Cultural Training Empowers SDOH, Prepping for Next Virus, At-Home Tests Raise $-The HSB Blog 1/26/21
Healthcare Must-Have, Cultural Competency To Empower SDOH
Our Take: Expanding access to digital tools with technology that incorporates cultural competencies and targets a diverse racial and ethnic population is an essential step toward ameliorating disparities. The ethnic community needs platforms that enhance the patient-physician connection by connecting patients with culturally competent medical professionals in ways that incorporate cultural, physical, and mental needs, allowing for decreased disparities and improved health outcomes for people of all backgrounds. Otherwise, as noted in a recent study in the Journal of the American Medical Informatics Association (JAMIA), innovations in health care policies and technologies risk reproducing and exacerbating existing inequalities caused by systemic racism making it less likely that members of racial and ethnic minority groups can benefit from advances in digital health.
Description: The COVID pandemic has laid bare the heightened concerns about inequities in healthcare access, particularly with respect to patients' race and ethnicity. In addition, by 2050, studies indicate that 50% of the U.S. population will be of non-European origins. With studies showing that African Americans and Latinos experience 30% to 40% poorer health outcomes than White Americans because they do not get the health and medical care they need, providers need to incorporate culturally competent care. Moreover, research shows this poor care for the underserved is because of fear, access to quality healthcare, distrust of doctors, and often dismissed symptoms and pains.The hurdles to gaining healthcare access have been persistent throughout the past years. Despite significant research and efforts to improve access on many fronts, people of color still experience decreased access and treatment to care compared to their White counterparts. Importantly, the research also shows a difference in the way people of color access, experience, and receive healthcare compared to their White counterparts. For example, according to a study in the Journal of Cultural Diversity, rebuilding the African American community's trust needs to be at the forefront of healthcare’s diversity efforts since they feel they will be used as test subjects, in part reflecting the legacy of the infamous “Tuskegee experiment”. The study also notes that many African Americans feel that the actual act of receiving health care is a degrading and humiliating experience attributing some of these problems to insults, lack of communication, and low quality of care. Insults may also include some form of gestures or comments that may be demeaning. For example, in a recent post in the Harvard Health blog a physician noted how a patient reported that during an emergency room visit for a painful medical condition. doctors had treated her like “she was trying to play them, like I was just trying to get pain meds out of them” simply because she was black. The article went on to note there was nothing in the patient chart to indicate any pain-medication seeking behavior, had never had any issues with substance abuse and eventually had to go elsewhere to get an appropriate diagnosis and care. Another study conducted by the Perelman School of Medicine at the University of Pennsylvania addressed the correlation between patient experience scores, race, and health systems' need to address implicit racial biases in medical settings. The study found that patients who saw physicians of their own race or ethnicity were more likely to rate their physicians higher on patient experience surveys than those who saw physicians of different races or ethnicities. The relationship also shows a higher occurrence of participation by the patients with their own health care needs. For health outcomes to be improved, mistrust of the healthcare system for minority racial and ethnic groups needs to be addressed by improving cultural competence amongst healthcare providers. In addition, the shortage of minorities working in the healthcare system needs to change in order to adequately represent solutions to the most salient issues of the minority population. With limited minority health care professionals at all levels, the diversity of the healthcare system will continue to be non-representative of the population which it’s serving, limiting its effectiveness.
Implications: The combination of historical and modern-day experiences has created mistrust of the health care system by many minority groups. The minority community has to be educated about promotion and prevention related to health and health care issues. If there is a continued distrust of the healthcare system, racial and ethnic groups will continue to experience increased disease complications, increased health costs, and poor health care management and outcomes. Health care must be re-directed to raise awareness by health care groups and communities so they .can mobilize and change these complex issues that remain in society today. Efforts on the part of the government, businesses, health care providers, and the general community will play critical roles in getting this accomplished. A study conducted by Rumi Chunara analyzed health records for 140,184 patients who sought care either in person or through telemedicine. An inference was made that Black patients using telemedicine were more likely to receive a suspected diagnosis of COVID and subsequently test positive as compared to White patients, suggesting that Black patients, “may be sicker when seeking care through telemedicine compared to White patients.” Evidence from the study showed that Black patients were less likely to receive a suspected COVID diagnosis overall than White patients suggesting that more equitable care occurs over telemedicine. This is an exact result of interactions normalizing between clinicians and patients virtually and decreasing biases in healthcare. Chunara also indicates that including diverse perspectives in a "participatory design" process and incorporating "cultural and linguistic adaptations can inform the redesign of telemedicine tools and platforms that cater to racial and ethnic populations. HealthcareITNews noted a study that used the Mount Sinai De-Identified COVID database to promote research showing that Black and Latinx patients were less likely than White patients to use telehealth services because they did not have access to a usual source of care, such as a primary care physician. Additionally, disparities in digital access, digital literacy, telehealth awareness, issues of cost and coverage, and mistrust of digital appointments were all potential barriers to using telehealth. In order to reduce disparities, public awareness should be given to racial and ethnic differences present in minority groups. Moreover, formal and informal policies and interactions that are rooted in inequality, discrimination, oppression and exclusion among patients and clinicians need to be addressed in the future. A recent paper found that there were eleven educational strategies which could be employed to teach and train about cultural competency and disparities. We believe some of the most interesting were: 1) immersion experiences; 2) discussion groups; 3) simulations; 4) reflections; case-based learnings (CBL); and, 5) assessments. These methods could prove quite useful for healthcare organizations that rely heavily on patient experience scores for assessing physicians as these directly impact PressGaney scores and reimbursement. Moreover, providers and educators need to invest in the re-education of providers and revamp the medical school curriculum so new providers can be culturally competent and care for patients of any race or ethnicity. In addition, a number of innovative new technological platforms like Mahmee, Spora Health, Hued, Health in Her HUE, and Therapy for Black Girls give access to minorities at their convenience to boost health outcomes for people of color. Mahmee is a secure management platform connecting payers, providers, and patients to comprehensive prenatal and postpartum healthcare from anywhere. Spora Health is a culture-centered healthcare provider that provides telemedicine services to people of color in order to navigate a healthier lifestyle. Hued, Health in Her Hue, and Therapy for Black Girls facilitates a compatible, matched physician-patient connection amongst minority communities and culturally diverse clinicians to improve the disproportionate health outcomes for people of color. By increasing cultural competence and access to minority clinicians within the current healthcare system, racial and ethnic minorities will engage the system early and have better health outcomes with lower costs, thereby improving performance.
2020 Revealed How Poorly Prepared the US Was for COVID-19--and Future Pandemics
Event: A recent article in JAMA Forum noted that not only were the effects of the COVID pandemic on the United States unexpected, the COVID pandemic exposed how poorly the U.S. was prepared for this-and potentially future pandemics. The author noted a number of steps that can be taken going forward to ensure that the U.S. is more prepared for the next pandemic.
Description: When the COVID pandemic reached the United States in January of 2020 with a man who had returned from Wuhan China four days earlier, no one could have been prepared for what followed. While the U.S. CDC began screening international travelers, in late February the first cases not related to international travel were confirmed. By the end of the year, the US had over 20 million COVID cases and 346,000 deaths. While the pandemic decimated the economy, with over 15 million fewer people on the payrolls in June than had existed in February, female workers were impacted disproportionately. According to the U.S. Bureau of Labor Statistics, over 5 million women lost their jobs and 2.1 million have left the workforce entirely given they were the primary caregivers in the home and the closure of in-person schooling had left them without childcare. In addition, while the development and emergency use authorization of a COVID vaccine occurred with record speed, the distribution and administration of vaccines has been haphazard at best. Drawing on state and local government’s role in the preservation of public health the prior administration gave them authority to devise distribution plans. However, between the the Federal government not providing state and local governments additional resources to handle distribution and the impact of the economic crisis on states finances, states were poorly positioned to take on this added responsibility.
Implications: While there were significant missteps that led to a lack of preparedness for the pandemic, and there is more than enough blame to go around, certain actions should be taken to increase preparedness for a future pandemic. First, while the global health position on the National Security Council had been eliminated under the prior administration and has been reestablished under the current one, this consistent pattern of brinksmanship needs to be avoided and the position made permanent. In addition, the Federal government needs to rethink the stockpiling of supplies and their deployment as well as develop strategies for providing surge capacities of medical personnel and facilities in preparation for another pandemic. Moreover, advance preparations need to be in place to determine which populations would be most vulnerable to a new threat and plan how best to distribute resources to protect them. Finally, authorities need to devise better communication and education strategies to encourage people to embrace and undertake actions for the common good (ex: mask wearing, social distancing) in the event of a future pandemic.
At Home Health Testing Kits Everlywell and Luciera Health Raise Money
Event: Recently TechCrunch and the San Francisco Business Journal reported that at-home health testing kit companies Everlywell and Lucira Health have raised $75 million and $115 million, respectively. In addition to a home collection kit for COVID (which both have developed) Everlywell has developed a test for thyroid issues, allergies and food sensitivities. Lucira, which was the first to receive authorization as the first at-home COVID self-test is also developing a combination COVID and flu test kit.
Description: Everlywell and Lucira are two examples of the increased acceptance and innovation in the at-home diagnostics and therapeutics space. Everlywell’s SARS-CoV-2 test, allows individuals to check infection without having to visit an in-person test site. After the individual collects and ships their sample, they receive secure digital results within 24-72 hours. A telehealth consult is available to guide users through the next steps. The kit rt-PCR test has received an EUA from the FDA, and meets their benchmarks for accuracy. Although the cost for the test is a steep $109, the test cost can be reimbursed with healthcare insurance or if the user is HSA & FSA eligible. Lucira has developed an at-home testing kit that allows individuals to self collect their nasal swab samples and receive their results within 30 minute without shipping it out. Although the test has been authorized by the FDA, it has not rolled out for sale yet. Lucira estimates the test will cost around $50. The testing platform that produces centralized-laboratory-accurate molecular testing in a single-use, consumer-friendly test kit is powered by two AA batteries. The company's initial focus is within respiratory diseases, starting with COVID and influenza A and B virus indications. In a Community Testing Study, where the Lucira test was compared to a FDA authorized SARS-CoV-2 test, Lucira achieved a 94% positive percent agreement (PPA) and a 98% negative percent agreement (NPA). The results are easy to read with a simple light up display.
Implications: Whether the at home testing kit delivers results within 30 minutes or within 24-72 hours, these solutions give individuals the ability to get tested and remain in their own homes. By contrast, in-person testing can have long wait lines and often require long commutes which can interfere with time working or caring for loved ones. In addition, as noted, in person-testing requires patients to expose themselves to more risk and potential danger. At home testing kits can be done anywhere, anytime and more safely. This results in improved access for people who don’t have time to make appointments or commute to the nearest clinic. While at home testing kits are currently more expensive than on-site testing, this could be addressed by insurers and regulators thereby broadening availability and access. Moreover, at home testing and therapeutics could easily become a way to address healthcare disparities by reducing commuting and waiting times for testing at clinics and increasing access to testing for those in under resourced communities.
HCAP Partners Announces New Investment in 83bar
Event: 83bar, an Austin, TX-based leader in patient journey management for both clinical trials and commercial clients across pharma, medical device, and diagnostic industries, has raised an undisclosed amount. 83bar provides a cost-effective patient activation platform to find and retain qualified individuals for clinical trials and commercial clients. The company locates patients on behalf of its clients, evaluates them using online screeners, and activates patients who are then ready to act with medical providers.
Description: 83bar is used to help identify patients for clinical trials. It locates patients on behalf of its clients, evaluates them using online screeners, and connects appropriate patients with medical providers. The distributed Patient Education Specialists call center provides personalized, rapid-response education, screening, and qualification for prospective patients. Its end-to-end data capture platform provides full campaign reporting, analytics, insights, forecasting, and optimization in a proprietary database of over one million patients that can be specifically targeted for future trials. Patients used in test trials are then compensated for their efforts. As of December 2020, the platform successfully scheduled 130,000 appointments, facilitated 6.8 million communications, and captured 840,000 completed surveys.
Implications: Clinical trials are necessary to develop drugs and learn more about the safety and efficacy of drugs. With over 48% of trial missing enrollment targets and almost half of patients dropping out of trials before its completion 83bar can capitalize on it’s unique investment and infrastructure to expand its clientele to help medical providers and patients to discover more about drugs under development. For example, clinical trials can help discover the long-term effectiveness of drugs for deadly illnesses like COVID vaccine, however these drugs must be developed as quickly and cost effectively as possible. In addition, once discovered drug dosages and safety profiles need to be adjusted/tested (ex: such as the effectiveness COVID vaccines for children) by administering the vaccine. Firms enabling digital clinical trials such as 83bar can help speed development and improve efficacy.
Washington State Taps Key Stakeholders for Help with COVID-19 Vaccine Rollout
Event: On January 18th, Medium reported that Governor Jay Inslee of Washington State announced a new statewide vaccine distribution and administration plan to increase the number of Washington state residents receiving the COVID vaccination. Through a partnership with key stakeholders, the state will work to reach the state’s daily vaccination goal of 45,000.
Description: With the Coronavirus growing, the need for COVID vaccination distribution has become even more pressing. As a result, Washington state created a new statewide public-private partnership, the Washington State Vaccine Command and Coordination Center, to boost vaccine distribution efforts. Under the plan, each stakeholder is expected to focus on different areas of vaccine distribution including logistics coordination, allocation strategies, infrastructure support and development, and cross-organizational and agency operational communications. Among the stakeholders Kaiser Permanente will be responsible for planning expertise for mass vaccination clinics and the distribution of vaccine to healthcare providers; Starbucks will be responsible for operational efficiency, scalable modeling, and human centered design expertise; Microsoft will be responsible for technology expertise and support; SeaMar will be responsible for representing historically underserved communities; and Costco will be responsible for vaccine delivery.
Implications: The involvement of these companies in this private-public partnership will both aid the state in reaching their goal and hopefully grab the attention of skeptical residents who need reassurance that they will be receiving a safe and thoroughly tested vaccine. However, despite the involvement of these companies in the plan's potential success, several changes to both distribution phases and state infrastructure are still necessary. This includes: 1) An update to vaccine distribution phases to include those 65 and older, aligning with new federal guidelines from the CDC and increasing accessibility to high risk populations, 2) Mandating providers administering vaccines to administer 95% of vaccine allocations within a week of receipt and reporting vaccine data to the state within 24 hours of administration, 3) The DOH will coordinate volunteer vaccinators to support vaccine administration, connect with all vaccine administrators across the state to assess where additional assistance is needed to meet the new requirements, and establish high vaccination sites to prepare for future vaccine allocations. Once these changes are achieved, and with the expertise and efforts of the companies involved, Washington State’s vaccination goals and resident’s access will be improved. This will give them a greater chance that their goal will be met, bringing Washingtonians’ that much closer to effectively combating the COVID virus.
Tech Partners Unveil Life Science Data Platform
Event: Healthcare IT News reported that Microsoft, the Broad Institute of MIT and Alphabet’s Verily subsidiary had formed a partnership that supports new life science data platform – the Terra platform designed to work across different types of biomedical information. Terra simplifies a range of processes allowing researchers to analyze and share data they have generated.
Description: Terra platform is a secure, scalable, open-source platform for biomedical researchers to access data, run analysis tools, and collaborate. The platform is a new strategic partnership with the goal of accelerating the pace of potential biomedical innovations. This aims at the potential benefits of collecting previously unimaginable amounts of biomedical data combined with the huge challenge of identifying how to organize and manage those same stockpiles. According to the partners, while more biomedical data (ex: genomics, imaging, biomarkers, EMR data, etc.) are being generated and digitized than ever before “making use of these important datasets remains difficult for researchers who face huge, siloed data estates, disparate tools and fragmented systems''. The goal of the partnership is to bring together technology experts, science researchers, and data scientists to combat challenges and boost Terra’s overall vision for health and life sciences.
Implications: The companies aim to create a seamless and secure workflow to quicken the delivery of data and insights between research and clinical domains. With such companies partnering together and developing digitals tools such as these it will speed up biomedical research and lower cost across healthcare and life sciences. The partnership combines multimodal data, secure analytics, and scalable cloud computing to improve insight and evidence generation to ultimately impact more patients’ lives. According to Stephen Gillett, chief operating officer at Verily, all three organizations share the goals of “improving patient care, driving innovation in biomedical research and lowering costs across life sciences”.