Health Care Tech for Low-Income Patients

As the technology gap shrinks, focus shifts to the needs of underserved populations.

By Jennifer Thomas

A stylized picture of a digital tablet with medical instruments and accessories on top of it.

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From established giants to buzzy new startups flush with funding, more tech companies are setting their sights on health care.

That means developing everything from innovative enterprise solutions meant to improve patient care to wearable consumer technology designed to track and monitor personal health.

In 2018 alone, investors poured $8.1 billion into digital health care startups in the U.S. And while the innovative solutions these healthtech companies are offering could help us live longer, healthier lives, many of these products are simply out of reach for populations who stand to benefit from them the most.

“Unfortunately, a lot of the technology in this country has been built for two populations — individuals with employer-based coverage and those who have the discretionary income to participate,” says Adimika Arthur, acting executive director of HealthTech4Medicaid, a nonprofit founded by healthtech CEOs focused on improving care for Medicaid recipients. “If you can pay for a smartwatch that helps you track your steps or monitor your blood pressure, you’ll see a direct impact on your health. But where is technology access for vulnerable populations?” 

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Online medical services devices with a laptop.

Outdated Assumptions

One thing is clear now: It is not about access. It is a common misconception that these technologies have failed to catch on with vulnerable populations because they lack the requisite smartphone and internet access. In 2019, 81% of Americans owned a smartphone, according to a Pew Research Center survey, and a 2018 Deloitte survey found that smartphone adoption rates among Medicaid participants remain similar to those of the general U.S. population.

“We can put the question to bed about whether or not people have access to technology, because even if they don’t have the fanciest data plan or phone, they are very resourceful about accessing the internet,” says Dr. Lisa Fitzpatrick, a medical epidemiologist and infectious diseases physician. Dr. Fitzpatrick recently founded Grapevine Health, an organization that works to improve health outcomes for Medicaid beneficiaries and their communities.

“We can put the question to bed about whether or not people have access to technology, because even if they don’t have the fanciest data plan or phone, they are very resourceful about accessing the internet.”

Beyond simply dispelling outdated assumptions, the healthtech industry must also change its standard metrics for success. Technology engagement can’t solely be judged by clicks and downloads, says Fred Dickson, executive vice president and chief information officer at AmeriHealth Caritas, a national leader in Medicaid managed care and other health care solutions for those most in need. “We are very excited that many of our members have leapfrogged traditional internet access methods to become savvy smartphone users. This is providing us the opportunity for a level of interaction that we only dreamed about a few years ago. Now it’s becoming a question of the depth of those interactions,” he says. “We measure the impact of those technologies on building stronger engagement and trust between the member and their care team.”

Some tech companies are beginning to get it right. Take startups like CareMessage, which offers text messaging services designed to facilitate preventive care outreach and reduce the likelihood of missed appointments among low-income patients. When a free clinic used the CareMessage platform to send regular informational text messages to diabetic patients over a 12-week period, patients’ total mean finger stick blood glucose levels dropped by an average of 11.3%.

California-based Omada Health is another good example of a company that has created smart, patient-facing solutions, says Veenu Aulakh, executive director of the Center for Care Innovations. One of Omada Health’s most successful tools is Prevent, a digital diabetes prevention and weight loss program that engages participants in an online curriculum that requires them to digitally track their exercise, diet and weight. Participants use a cellular-connected scale and blood pressure monitor. By building the system around cellular networks, designers aimed to create something that was as easy as possible to use out of the box without the need for home internet access.

Over three years, patients who participated in Prevent saw significant, sustained weight loss and a reduction in their A1C blood sugar test results, with an average remission from the prediabetes range to the normal glycemic range, according to a peer-reviewed study conducted by Omada Health.

“That product really resonated with a low-income, low-literacy population,” Aulakh says. The program was specifically targeted at underserved populations, offering an online peer network and round-the-clock access to a virtual health coach. Even the recipes offered were created with an awareness about the cost or lack of access to certain types of food, and the curriculum was available in both English and Spanish, broadening its reach.

An iPhone with medicine pills showing on the screen.

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Plugged In

Historically, lower-income Americans have had less access to smartphones and broadband internet than those with higher incomes. However, the technology gap is now narrowing.

71% of adults who earn less than $30,000 now own a smartphone.

26% of low-income adults rely on smartphones as their sole source of internet access at home.

56% of adults earning less than $30,000 have broadband access at home.

86% of people on Medicaid own a smartphone.

94% of people with employer-based health care own a smartphone.

63% of rural Americans have broadband internet access at home, up from 35% in 2007

Finding Funding

Of course, these kinds of technological advancements come at a cost. And increasingly the industry is shifting from a focus on access to one of addressing affordability of these innovative solutions. To help incentivize innovation like that found at Omada Health, HealthTech4Medicaid is bringing together payers, providers, policymakers and entrepreneurs to find a more workable reimbursement model in the Medicaid space. That’s what it will take to “radically change the pace of innovation,” Arthur says.

Some companies are finding that text-message-based solutions, like appointment reminders to limit no-shows, have had the most staying power. The financials make sense: If you can keep appointment slots filled, the technology essentially pays for itself. Text messaging also is inexpensive, broadly accessible and popular among patients of all income levels.

“Seeing healthier mothers and babies confirms that we need to keep moving forward with these technologies to help address the needs of underserved populations.”

Online medical services devices with an iPad.

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“For an individual who has a lower mobile data allowance and limited access to high-speed internet in their home, we have to design around that reality,” Dickson says. And that understanding has led to AmeriHealth Caritas forming strategic partnerships with local internet and cellphone service providers to offer subsidized home internet and personal smartphones.

“Our members’ unique needs help to shape our engagement strategies,” Dickson adds. A prime example of this in action is AmeriHealth Caritas’ innovative Keys to Your Care program, which delivers informational text messages and telephonic outreach to pregnant members during and after their pregnancy. Within one market where the maternity engagement program was deployed, members’ positive behavior changes contributed to better health outcomes for mothers and newborns, including statistically significantly lower rates of premature births and neonatal intensive care unit visits over time. “Seeing healthier mothers and babies confirms that we need to keep moving forward with these technologies to help address the needs of underserved populations.”

Building Trust

While gains have been made, Dr. Fitzpatrick still finds many of the current tech solutions incomplete, especially for populations with low health literacy and a general distrust of the health care system. “This is what’s driving disengagement,” she says. She believes that by increasing health literacy and trust, tech advancements will achieve greater engagement and, as a result, better outcomes.

“We’re missing huge flocks of people because they’re not engaged, or the service isn’t presented in a way that they trust or they can even relate to culturally,” she says.

Building that trust requires very personalized outreach, Dickson says. AmeriHealth Caritas organizes community wellness events and health fairs and has high-touch interaction any time a new technology is available to its members, he adds.

Despite the need for improvements, those working at the intersection of health care and underserved populations are hopeful that a new wave of more equitable and accessible healthtech solutions is right around the corner.

“It has to,” Arthur says. “We have an ethical imperative to make sure that if we’re providing solutions to people who can afford to pay for them, we’re providing those same solutions to people who can’t.”