4 Ways to Prioritize Health Equity In Your Care-At-Home Program

The healthcare industry is in the middle of navigating two major trends: technology is moving into healthcare, and healthcare is moving into the home. As providers, payers, vendors, and industry newcomers scramble to figure out “who’s on first,” we all sense the possibility of this quantum leap moment for healthcare. 

Many of our collective conversations right now are focused on a critical imperative for these emerging care models: improving health equity across racial, gender, age, economic, educational, and geographic lines. This goal has rightly become front and center for many care-at-home programs across the country. 

With new care-at-home programs announced every week, it’s vital that these initiatives implement the right technology and support to address and improve inequities. Here are four ways care-at-home programs can make or break the pursuit of improved equity in access, adherence, and outcomes.

1. Build digital product interfaces designed for patients and accessible across languages and health literacy levels. 

As we move care into the home, patients must be able to access and navigate the digital products that care-at-home programs rely on. Whether the application lives on the patient’s own device, a provided device, or lacks a true interface, whatever the patient is interacting with must be broadly accessible.  

Any gaps in accessibility, as minor as they might appear, could impact the patient’s ability to adhere to their care plan. In the U.S., 21.6% of people speak a language other than English at home—that’s one in every five adults[2]. Low health literacy often correlates to groups who face barriers to accessing care[1]. Often, these patients also need care the most or have chronic or comorbid conditions that could benefit from ongoing monitoring.

Key program touchpoints that can support equity across language and literacy:

– Product Setup Instructions: Simple, well-defined, and accessible product setup instructions can differentiate between a successful experience and a complete failure. It must be approached as more than just “how-to” material and must be tested with patient populations while in development; it contributes to the overall experience and is part of the patient’s care. 

– Task Descriptions: When outlining tasks, follow general best practices, such as striving for short descriptions, plain language, and bullet points. However, go beyond to include clear graphics and/or animation that show how to take a measurement or use a device. Well-designed graphics will enable comprehension for patients with low reading comprehension. Make sure you use a health literacy assessment to evaluate all patient interfaces.

– Telehealth Interactions: In addition to ensuring interfaces can be configured for accessibility, it’s imperative that translation within telehealth calls can be easily accessible and readily available. Multi-party calls should allow for on-demand translators, family members, or other providers to join via video or audio.

 2. Provide human support for the initial activation.

Activation at the beginning of a care-at-home experience is a critical moment for equitable patient experiences. The degree of support that patients need will depend on several variables, including the technology components, the logistics process, and the patient’s acuity level. For some care models, you may need to provide over-the-threshold support for setup. For others, it may be sufficient to provide written and video instructions for setup, or to complete setup before the patient leaves the clinic or healthcare facility.  

Regardless of the activation process, adding a layer of human support can help ensure no patient is left behind. Have someone reach out to the patient confirming receipt of the first health data transmission and answer any questions that may have arisen since the patient last spoke with a member of their care team. Then, provide patients with multiple options to access support: phone, email, and chat within the digital health application.

3. Deliver connectivity. 

More than one in six people in poverty had no Internet access in 2019.[4] Pursuing equity within care-at-home programs requires removing in-home high-speed internet as an eligibility requirement. To do this, we have to ensure data transmission and communication without relying on in-home broadband access. Offer cellular-enabled connectivity hubs, and, if the patient needs one, a smart device. 

Troubleshooting connectivity is another key opportunity for human support. If a device loses connection or something happens in the patient’s environment, responsibility shouldn’t fall to the patient, their family, or a clinician to get everything back online. Dedicated technology support can make care-at-home experiences better for providers and patients alike, especially if that support can extend into patients’ homes (e.g., the Geek Squad).

4. Don’t wait for patients to reach out.

A proactive approach to patient engagement is important for an equitable program because it removes the onus from patients to ask questions or ask for help. 

Throughout a care-at-home experience, there are several patient engagement opportunities that should not be missed: at the point of activation, in response to biometric data trends, in response to non-compliance or non-adherence, and at regular junctures during a patient journey or care plan (e.g., every patient receives a call on day five just to check in).

The best medium for patient engagement will depend on the program type and patient population. Some patients may prefer text-based messages, while others need or want to hear someone’s voice on the phone. Scaling multi-modal patient engagement can be challenging (and even be unsustainable) for teams whose work is not dedicated to the care-at-home model. But virtual Command Centers can provide that dedicated support and enable programs to scale sustainably. 

A Holistic Approach

To make a meaningful difference in health equity in our communities, we have to take a holistic approach and move beyond a “check the box” mentality. In addition to the opportunities mentioned here, program leaders must look at patient eligibility and exclusion criteria with an inclusive lens, and test to ensure the technology and algorithms involved in remote patient monitoring are not exacerbating inequities. And finally, healthcare is delivered by people, so hiring and training plans must reflect the communities and populations a program aims to serve. Cultural appropriateness is key. Cultivating skills within the design and care delivery teams that improve cultural competence and humility, as well as cross-cultural communication, will enable the delivery of equitable care and support improved patient outcomes.

Care at home has the potential to offer more accessible longitudinal healthcare interactions that can improve outcomes and lower costs. However, making this happen in an equitable way requires a thoughtful and intentional approach to people, processes, and technology that are powering care at home. 

About Chemu Langat

Chemu Langat is the Chief Operating Officer for Best Buy Health, leading the Operations and Quality & Regulatory functions. In this role, she is responsible for the Caring Centers, expanding the reach of our supply chain and operational ecosystem, driving a culture of quality and ensuring compliance of our offerings and medical devices. She also leads the health equity work for Best Buy Health.

Prior to joining Best Buy, Chemu was the Regional Head for Africa under Medtronic Labs, developing and scaling community-based, technology-enabled solutions for chronic disease management across. Chemu previously worked as a Principal Biomedical Engineer for Medtronic, as well as a Systems Safety and Reliability Engineer at NASA’s Johnson Space Center.

References

[1] Levy H, Janke A. Health Literacy and Access to Care. J Health Commun. 2016;21 Suppl 1(Suppl):43-50. doi: 10.1080/10810730.2015.1131776. PMID: 27043757; PMCID: PMC4924568.

[2] United States Census Bureau: https://data.census.gov/cedsci/table?tid=ACSDP5Y2019.DP02&hidePreview=true

[3] United States Census Bureau: https://www.census.gov/quickfacts/CA[4] Office of the Assistant Secretary for Planning & Evaluation ● U.S. Department of Health & Human Services: https://aspe.hhs.gov/sites/default/files/private/pdf/263601/internet-access-among-low-income-2019.pdf

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