of the Maxim's is doing the same thing over and over and over is your definition of madness. So let's take this pivotal moment, a pandemic was slammed on us, let's use the advantages of that, to make structural changes to benefit everybody. And I'll say the last thing, patients in a medical home every clinician knows about patients in a medical home as relates to ambulatory clinics, and that's what we strive for. I think we need to change what that looks like. Make patient centered measures truly patient centered, and not just some measures that we create, that we think should be theirs. Thank you guys.

2022-12-12 08:19

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