Dr. William Osler the father of modern medicine, once said, “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
For digital health companies looking to innovate in the virtual care space, Osler’s mantra reinforces the importance of a patient-centered approach to care delivery. Perhaps lesser known is the positive effect this approach can have on health equity, especially when compared to traditional models of care. Innovative companies can leverage a virtual care platform to address key social determinants of health including access, quality, health literacy and education to drive greater health equity.
To more easily understand the effect of virtual care on health equity, it’s best to operate from a common set of definitions. Health equity refers to one’s ability to attain his or her full health potential, where no one is disadvantaged from achieving it due to social position or circumstances, according to the Centers for Disease Control and Prevention. In contrast, social determinants of health refer to the conditions in the environment (e.g. location, education, employment, recreation, religion, age, etc.) that affect health, risk, and outcomes.
There is complex interplay between health equity and social determinants with the latter often contributing to the former. More attention is being paid to these topics because of their significant impact on health disparities and outcomes. For example, the World Health Organization estimates that between 30-55% of health outcomes are dependent on social determinants. How then can virtual care be used to address these sobering realities? Not surprisingly, the answer comes back to focusing on the patient.
The first point to make is that virtual care (or any technology innovation) does not intrinsically address social determinants of health. Recent evidence showed that early telemedicine efforts during COVID resulted in an exacerbation of disparities. These examples demonstrate the critical need for purposeful design of virtual care solutions that intentionally mitigate inequities. Re-imagining virtual care from the perspective of the patient is fundamental to this design. More specifically, recognizing the diversity of patient experience and incorporating these variations into design requirements are needed.
Here are some examples of patient-centered virtual care design that improve social determinants of health, leading to greater health equity:
Access and quality
Access and quality are perhaps the most straightforward to put in context. Access to video consultations may seem sufficient, but the patients who are in the greatest need likely do not have reliable access to broadband internet connections. As a result, alternatives such as mobile chat and traditional telephone should be offered. Similarly, only providing access to providers during traditional working hours disadvantages those who get paid a daily wage and those facing job insecurity. It puts the patient in the unfair position of choosing between taking time away from work to get seen for a medical issue or having enough money for food or childcare that day. As a result, virtual care solutions must provide flexibility on the availability of services, including evenings and weekends.
Quality of care means ensuring that patients can reliably receive comprehensive care by providers who can meet evidence-based standards. Given the AMA estimated shortage of up to 124,000 physicians (in both primary and specialty care) in the coming decade, virtual care will need to expand beyond its historic primary care footprint and support a broader range of clinical services. It also must demonstrate comparable or improved clinical efficacy compared to brick-and-mortar care. Transparency in clinical outcomes and patient experience are also components of providing high quality care. Given that virtual care solutions have a technology and data backbone intrinsic to their product, the ability to extract meaningful data should be easier, particularly since there are no legacy systems to manage.
Health literacy and education
Low health literacy in the US approaches 34% according to the Center for Health Care Strategies leading to medical errors, increased illness, disability and cost. The conventional healthcare system unfortunately does not routinely screen for this limitation and is not set up to identify this important gap in the context of an increasingly rushed medical encounter. However, an integrated, patient-centered virtual care ecosystem can introduce many different roles, including coaches, counselors, and educators who can take dedicated time and effort to assess patients and provide them with appropriate resources to support their understanding and compliance.
Virtual care solutions can also provide a chaperoned or co-navigated experience to guide patients along their health journey. There is a clear relationship between low health literacy and low education level, which is also associated with worse clinical outcomes. Virtual care solutions can use multi-modal educational approaches, from traditional printouts to videos to interactive modules, and to dedicated in-person communication. By leveraging the virtual environments inherent flexibility, it is possible to accommodate a wide range of patient learning styles and levels.
Driver of health equity
The flexibility of the virtual care environment provides an unprecedented opportunity to personalize care based on the needs of the individual. In practice, this means meeting patients where they are—that is, identifying their unique barriers and preferences of care and offering solutions that meet their needs. However, virtual care must be designed this way or risk recapitulating the “one size fits all” approach of traditional care, which inherently detracts from health equity. By directly affecting key social determinants of health levers, including increased access, better quality, improved health literacy, and expanded education, virtual care can tangibly advance greater health equity.
