On August 9, 2021, Dr. Venice Haynes and Jen DeYoung of USofCare — together with Founders Council member Abner Mason and Voices of Real Life member Omar Ibarra — presented to 94 attendees at the 14th session in the National Committee for Quality Assurance’s 2021 Quality Innovation Series.
Titled “An Equity Approach to People-Centered Virtual Care Policy Design,” the 90-minute presentation encompassed USofCare’s listening-based research on barriers to virtual care access and virtual care policy recommendations for health systems and policy makers in the wake of the COVID-19 pandemic. The latter half of the presentation consisted of a Fireside Chat and audience Q&A with all four panelists, with special focus on the importance of community perspectives and visions for a virtual care system of the future.
The invaluable presence of community leaders and underrepresented voices in the virtual care conversation emerged early in the discussion. “The United States has increasingly become a highly multicultural country over the last 40 to 50 years, but its health care system has not adapted accordingly,” said Founders Council member Abner Mason, who is the CEO of ConsejoSano, a cultural connection platform committed to ensuring healthcare leaves no member or culture behind. With virtual care having its beginnings in serving a wealthier patient population that Mason termed the “Peloton crowd,” he stated that considering how to scale up and adjust virtual care to work for everyone is an essential course of action that will require the input of community leaders. “The brick and mortar is going away,” he said. “Virtual care is a big part of the solution, but we could be leaving a lot of people behind if we aren’t super conscientious of how we go about the next few years.”
Voices of Real Life member and Congressional Hispanic Caucus Institute fellow Omar Ibarra cited his own community’s experiences with virtual care as further support for community involvement in the virtual care conversation. Coming from a rural, mostly Latino community in Oklahoma, Ibarra highlighted the unique considerations of his community regarding virtual care: language barriers not only during virtual clinical encounters, but on hospital websites and phone calls; increased feelings of safety for immigrant and undocumented individuals who previously feared deportation while going to in-person clinics; and systemic racism embedded in quality of care, both virtual and in-person. “Leaders need to work with not only community leaders, but also groups that are traditionally not heard or brought to the table,” Ibarra said. “Even if you can’t talk with those groups directly, work with nonprofits or community organizations that may have experience facilitating those conversations.”
In addition to ongoing conversations with community members, all four panelists highlighted near-term solutions that health systems and policy makers can target to advance equity in virtual care. “There’s a lot of low-hanging fruit toward achieving equity in virtual care when we listen to what people actually want,” said USofCare’s Dr. Venice Haynes. “Number one is to make permanent and expand many of the pandemic provisions for virtual care,” referring to increased flexibility in state licensure laws and reimbursement policies for video and audio-only telehealth visits.
Other low-hanging fruits, Mason said, include making telehealth platforms easier to navigate and enabling text messaging as a mode of virtual care. In his own most recent telehealth appointments, Mason recalled struggling to log on to the platform because the system had his work email, not his personal email, on record. “The technology platform was really convoluted… And I run a healthcare technology company,” he said, “so I can only imagine how difficult this would be for a lot of older adults, for example.”
Furthermore, while text messaging is the preferred mode of communication for most people, especially for workers who may otherwise struggle to take time off for health care appointments, Mason said it remains difficult for health plans and providers to connect with patients via text. “It comes down to meeting people where they’re at and recognizing that the health care consumer’s preferences need to be top priority,” he said. “If we can’t make text messaging work in 2021, how are we going to deal with what’s coming with virtual care solutions?”
Finally, USofCare’s Jen DeYoung emphasized the importance of investing in data collection and research on equity in order to establish a sustainable, equitable virtual care system that takes into account people’s care quality, cost, and access. As the nation moves into a new phase of the pandemic, DeYoung said, it will be even more important to research how different communities continue to engage with virtual care and perceive quality of care. Echoing DeYoung’s sentiments, Mason added that researchers need to build trusting relationships with people to overcome discomfort surrounding the collection of race and ethnicity data. “Now that the system is pivoting, we need to be patient with people who have good reason not to trust it, because the system has never cared before,” Mason said. “Before you ask for something, offer something… Build the relationship first, and people will tell you this information. They’re not ashamed of their race, ethnicity, or language, but they don’t trust you.”
Closing out the conversation, the panelists concluded with hopeful visions for the potential of virtual care to close health inequities. “I see two different paths for virtual care going forward,” Ibarra said. “It can continue to be a commodity for the wealthiest people, or it can become a great tool for different communities and people. It’s up to our choices and actions now.”