More than a decade into the digital health revolution, it’s time for a reckoning about a chief shortcoming of our industry: leaving too many people behind. Part of the promise of innovators joining the fight to improve health care was that by expanding the ways people can receive care, we could increase access and help equalize the health care system for more patients. But we still see reports about how digital and virtual solutions continue to leave many vulnerable populations behind. Fragmented point solutions, incomplete data, and bias in our system have drawn a line in the sand between those who benefit from health innovation and those who are missing out.
That’s not to discount the fact that this surge of innovation has connected more people to care than ever before, and has given many populations a greater ability to receive care at home, which has been especially critical during a global pandemic. But those accomplishments haven’t been enough to truly democratize digital health and get these innovations into the hands of everyone who needs them. Doing so requires us as innovators and leaders to ask ourselves what steps we can take to bring more people, especially historically marginalized populations, into this new era of digital health’s evolution and deliver the care they need.
We need to start by evaluating who can really access our innovations, and how the sales channels we pursue limit our reach. Solutions can’t only be accessible to those working for large companies when nearly half of all Americans work for small businesses. Ground-up scalability is one key component – innovations must be able to integrate into an employer’s existing health care infrastructure regardless of size. We also need to consider the price tag, since pricing models for many digital solutions put them out of range for small business owners. It’s not enough for our solutions to be high-value. They also need to be cost-competitive.
Even in 2022, we know that people of lower socioeconomic status, older Americans, rural populations, and populations of color carry some of the highest chronic disease burdens. Yet digital solutions continue to make the most inroads among younger and wealthier Americans. In fact, the United States Health Resources & Services Administration has found that 87 million Americans live in health care professional shortage areas. If the populations with the highest needs are the ones being left behind, we’re missing the real opportunity for digital solutions to improve outcomes. Reaching those populations will take some structural change. Championing the expansion of access to rural broadband should be a priority for all digital health innovators. And we’ll need support from the Centers for Medicare and Medicaid Services to make sure that Medicaid beneficiaries aren’t left behind because of limited coverage options for digital solutions. On the tech side, we need to make sure that we’re designing easy-to-use interfaces that meet these populations where they are. We should optimize our solutions to provide recommendations that take into account users’ preferences, social determinants of health, and current health status. For example, by ensuring that healthy food recommendations align with a user’s cultural experience and taste preferences, those recommendations feel familiar and comfortable for a user, making it more likely that they will act on them, and thereby improve their outcomes.
We also don’t need to reinvent the wheel to successfully help target interventions to populations in need. By applying an “equity-customized care” lens, we can optimize existing tools in new ways to achieve more equitable outcomes. This requires a continuous effort to ensure that our algorithms and the questions we’re asking them don’t reinforce existing biases in the health care system. For example, there are many universal screening measures designed to identify at-risk patients that are easy to adapt virtually. The key is designing solutions that can interpret what those results mean in the context of a person’s unique experience, and translate them into actionable recommendations that can practically be implemented in the patient’s daily life.
As we move into the next phase of digital health’s evolution, we have a responsibility to break this cycle, bridge gaps in access, and provide solutions capable of delivering more equitable, outcomes-driven care for all.