Connected Healthcare Strategies to Boost Rural Access, Digital Equity

DEPLOYING CONNECTED CARE TOOLS IN RURAL AMERICA

Healthcare challenges abound for people living in rural areas, ranging from social determinants of health (SDOH), like food insecurity and transportation barriers, to the clinician shortage.

“One of the biggest factors that determines health outcomes — you would think things like smoking, or diet, or physical activity — but the biggest factor when you look at everything combined is zip code,” said Jared Antczak, chief digital officer for Sanford Health, during a keynote session at the conference. “And I think that's astonishing, right? Sixty percent of the health outcomes in this country are determined by a person's zip code — where they live.”

Headquartered in Sioux Falls, South Dakota, Sanford Health is the largest rural health system in the country, with a geographic footprint that extends approximately 250,000 square miles across parts of South Dakota, North Dakota, Minnesota, and Iowa.

To combat healthcare challenges facing its patient populations, the health system has offered connected care services for more than a decade, including telehealth, telebehavioral healthcare, and a text message-based remote patient monitoring service through which clinicians can track specific patient-reported outcome measures.

However, in deploying digital tools, Sanford Health has also kept a close eye on accessibility.

For instance, the health system recently launched a new digital registration tool allowing patients to complete registration for medical appointments from their homes. Antczak noted that the tool makes the registration process more convenient for patients and provides a reciprocal benefit for staff by lessening administrative burden.

While rolling out the digital registration tool, the health system aimed to create a frictionless patient experience. The tool doesn’t require patients to download a new application or create a username and password. They can access the digital registration tool via text or email and provide their demographic information.

By alleviating friction, the health system drove digital registration adoption from 7.9 percent with their previous tool to almost 52 percent with the new tool, Antczak said.

One of the ways in which Sanford Health was able to identify and eliminate patient pain points in digital registration and other technology-enabled processes was by taking into account patient preferences.

“We do a great job in healthcare sometimes at assuming we know what the patient wants because we say, ‘Well, we're all patients; I know what I would want,’” he said. “But the reality is we bring a lot of institutional jargon and industry knowledge and bias to the table when we don't include our actual patients and bring their voices to the table.”

Thus, connected healthcare efforts in rural areas are more successful when patient focus groups and usability testing are incorporated.

“The reality is, you're asking the wrong question if you're asking patients, ‘What's your ideal solution?’” Antczak said. “What you need to be doing is asking patients, ‘What are your problems?’ So that we can define the right solution that's going to alleviate those problems in the best way.”

TACKLING DIGITAL HEALTH INEQUITIES

A trenchant problem in extending virtual care access is the lack of digital health equity in the US.

According to Natasha Khouri, associate vice president of Digital Health Strategy & Solutions at UPMC Health Plan, digital health equity refers to equitable access to digital healthcare.

“Equitable meaning the design and delivery of the digital intervention or the digital healthcare is thoughtfully done so that ideally everyone has access to the same intended outcomes if not the same experience,” she said during a keynote address. “And we know that similar to social determinants of health, there are really digital determinants of health that get in the way of that digital health equity.”

Three main factors are driving digital health inequity: the lack of access to technology, digital health literacy issues or lack of digital readiness, and technological infrastructure problems.

To combat these challenges, UPMC Health Plan has employed numerous strategies.

For instance, the organization created a neighborhood center in a traditionally underserved area of Pittsburgh. The center offers access to virtual health consultations through telehealth kiosks as well as other resources, like a community food pantry, to address SDOH.

Not only that, but UPMC Health Plan has a partnership through which it has installed WiFi in laundromats.

“The laundromat is a place you might spend a couple of hours a week, for better or worse,” Khouri said. “So, we have partnered with a nonprofit that builds that access in laundromats [and] promotes SDOH resources.”

The health plan is also simplifying digital health processes and supporting people as they navigate technology tools. It aims to design accessible, device-agnostic digital programs by offering onboarding resources and limiting barriers to adoption, like app downloads.

At the beginning of 2023, the organization created the UPMC Health Plan Tech Guides Teams, a specially trained subset of the member services team focused on digital equity. The teams can share information on affordable connectivity and lifeline programs and help health plan members with various digital needs, such as preparing a camera for a telehealth visit.

“Digital health applications can be really complex, actually, with the literacy level we're asking for,” Khouri said. “So, we have been thinking in terms of digital readiness as a metric that we want to track and assess across our population.”

The health plan is developing a digital readiness score that reflects patient engagement with technology. Khouri explained that the score will measure factors like whether patients participate in telehealth visits and how many times a year they log into an app.

“The vision is that the readiness score is something that can inform, help us target who we might want to really engage more, engage with at a greater depth, offer additional support around,” she said.

This approach also supports another strategic priority for UPMC Health Plan: boosting digital engagement among members.

The organization has long since been tracking its members’ digital health technology use, setting goals around engagement at the product level and using that to evaluate the success of digital health apps, said Khouri. It is now focusing on enriching its digital engagement data, gathering information on how often members go online and what types of technology they have in the home.

“If you're seeing those different outcomes from digital solutions or strategies at that subgroup level, you know you need to look deeper because you have an equity issue,” she said.

Moving forward, UPMC Health Plan hopes to build equitable digital engagement levels across subpopulations.

“We've been really interested in this issue or this thread that different types of solutions will work differently for different populations in different settings, and that we need to invest more to understand that better as we build out our digital health strategy,” Khouri said.