HIMSS21: Post-pandemic virtual care policies threaten to undo low-income patients' access gains

Reimbursing video-enabled virtual care at a higher rate than phone-only telehealth incentivizes a modality that underserved patients either cannot access or do not prefer, Abner Mason, founder and CEO of ConsejoSano, said at HIMSS21. (Getty/Fertnig)

From diminishing wealth to unaddressed health needs, the COVID-19 pandemic hit those on the lower end of the income spectrum hardest.

But while these populations have traditionally been underserved by the healthcare industry, growing awareness and technology opportunities have, at least temporarily, offered a silver lining to the people and communities hardest hit by social determinants of health (SDOH).

“I think there’s a willingness to address some of those issues—a new willingness—based on what we’ve seen happen,” Abner Mason, founder and CEO of ConsejoSano, said Monday during a panel on SDOH and patient experiences at the Healthcare Information and Management Systems Society (HIMSS) Global Conference in Las Vegas. ConsejoSano is a company specializing in multicultural patient engagement technology.

“The most important thing we’re seeing that’s new is that plans and systems are increasingly saying that collecting the [SDOH] data isn’t enough,” said. If you just collect the data, [if] people tell you their problems but you don’t do anything about it, there’s no better way to build distrust … I’m actually optimistic that, going forward we’re going to see [them] closing the loop and finding out not only what people need, but doing something about it.”

Concurrent to the new mindset among payers and providers was the loosening of virtual care restrictions and expanded reimbursement, Mason and Madhur Garg, M.D., medical director of radiation oncology at Montefiore Health System, said during the panel discussion.

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This opening of the telehealth floodgates wasn’t perfect. Garg, who helped implement an EHR-linked SDOH screening tool at his system, noted that many institutions rushing telehealth programs out the door didn’t adequately address underserved patients’ broadband access, comfort with technology or whether they had the privacy to conduct sensitive calls in their homes.

Still, the emergency allowances opened more doors than they closed for patients who may not be able to travel or devote time to appointments, the speakers said. Policymakers now looking to hash out a long-term landscape for the technology without preserving these gains would be doing these patients a severe disservice, they said.

“It’s a shame that it took a pandemic to provide low-income people with innovations in healthcare that high-income people had for 10 or 15 years and didn’t even want to use,” Mason said. “We know people will use it, but if policy doesn’t reimburse for it [and] we go back to the old way, that would be a shame.”

A virtual visit with an out-of-state doctor provides one example of a regulatory policy that particularly harms minorities, he said. A Vietnamese-speaking patient living in a rural state like Wyoming might only be able to find a provider who speaks their language and can connect to them culturally in a more populous area like Denver.

“You ought to be able to talk to the doctor in Denver. That’s what virtual care can do for us today, but policy prevents that,” he said.

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Another hang-up comes with discussions to reimburse audio-only telehealth at a lower rate than video-enabled virtual visits, Mason continued. Not only do these policies again run into issues of broadband access, the policies also go out of their way to incentivize a specific modality that’s less often preferred by low-income patients.

“What happens in healthcare [is] whatever you reimburse higher is what everyone’s going to do,” he said. “We are saying to the patient that the way you prefer to communicate, that you’re willing to communicate, we’re not going to encourage that. We’re actually going to penalize the healthcare system for engaging you the way that we want to engage.

“That’s crazy. It should be turned on its head … Right now, as I speak, policymakers are about to, I think, make a big mistake," Mason said.

As encouraging as it is to see providers and payers taking a more involved role in SDOH, government interventions are the most likely source of lasting change for these populations, the speakers said. Much in the same way that the Medicare population has benefited from supplemental benefits, the industry should be pushing for public investment in programs addressing social needs before they escalate into major health concerns.

“If it’s addressed proactively by taking care of living conditions, or by taking care of some of the education and awareness which is needed, [the government] in the long run is going to improve healthcare,” Garg said. “This has to come from the government. It has to come from somewhere, because ultimately that’s how it’s going to improve overall health."