Throughout the COVID-19 pandemic, mPulse and our customers have placed a major focus on delivering programs geared toward vulnerable, hard-to-reach and culturally diverse populations. We have been encouraged by the results so far. Early analysis of 2,500,000 messages across multiple mPulse customers sent to approximately 319,000 Medicaid plan members in Cook County, Illinois (primarily the greater Chicago area), showed individuals who had greater SDOH barriers were actually more likely to engage with our COVID-19 programs than those with lower SDOH barriers. There are several factors that contributed to this reversal in normal engagement levels. Lower income populations were disproportionally infected with COVID-19 cases, which created urgency for engaging with COVID-19 content. Outreach that provided information about free resources and subsidies were most valuable to members who were more adversely impacted by SDOH. And lastly, content was tailored to culturally diverse populations. Program content was developed in multiple languages, and our customers leveraged our mobile-optimized fotonovela outreach. Every healthcare organization understands the importance of engaging hard-to-reach populations, and as we look to the ‘new normal’ post-COVID, there are important learnings from this period that should be a part of every engagement strategy.
One of the more prominent aspects of the new normal will be the accelerated and important role of telehealth in care delivery. The pandemic has forced rapid adoption by providers, plans, and patients. This is a positive step for many reasons: more cost-efficient delivery of care, and much improved access and convenience for healthcare consumers. However, low income populations have some of the lowest levels of adoption of telehealth services, so as healthcare adapts and new innovative care deliver approaches are developed, we must ensure the hard-to-reach are included in the shift to virtual care, and apply proven strategies for engaging these populations on topics that are important to their health.
Telehealth has been sold as an equalizer for disadvantaged and rural communities, but there are challenges with this. Safety net providers have been slower to adopt telehealth in comparison to larger health systems. Rural and community health clinics lack the funding to keep abreast with the latest technology, but also manage populations who lack internet coverage and/or are at poverty levels that prevent them from accessing the technology needed to connect virtually. 2019 data suggests only 50% of low-income households have home broadband, and over 30% of these households are smartphone-reliant for internet.
The low adoption of stable home internet and desktop/laptop computers in these populations means government-subsidized mobile phone programs must include smartphones with capabilities to support virtual visits. The data needed to support these visits must be included in the phone’s data plan, so patients are forced to decide whether to use their own mobile plan data to have a health consultation or connect with their friends through social media. And the telehealth platform itself must be a high-quality experience comparable to leading healthcare providers for any chance of success.
But providing the technology is not enough. As with almost all health services and benefits, awareness and education are critical for lasting adoption. Health plans and providers must invest in telehealth engagement, so that their members and patients know the service exists, how and when to access it, and provide support so they become fluent with the technology. All these potential barriers are accentuated with lower-income and culturally-diverse populations. But those populations must be areas of significant investment in engagement and education, if there is any chance of healthy equity in the new normal.