The technology to enable effective telemedicine interactions amongst patients and doctors has been present all over the world. We've seen the last 10 years tech empower remote monitoring technology for chronic conditions, such as diabetes and hypertension. What we haven't had aligned with the technology are the policies that allow multi-regional and national employers to efficiently deploy these solutions across their entire populations. Many states previously blocked telemedicine and the ability to prescribe. And other roadblocks seemed to instantaneously disappear when COVID no longer allowed for patients to physically visit their doctors during the mass shutdown during early spring 2020. The question is, was the technology lagging or was politics and industry lobbying prohibiting broader access and adoption?
Now that we've seen it's possible, there is a great opportunity to make things much more seamless and efficacious. It's great if you can see your doctor via video and have a meaningful interaction, but how effective is it if you don't have a remote blood pressure cuff at home? And wouldn't it be even better if your doctor was able to receive your A1C through a data cloud based report in between appointments to better prepare to address any emerging issues?
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The challenges I see are way too many "point solutions." Some have the telemedicine play, others chronic disease management with coaching services, or even AI-enabled interactions. Meanwhile, yet others have the data play that allows for greater transparency and less subjectivity in the patient-doctor relationship; however, in order to create the optimal experience for both employer and patients, we'd need greater connections between and amongst these solutions, as having to contract with 5 to 10 different vendors to manage the population's health seems cumbersome and short-lived, and white labeling these solutions is not enough.
Another call-out that I think is largely missing from this discussion is the inequity that exists in both the technology and access to the technology. We have witnessed many people being left out of this new digital virtual reality; many don't have access to reliable Wi-Fi or internet in their homes. And while most people have cell phones, not all have smart phones which allow for video visits with the doctor.
We saw this disparity in the health care system and the educational system. Remember the picture of the two kids doing schoolwork on their school laptops outside of a Taco Bell? This was the perfect depiction of when bias and marginalization are at the root and instead of trying to solve the issues, we just build technology on top of it.
Another area that needs great attention is artificial intelligence and the bias that has crept into the algorithms. A tool may be AI-enabled, but it has likely not been developed by people of color and others who have traditionally been left behind in our health care system. As the acceleration and adoption of AI and telemedicine continues, I urge purchasers (employers and employees) as well as innovators and providers to evaluate the tools and processes needed to roll out these tools in order to ensure they prioritize cultural competency and evaluate the level of bias that may create adverse experiences for the diverse populations.
Pandemic impacts
At the onset of the pandemic, we saw decreased utilization of all lagging indicators (inpatient, ER, ICU, urgent care and mental health) except for a significant spike in members utilizing telehealth in March 2020. In the subsequent months, we noticed a consistent and significant uptick in tele-mental health services. This is an area I expect to continue to grow and one that will need to evolve to include adolescent/pediatric mental health services.
Yes, there is new technology, openness and comfortability with leveraging technology, but we should work to ensure politics and bureaucracy doesn't get in the way of the continued growth and utilization of these tools. The world is ready for them. There are many new ideas and technologies that are emerging as a result of the pandemic as well.
Due to the drop in in patient care, out-patient services, urgent care etc., many employers are leveraging data more now than pre-pandemic to determine what necessary care was delayed, what inappropriate care was avoided, and which tools need to be put in place to address the most vulnerable within their populations. Certainly the trend of leveraging data and transparency to make strategic value based benefit decisions will continue. Again, innovation adoption will occur, but at this time, vaccine access is top of mind for employers as well as what the future of work looks like.
In addition, more employers are focused on social determinants of health, health equity and health disparities, outcomes-based care, adherence in care, access, chronic disease management and new Rx innovations. Transparency, identifying appropriate treatment, culturally competent care and the fiduciary management are going to be developing focus areas for employers in which tools, platforms, and innovation will have an opportunity to thrive.
Jessica Brooks is the the CEO and Executive Director for the Pittsburgh Business Group on Health.
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