Digital Health: Revolutionizing Delivery Quality for African-Americans

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Last November, the African American Wellness Project organized a conference to explore technology-based solutions to health problems plaguing communities of color, notably heart disease, diabetes, hypertension and asthma. Titled “Tech Health Conference Communities of Color” and held, appropriately, at Impact Hub Oakland, a co-working and events space in Oakland, Calif., for those involved in driving positive social and environmental change, the conference included a pitch competition for digital health startups.

Of the six competing startups, ProjectVision, an analytics platform that helps care providers offer personalized preventive care services to patients with obesity or diabetes-related conditions, claimed the first prize. Patients selected for ProjectVision monitoring receive daily tailored wellness guidance in fitness, diet, and stress reduction via a smartphone app. Information on these patients’ response to the daily guidance is gathered via the app and shared with clinicians, who then coordinate clinical and non-clinical services to support changes in behavior for improved health.

“We founded the company because we felt that there were some serious problems with how patients, and particularly low-income patients like Medicare/Medicaid patients, received care in managing their conditions,” Shingai Samudzi, the company’s Zimbabwe-born founder and CEO, said in a December interview with Downtown Podcast. “If you look at all these new digital health technologies that have come out – Fitbit, the Apple Health Kit – all are great technologies but fundamentally they’re inaccessible to a large portion of our population in our country.”

At the time of his interview, Samudzi, a graduate of Carnegie Mellon in design science, was in Las Vegas as a participant in The Mill Startup Accelerator. His ProjectVision is just one of hundreds of digital health innovations, many of them created by Blacks, positioned to address the health challenges of the country’s aging population, increasing chronic illness, emphasis on self-care, accelerating health costs, regulatory reform, and new value-based payment models that reward outcomes (including lower total cost of care) rather than utilization. Established in 2002 as a nonprofit to address disparities in access to and delivery of quality healthcare that exist in communities of color, the African American Wellness Project, supports these innovations. In addition to its pitch competition, it is launching a cross-media digital presence “to be the premier media communications organization in the health space for African Americans.”

What’s driving digital health?

Driven by the Affordable Care Act (Obamacare)’s emphasis on value, patient satisfaction, prevention and improved outcomes, digital technology is transforming—some say ‘revolutionizing’— the delivery of health and social care in the United States. Digital health, as this trend is called, uses information and communication technologies, such as mobile phones (mHealth) and videoconferencing (telehealth), to deliver faster, more efficient and lower-cost healthcare. It allows patients to access care any time via different devices – a web browser, a mobile phone or tablet, or a standalone kiosk in a retail clinic.

A joint policy brief by the Deloitte Center for Health Solutions and the Deloitte Center for Regulatory Strategy says telehealth has the potential to improve remote monitoring and self-care strategies and, ultimately, reduce treatment costs by keeping people out of the hospital and emergency room, and reducing physician office visits. “Chronic disease rates are rising, and mental health issues, including depression, are also affecting millions of Americans. The Department of Health and Human Services reports that nearly 80 million Americans live in a mental health professional shortage area. Even in urban environments, transportation, time constraints, and the stigma of mental illness often prevent people from seeking mental health services. Telehealth may help address these situations,” brief says.

For Vanessa Mason, CEO and founder at Riveted Partners, a digital health consultancy, and co-founder of WISE Health, a nonprofit that aims to spark innovative solutions to build healthy communities, and of P2Health, an incubator and fund for public health tech startups in preventive and population health, including companies that aim to reduce or eliminate health disparities, well designed tech solutions can:

  • Provide ancillary support, skills training, and feedback to patients;
  • Help patients navigate confusing health systems and monitor their conditions outside the clinic, reducing readmission rates to EDs and easing the patient volume at overloaded clinics;
  • Building and adding to the evidence base for smart, well-designed, cost-effective digital health innovations in medically vulnerable populations, potentially revolutionize federal reimbursement models, thereby generating alternative funding streams for such innovations; and
  • Best of all, help patients achieve health.

Digital health technology has attracted significant amounts of venture capital, topping $4.3 billion in 2014 and $4.5 billion in 2015. Valued at $60 billion in 2013, the global digital health market is expected to increase fourfold by 2020, led by mobile health and telehealth. Last year, nearly $8 billion was invested in more than 500 digital health companies, with 200 new investors entering the funding ecosystem. Health insurers are among the biggest investors, hoping that the companies they fund will help policyholders’ health. Many healthcare organizations, too, are exploring strategies to leverage technology to increase consumer engagement and focus on prevention and chronic care management outside the traditional physician office visit, according to Deloitte’s “2016 Survey of US Health Care Consumers.”

Benefit to African-Americans

Communities that historically have been underserved in healthcare stand to benefit from digital health. Research by Nielsen shows African-Americans ahead of the digital curve, making them a premium target for digital health solutions. “Technological advances and the deluge of smartphones in the marketplace have all but erased the once-much-talked-about ‘digital divide’ between African-Americans and mainstream America,” Nielsen says. It notes that 91 percent of Black TV households have one or more smartphones or high-speed Internet connection; 84 percent of African-Americans use search engines; 62 percent use social networks, 55 percent use video sharing websites, and 21 percent follow expert recommendations. Black millennials in particular over-index on a variety of platforms. The WhiteCoats4BlackLives Movement is a case in point. Run by medical students, the group uses digital platforms to organize activities around its goals of raising awareness of racism as a threat to the health and wellbeing of people of color, ending racial discrimination in medical care, and preparing future physicians to be advocates of racial justice. It has chapters on Ivy League and other university campuses across the country and in the Caribbean.

Ethnic minority communities are home to the most medically vulnerable patients and consumers. Typically, they exhibit higher rates of disease and a harder time managing health conditions, both infectious and non-communicable. African-American communities for years have shown the highest incidence, prevalence and mortality rates from chronic diseases like cardiovascular disease, diabetes and obesity, and continue to be overwhelmed by such issues as HIV/AIDS more than any other racial or ethnic group.

“For years, these populations were disconnected from technology. Living and working in low-income, sometimes rural areas, these populations lacked Internet access and by and large did not have computers at home. Today, however, technology may be the key to engaging people, and connecting them to information, resources and clinical care,” says Mason of P2Health.

Writing last July in a blog post, “Innovation for Medically Vulnerable Populations,” she cited Pew Research Center data showing some of the most significant changes in phone and Internet adoption patterns to be taking place among African-Americans. Between April 26 and May 22 in 2011, for example, non-Hispanic Blacks on average sent 70.1 text messages a day, against 31.2 sent by non-Hispanic Whites and 48.9 by Hispanics. “This all translates into a great opportunity for innovation in these communities,” wrote Mason, who was a panelist at The African American Wellness Project’s Tech Health Conference Communities of Color. “We can meet medically vulnerable, historically disconnected populations where they are…We can deliver efficacious, scalable interventions to change behavior and improve health outcomes at increasingly lower cost.”

The opportunity

With the fastest employment growth since 2014, healthcare is expected to be the largest employer in the United States by 2024. By 2020 alone, 117 million Americans are expected to need assistance of some kind. Well-designed technology solutions can help to reduce the complexities, stress, and sheer hard work of caregivers, including unpaid caregivers such as family members whose numbers are expected to reach 45 million by 2020. Blacks can get involved in digital health as innovators/entrepreneurs, as some already have done.

“Technology is not a panacea”

Research published by the California Health Care Foundation shows innovations found to be gaining traction in minority communities include those that use texting; deliver health information via video, telephone or cable television; combine medical and social services; and deliver health information via portals and kiosks. Of particular interest to funders are innovations that promote behavioral changes in consumers so that they manage their health better, such as getting patients to adhere to and manage their medications or manage a specific disease or disorder.

There also are opportunities in data security and in retraining providers to practice medicine digitally.

Technology is not a panacea, asserts Mason, but it can help to improve patient-provider communication, keep patients engaged in behavior change, and ultimately make an impact on the health of those at highest risk.