UNDERSERVED POPULATIONS IN HEALTHCARE: 5 WAYS TO BRIDGE THE GAP

1. FEDERAL GOVERNMENT INITIATIVES

Work that the HHS and other federal agencies are doing to improve the provision of health care to underserved groups focuses on three areas:

• Expanding access through health centers that serve as safety nets to prevent infectious diseases and address other health needs

• Promoting health care professions through training of new workers and continuing education for existing health care employees

• Transitioning from a fee-for-service model to value-based care that emphasizes quality care and cost containment

U.S. NATIONAL INSTITUTES OF HEALTH UNITE INITIATIVE

The goal of the NIH UNITE program is to identify and eliminate structural racism within NIH-supported organizations and throughout the scientific community by:

• Addressing barriers to racial equality in biomedical research

• Creating an equitable and civil culture for research work environments

• Increasing inclusivity and diversity in science

The five committees that make up the UNITE initiative focus on stakeholder experiences; health equity, minority health, and health disparities; creating a culture of inclusion; transparency and accountability to all stakeholders; and promoting workforce diversity throughout the research community.

EXECUTIVE ORDERS

In the absence of congressional consensus on legislation addressing the critical problem of underserved populations in health care, federal executive orders can be a way to bring more equity and fairness to the provision of health care in the U.S. Two such executive orders that President Joe Biden issued in 2021 address existing federal health care programs and target equitability in the nation’s response to and recovery from the COVID-19 pandemic.

• Executive Order on Strengthening Medicare and the Affordable Care Act. This order creates a special enrollment period for the ACA to provide more coverage to people at risk of contracting the coronavirus. The executive order also called for a review of agency actions to ensure that they promote and support Medicaid and the ACA.

• Executive Order on Ensuring an Equitable Pandemic Response and Recovery. This order mandates that federal agencies take swift action to ensure that COVID-19 care and outcomes in communities of color and other underserved populations are equitable to all other communities.

US DEPARTMENT OF HEALTH & HUMAN SERVICES HEALTHY PEOPLE 2030 INITIATIVE

The HHS Healthy People 2030 program builds on the department’s Healthy People 2020 initiative by focusing on the most pressing health care issues:

• Helping all people live healthy, thriving lives

• Eliminating health disparities and achieving health equity

• Establishing social, physical, and economic environments that promote health and well-being for all

• Promoting health development and healthy behaviors in all life stages

• Engaging health care leaders and public officials in implementing policies and taking actions that improve everyone’s health and well-being

2. ARTIFICIAL INTELLIGENCE TO OVERCOME THE SHORTAGE OF HEALTH CARE PROFESSIONALS

Current models of health care provision are unsustainable because demand for health services will soon overwhelm the capacity of health care professionals and providers. McKinsey reports that even if the health care industry created 40 million new jobs by 2030, it would still be 9.9 million jobs short of needed physicians, nurses, and other health care professionals.

Automation and artificial intelligence (AI) promise to fill the gap by improving patient outcomes effectively and affordably in conjunction with human health care providers in these areas:

• Chronic care management

• Self-care, prevention, and wellness

• Triage and diagnosis

• Diagnostics

• Clinical decision support

• Care delivery

The first generation of AI in health care will automate repetitive, routine tasks, including much administration. The second generation will shift from hospital-based care to home-based care, including remote monitoring, alert systems, and virtual assistants. The third generation will be in clinical practice, including clinical decision support.

3. SMART DEVICES TO DEMOCRATIZE ACCESS TO BASIC HEALTH CARE

The health care industry is catching up with the personal digital revolution that’s seen smartphones and other intelligent devices become ubiquitous. Portables, wearables, and other consumer-facing technologies generate a vast amount of health-related data that can be gathered, analyzed, and applied to personalize health care, thus making health information more readily available.

Do-it-yourself health care makes patients true partners with health care providers in maintaining health and diagnosing and treating medical problems.

• Digital devices can serve as electrocardiogram (EKG) monitors, blood glucose monitors, and pulse oximeters.

• They’ve been designed to measure carbon monoxide in exhaled breath to support smoking cessation programs.

• They create a new “data pipeline” that links health data that patients report in real time to a dashboard that providers who are able to prescribe therapies or interventions that are delivered back to the patients can access.

4. MORE SOPHISTICATED AND LESS EXPENSIVE TELEHEALTH SERVICES

The use of telehealth services expanded rapidly as a result of the COVID-19 pandemic, but the widespread use of the technology also highlighted shortcomings in the current versions of the services. HealthAffairs refers to the current state of telehealth technology as a “punctuated equilibrium,” borrowing a phrase from the late scientist and educator Stephen Jay Gould.

While telehealth services enhance the availability and convenience of health care provision, they must go beyond cost savings to improve patient outcomes and the quality of care patients receive.

• Telehealth services can lead to an increase in patient “visits” because patients may not have sought help if the telehealth services weren’t available. This can actually increase costs for health care providers.

• Little effort has been made to address disparities in access to the technologies that telehealth services require, including broadband internet access, digital devices, translation services, and defined best practices for cultural and social competency.

• Some health issues can’t be addressed adequately via telehealth services, potentially increasing the workload for caregivers who have to follow up a telehealth session with an in-person visit.

• At present, few mechanisms are in place to measure the quality and effectiveness of telehealth visits or to understand how the technology affects patients’ experience. Regulatory and policy approaches are required that address the unique attributes of telehealth visits.

5. INCREASED CANCER SCREENING AND OTHER DIAGNOSTIC AND PREVENTIVE CARE FOR UNDERSERVED COMMUNITIES

Cancer is more prevalent in underserved populations due to social, environmental, and economic disadvantages of poor people and racial and ethnic minorities. The National Cancer Institute notes that African Americans have higher death rates for many types of cancer, including breast cancer and prostate cancer.

• Latina and African American women have higher rates of cervical cancer than women in other racial and ethnic groups.

• The AI/AN population has higher death rates from kidney cancer than any other racial or ethnic group.

• People living in rural Appalachia have higher rates of colorectal, lung, and cervical cancers than people who live in nearby urban areas.

The CDC’s National Breast and Cervical Cancer Early Detection Program has been successful in delivering cancer screening to women living on an isolated Navajo reservation. In addition, between October 2019 and February 2020 the program provided mammograms and other breast cancer screening to women in Arkansas who lived in 23 different shelters, facilities for battered women, rehabilitation centers, and prison release homes. It also worked with the New York State Department of Health to offer cancer screening tests; in one year, the program treated more than 26,000 people who lacked insurance or a regular doctor.