INNOVATION

Bridging the Digital Divide to Achieve Health Care Equity

From telemedicine to mobile health apps, the increased adoption of digital health care is improving people’s lives like never before.  

“The advances we’ve seen in a relatively short period of time have been transformative for the majority of Americans who have access and the ability to utilize digital platforms,” says David Grandy, the national vice president of innovation for Kaiser Permanente. “Providers can engage and deliver care to patients in new and more personalized ways—improving outcomes, access and the end-to-end care experience.” 

As exciting as this is, Grandy stresses that it is also important to be mindful of the millions of individuals who face barriers to the digital world and are in jeopardy of being left behind in an increasingly technology-first society. 

“The challenge is finding ways to develop and implement digital tools and services that can be accessed and used by everyone,” he notes. “At Kaiser Permanente, this is a priority we’ve been deeply committed to for years. We view digital equity as a super social determinant of health and have made it a pillar of our system commitment to health equity.”  

Grandy and Caroline Franz, the company’s associate studio director for innovation, spoke on the topic in September at the SHSMD23 Connections annual conference. 
 
Launching an Organization-Wide Initiative  

To learn more and identify solutions to the challenge, Grandy says the Garfield Innovation Center in partnership with the Social Health Practice at Kaiser Permanente launched an organization-wide initiative involving more than 200 executives, clinicians, front-line staff and leaders from planning, government relations, information systems, marketing and social media.  

The taskforce’s first step was to perform significant research to better understand the needs of those who face barriers to digital equity. “We conducted primary research with a diverse pool of participants from across the country representing a wide range of ages, languages, ethnicities, incomes, health statuses and technological capabilities,” Grandy explains.  

“We also studied member data, community-level data and data from other secondary sources,” he adds. “In addition, we sought extensive input from our providers about their patients’ real-world experiences.” 
 
Research Pinpoints Key Obstacles  

What the research uncovered is that access to high-speed internet is a significant foundational issue. The Federal Communications Commission estimates that 19 million people in the United States don’t have broadband access, while Microsoft indicates that the figure could be as high as 157 million people. Either way, Grandy says the situation is unacceptable.  

The research also revealed that certain demographic groups are more affected by the problem than others: 

• Older adults (65 years of age and older) use computers less and have fewer broadband subscriptions than younger generations. 
• Among adults who don’t have high school diplomas, only a small percentage have internet access. 
  People who live in certain urban and rural areas have limited broadband access. 
• People of color use smartphones more than laptops, desktops or tablets, and are not as likely to have broadband subscriptions. 
• Adults with household incomes under $25,000 use digital technology less than those in higher income categories. 

Another barrier discovered through the research is usability:  

• Patients are often frustrated by electronic glitches that disrupt telemedicine visits. 
• Adults who speak a language other than English commonly have difficulty with digital health care services. 
• One-fourth of older adults do not use the internet, and many of those who do find it hard to negotiate virtual care. 
• A large number of individuals with disabilities are unable to use standard digital platforms. 
• Those who are not tech savvy frequently have trouble using health and wellness apps.  

Additional hurdles relate to literacy and comfort: 

• Many consumers need more knowledge and guidance to confidently engage in online health care. 
• Medical terminology is often confusing to patients. 
• People generally don’t feel comfortable sharing personal health issues via the internet and are concerned about data privacy and security. 

Bridging the Digital Divide 

To address the obstacles and bridge the digital divide for Kaiser Permanente members, the taskforce is pursuing three key strategies, according to Franz. “The first is driving adoption,” she says. “We want to help our members access and become proficient with digital health care tools. The second is enabling use by educating members about how to use the company’s online resources and providing tailored support when necessary. And the third is continuously learning from our efforts and ongoing research to inform process improvements along the way.”  

The taskforce developed several pilot projects to accomplish these strategies, the first of which involved Kaiser Permanente’s Connections Call Center (CCC). “Representatives from the call center contacted financially at-risk members to share information and connect them with federal subsidy programs designed to make broadband more affordable,” Franz explains. The representatives also offered to assist members in navigating the organization’s website.  

Franz says the campaign was highly successful. “The CCC was able to contact more than 40% of the targeted members,” she explains. “Almost all of them expressed interest in learning more about the subsidy programs, and 70% were deemed eligible and referred to third parties to submit applications. Moreover, 75% of those who responded agreed to schedule a follow-up appointment with the call center to receive training in using services on kp.org.” Based on the results, Franz says the pilot will expand nationwide later this year. 

Future priority tactics planned by the taskforce include:  

• articulating Kaiser Permanente’s commitment to digital equity on a national scale; 
• bringing awareness of digital offerings and their benefits to Kaiser Permanente members, employers and staff; 
• building the evidence on effective ways to address digital equity; 
• initiating technical support for individuals with disabilities; 
• assessing existing digital education content for providers and members alike, then filling gaps; and
• updating the company’s digital platform standards to be more accessible, usable and equitable—including requirements for vendors and technology partners. 

Franz notes: “We’ll be focusing on testing these and additional pilot projects to learn what works and what needs improvement as we strive to achieve digital health care equity for everyone we serve.”