Hospitals, MedCity Influencers

Technology is the next social determinant of health

This is what we have known for years: medical care alone does not equal better […]

virtual care

This is what we have known for years: medical care alone does not equal better health outcomes. Current research by the National Library of Medicine shows that medical care accounts for 10 to 20 percent of the modifiable contributors to healthy outcomes for a population. The lion’s share of the contributors — the other 80 to 90 percent — are referred to as social determinants of health (SDoH). These factors — including access to transportation and food security — are shaped by the distribution of money, power and resources at global, national and local levels, according to WHO.

We also know that access to technology and reliable information is critical to making healthy decisions and now to accessing care, and as such, it should be officially considered a leading social determinant. Arguably, during the pandemic, issues related to technology — from access to trust — have had life-changing impact on communities across our nation, most notably seniors and minorities.

This tech gap isn’t a “future challenge”: it’s expanding daily and must be solved with equal parts empathy and urgency.

Unfortunately, a large portion of our at-risk population remains tech adverse. According to a University of Michigan National Poll on Healthy Aging, older adults in the U.S. have trust issues. Forty-nine percent report being concerned about privacy during telemedicine visits. What’s more, socioeconomics worsens the situation. In the JAMA report, “Assessing Telemedicine Unreadiness Among Older Adults in the United States During the Covid-19 Pandemic,” 13 million older adults (38%) reported that they were “unready” to have a telehealth visit (per a paper by the JAMA Internal Medicine) and sadly, that ratio is even higher among populations of lower socioeconomic status.

Whether it’s due to apathy, mistrust, confusion or simply personal preference, as health care delivery “goes digital,” the experiences and outcomes for older Americans will likely get worse. Too many seniors lack the support of a digital health advocate — much less any health advocate. Every day, seniors fall into the cracks of lack of care coordination, and their lack of access to technology will widen these cracks even further.

Seniors deserve empathy from the health care system.

Close your eyes and think of an older loved one who may not be tech savvy. Now think of how they would feel if they were in need of urgent care, you’re not around, and someone they don’t know is on the phone telling them to “hop on a Zoom call with the on-call physician.” They’d likely feel frustrated, intimidated or downright angry.

When my mother suffered a heart attack, I witnessed first-hand how difficult it was to navigate the health care system and how that experience can dramatically slow down recovery. It was a serious wake up call. For seniors without a family advocate, navigating our technology-reliant health systems is both intimidating and overwhelming. Communicating through digital platforms can make our seniors feel isolated, ignored, misunderstood and, many times, disenfranchised in how to best manage their own care.

There are two mounting reasons we need a greater sense of urgency.

First, we have a serious backlog problem. Covid-19 created an unprecedented backlog of cancelled surgeries and delayed treatments that now take precedence over routine check-ups and follow-up visits. For example, a delayed breast cancer surgery for a young mother is likely now to take precedence over an older patient’s follow-up visit with the oncologist. Delayed treatment has a cascading impact on everyone — especially seniors who, even when healthy, require closer monitoring and care. Digital health can be a strong weapon in the arsenal of our nation’s providers, who continue to work over-time to catch up, but only if patients can effectively engage with them digitally.

Second, our supply & demand for professionals is upside down. We simply don’t have the manpower to see everyone face to face. The U.S. population over the age of 65 is the largest in its history. This demographic jumped 73 percent from 41 million people in 2011 to 71 million in 2019. The growth isn’t over, either. Estimates project 73 million U.S. seniors by 2030 — just in time for a huge nursing shortage. By 2030, the United States will need 1.2 million new registered nurses. California alone will have a 44,500-nurse shortage. This is of course why telehealth is soaring. But is it really soaring for this patient population? Not if 38 percent of seniors remain telehealth unready.

So what do we do? I propose embedding four priorities into solutions that go beyond an internet connection and a screen.

Priority 1: Empathize

Closing the technology gap requires putting seniors at the center of care. Much like UX and UI design, the individual journey must start from the perspective of the senior. The journey must include no assumptions, but acknowledge the real-world emotional and physical challenges some seniors have in seeking and receiving care. For example, if a senior does not have a family advocate, can we provide one? If the senior is intimidated by technology, how can we seek to understand why and how can we offer real resources to help them overcome those feelings? What does empathy in action look like? How about 24/7 access to a care team that helps seniors navigate their options, whether that’s coordinating appointments or simply scheduling transportation.

Priority 2: Equip

Overcoming tech aversion requires equipping seniors with tools, training and access. It means advocating for supplemental benefits that make iPads, smartphones or other connected devices more affordable, but also packs those devices with the hardware and training that seniors need to become independent, confident users. Ultimately, the how, when, and where of accessing care has to go beyond two choices: an office visit or a Zoom call. Technology should extend into providing help 24/7, coordinating care across providers, and physically bringing resources to their door.

Priority 3: Educate

Every solution should prize trustworthy information and education at its foundation. Taking the time to vet and provide data-based information that helps seniors navigate their care is critical. A great example of this is giving seniors simple tools to recognize risk factors for age-related illness such as diabetes or heart disease, while giving them structured advice and resources for what to do next. A timely example of executing this looks like the virtual town hall series we recently held to answer member questions, and share vital information related to Covid-19.

Priority 4: Empower

Empowering both seniors and their care teams is the final, but critical step. This includes providing caregivers and care teams with insightful and actionable health data to spot trends, to make real-time care decisions that improve outcomes every day, and even, to predict necessary health interventions. But we must go further. We must empower patients to receive care in the manner that works best for them, and to give them health data — electronically or otherwise — that puts them in the driver’s seat of their own care. This “fluidity of data” empowers the ecosystem around the singular mission of putting our seniors first. This means that efforts can and must meet them where they are — whether it’s virtually or in-person, at home or at a care facility — breaking down fears and roadblocks around tech-based care in the meantime. When we engage, we’re focused on making sure they understand how and why this technology supports their personal health.

It’s time to add technology as a significant social determinant of health. The faster we work to ensure technology can simplify access to great care, the faster we can prove to seniors that technology is indeed on their side. Once they see this, they’ll be empowered to benefit from the full potential of digital health solutions.

Photo: ipopba, Getty Images


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John Kao

John Kao is founder and CEO of Alignment Healthcare (NASDAQ: ALHC), a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Mr. Kao has had a long career committed to the health care industry and has served in executive roles at CareMore Medical Enterprises, The TriZetto Group, PacifiCare Health Systems, Secure Horizons USA, and FHP International. Mr. Kao believes strongly in the tenets of servant leadership and serves on various boards of non-profit organizations. He received his bachelor’s degree from Santa Clara University and his MBA from UCLA Anderson Graduate School of Management.

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