Telehealth, efforts to address social determinants of health and a focus on health disparities are likely to be among the top priorities in population health this year. by KAREN APPOLD
|COVID-19 will continue to cast its long shadow on U.S. healthcare in 2022. But for population health, there is that silver lining people so often look for: innovations and adoption of telehealth that started in 2020 will continue in 2022, even if the peak use of telehealth has tapered off. Providers and payers are also continuing to move “upstream” to the social determinants of health (SDOH), investing in housing, transportation and other factors that affect people’s health but are outside of traditional healthcare. Another major agenda item for population health leaders next year is efforts to address healthcare disparities. Disparities in outcomes and access are deeply rooted problems that lend themselves to a population health approach — but not to quick fixes.|
Almost two years after COVID-19 forced a telehealth revolution, patients have come to expect live video interaction offerings from their health plans and providers. Telehealth — which once meant having a live video visit with a physician — has become a commodity, with hundreds of options now available to patients, says Sebastian Seiguer, J.D., MBA, CEO of emocha Health, a medication adherence company in Baltimore that is a Johns Hopkins spin-off. Simultaneously the very definition of “tele- health” is changing, as consumers and providers alike become comfortable using a variety of digital tools such as texting, online portals and artificial intelligence (AI)-powered chatbots to give personalized healthcare advice and support.
Specifically, Jessica Sweeney- Platt, vice president of research and editorial strategy at a then a health in Watertown, Massa-chusetts, expects virtual care to continue to evolve, as it expands from a reactive mode of handling sick visits to incorporate pro- active, convenient, preventive care. This is particularly true for patients working with care teams to manage chronic illnesses. In tandem, wearables, which provide the ability to monitor health at home, will gain popularity.
Along these lines, Nina Birnbaum, M.D., medical director of innovation acceleration at Blue Shield of California, says that more home monitoring is coming online with on-demand electrocardiograms, continuous glucose monitors and other opportunities for people to actively engage in their healthcare. These tools should help physicians better determine what diagnostic workups and treatments are needed, potentially lowering costs.
One example of telehealth saving money occurred when the Fresno County, California, Department of Public Health used emocha Health’s digital medication adherence program for one year. The department avoided about 110,000 vehicle miles while saving $10,000 in fuel and $100,000 in salaries, Seiguer says.
Another group of products are from companies looking to amplify existing models of in-home care with technology. A company called Heal is looking to bring back house calls; Papa Health provides health- care worker visits and general help at home for lonely older adults; and Ready offers in-home urgent care visits. These are just a few examples of emerging categories, with some players overlapping and others defining entirely new segments, Seiguer says.
Telehealth can also enable a hesitant or time-constrained person to access care convenient- ly and quickly, helping to catch disease progression earlier and ultimately prevent small problems from becoming big ones, says Karen Ignagni, president and CEO of EmblemHealth in New York, New York. In addition, telehealth helps to manage chronic conditions and treatment adherence by providing simple, quick ways for people to check in with providers.
The government is beginning to recognize the benefits of telehealth and, more broadly, care that is de- livered remotely and digitally. CMS provided reimbursement guidance for a new category of digital health, remote therapeutic monitoring, in early November 2021 that compensates providers for caring for patients outside of a physician’s of- fice. Healthcare providers have not had a financial incentive to ensure that their patients understand and take their medication completely and properly. These new remote therapeutic monitoring codes provide reimbursement for the kind of support that can lead to greater adherence, Seiguer says.
An emerging trend in tackling SDOH is a greater focus on analyzing barriers to care at the population level and then investing in community programs that can have the greatest impact on the most people. Sweeny-Platt says that providers and payers both have obstacles to overcome. “While provider organizations are driving these conversations — especially those who have taken on Medicare Advantage or managed Medicaid risk — they don’t always have the resources to build programs,” she observes. “Payers have also invested in these types of programs but have struggled with low adoption. This leaves a lot of opportunities for payer and provider collaboration.”
SDOH present issues that can’t be solved peripherally, say experts. “Successful organizations are those that can marry sophisticated network-level analytics in order to identify hot-spot practices with common sets of needs, with deep local knowledge of community resources and partnerships,” observes Sweeney-Platt.
Among the biggest challenges, she adds, is determining who pays for these programs. Robert Bollinger, M.D., M.P.H., a professor of infectious diseases at the Johns Hopkins University School of Medicine and one of the inventors of the technology licensed to emocha Health, says healthcare institutions should engage in strategic public-private partnerships with government and nongovernmental programs (e.g., Medicaid, community/faith-based organizations) to address SDOH issues. He also says they need to push for more resources to support SDOH efforts.
There is a good deal of overlap between dealing with SDOH and closing healthcare disparity gaps. Bollinger says it’s important to remember that any population health effort to address SDOH must also take into account racial discrimination — in society as a whole as well as in healthcare. He listed some steps that leaders of healthcare entities can take to begin to deal with disparities:
I Prioritize the measurement and re- port health disparities based on race and other SDOH factors within their clinics, facilities, digital programs and among providers.
I Build meaningful partnerships with trusted community partners — churches, local politicians — to enable patients and members to play significant roles in developing solutions that are meant to address these disparities.
I Make racial equity a strategic prior- ity for an entire organization. Many organizations are emphasizing and implementing training, cultural competency or workforce diversity initiatives. But training alone is not sufficient. “Equity needs to be more than a standing topic for every C-suite meeting, leadership meeting and program,” Bollinger says.
Christopher Dodd, M.D., chief medical officer of PopHealthCare in Franklin, Tennessee, and its home care business, Em- cara Health, says that Emcara de- ploys home-based advanced primary care teams that include culturally aligned community health workers. “This approach enables us to build trusting relation- ships with underserved community members,” Dodd says. This model, along understanding the social and environmental factors affecting health, helps to prevent serious and costly health issues before they arise, he adds.