A mother talked about the difficulty that she faces using telehealth for her daughter, who has epilepsy, with episodes triggered by too much light while using a laptop for a doctor’s visit online.
Another mother spoke about how her daughter has a speech development issue, and telehealth made it difficult for the doctor to clearly see the child's mouth movements to determine whether she was accurately using her muscles.
These anecdotes were shared by a panelist on a June webinar panel entitled “Leveraging Digital Health to Drive Equity and Integration in Primary Care,” organized by Blue Shield of California. The panel discussed how improving health and “digital” equity and inclusion in primary care has made advances in recent years, but much work still needs to be done.
The panelist sharing the anecdotes, Gabriella Barbosa, cited both the advantages of telehealth, and its current shortcomings for lower income and rural populations. Barbosa is managing director of policy at The Children’s Partnership—a California advocacy organization dedicated to advancing child health equity.
“We focus on telehealth because of the potential to address some of the barriers that children and families face and accessing healthcare, especially when schools and doctors’ offices closed,” she said. Yet we see “three main longstanding systemic challenges” of digital, educational and language barriers.
The parents Barbosa talked about were part of a study of 85 families on telehealth and children of color with special needs, published last year. The report focused on three California communities in Pomona, Tulare and Riverside. For example, more than half (52%) of families of color reported having language barriers in their telehealth visits. And 60% of parents experienced some sort of technological barrier to using telehealth.
One basic problem found with families with language barriers: precious time had to be spent on translation through an interpreter. “Non-English speakers should be given more time for appointments because multiple people are speaking,” Barbosa said.
Amid the obstacles, some steps forward
While the challenges are numerous and even daunting, the participants noted positive steps. “We learned from families in terms of how telehealth made it easier for them to access healthcare services for their children,” Barbosa said.
In a sense, it’s just the beginning for virtual primary care. For its part, Blue Shield in April made available to employers Virtual Blue, a preferred provider organization that emphasizes telehealth, with a $0 deductible and $0 copay for virtual-only providers, and the ability for members to search for doctors that better match their demographic, such as language, gender identity, sexual orientation, race, and ethnicity.
“It gives our members a chance to pick a primary care doctor based on the criteria they select,” said Krishna Ramachandran, senior vice president of health transformation and provider adoption at BSC. He also noted that while it is still early as a care modality, Virtual Blue gives access to care at “non-traditional hours” in “non-traditional ways.”
Panel participant Dr. Brian Knox, medical director at Included Health, is leading innovative work to add transparency in its network of providers to better match members and physicians in terms of demographics. For example, to help support LGBTQ+ members, Included Health is improving its provider directory to make it easier to identify empathetic doctors who are skilled in specific care, such as prescribing pre-exposure prophylaxis (PrEP), a medicine designed to prevent HIV, and hormone therapy.
“These are providers who we can entrust our members through knowing they’ll get high quality and affirming health care,” said Dr. Knox.
The changing nature of the doctor’s visit
Telehealth could make inroads if there were more structure for reimbursement and financial alignment in the industry for primary care physicians and supporting care teams to communicate with patient and their caregivers outside of video visits, added Dr. Yumi Taylor, intrapreneur, virtual, value based primary care product at Sutter Health.
“If we want to be successful in reaching the overload to global populations or specifically populations that are just not engaging with healthcare, we need to be purposeful in our outreach,” Taylor said.
More coordination among all stakeholders will be needed, including help from employers. The moderator of the panel, Joe Castiglione, a principal program manager of Industry Initiatives at BSC, made an appeal to health plans to work with their corporate customers to better align reimbursement and various forms of patient care. “If you're an employer, you have an opportunity here to also work with your health plans with your own contracts to try to really drive that alignment,” he said.