Digital Health: Tools to Improve Access to Care
Over the last 18 months, we’ve seen extraordinary changes in the way people access medical care. Medicine has always been in search of the next invention or innovation. Some of them, like the polio vaccine and leading the world in organ transplant, were developed and perfected right here in Pittsburgh. But it is the rise of consumer-focused digital health tools that excites me most about the future of health care. And once again, Pittsburgh is leading the way, thanks to its unique position as incubator for both health care and technology companies.
Digital health tools are not new. For more than 15 years, health care organizations, including UPMC, have been developing mobile apps that support health and wellness and patient-physician communication. These tools give individuals on-demand access via a smartphone or computer to various resources, including their own doctors, health education materials, and a broad array of services from health coaches, nurses, nutritionists, dietitians, and counselors.
At UPMC Health Plan, digital health tools are an increasingly important part of our member engagement strategy. We know that the continued prioritization of innovative digital health tools will ensure that members have access to quality, affordable care where, when, and how they need it.
The impact of the COVID-19 pandemic
Prior to March 2020, digital health tools were available but not broadly utilized. With the exception of a small group of early adopters, most consumers and patients simply did not consider these tools as an option for accessing health care or information. While the potential of digital health tools for transforming health care was often discussed within the industry, there just wasn’t much urgency to use them.
When the coronavirus pandemic emerged as a serious public health threat, attitudes quickly changed. People sought digital tools to find the most accurate, up-to-date health information; continue to meet their health and wellness goals; and safely connect with their physicians. Similarly, physicans and other providers needed a way to maintain visits with their patients, especially those with chronic health conditions or those at higher risk for contracting the coronavirus.
Due to our ongoing investments in digital support tools, UPMC and UPMC Health Plan were able to leverage existing assets and infrastructure to meet this need. We immediately worked with our provider partners to expand the types of care and support that individuals could access through the UPMC AnywhereCare mobile app, including urgent care visits for children aged 0-18 provided through UPMC Children’s Hospital as well as complex pediatric care management; virtual counseling for behavioral health; pregnancy support; dental support; care navigation for those seeking a new provider; and one-on-one coaching from a certified health coach. We also launched a new mobile app, RxWell, complete with a digital health coach to help individuals cope with stress, anxiety, and depression and improve their health behaviors. Apps like these dramatically increase the ability of users to have on-demand, virtual face-to-face conversations in real-time or access support via chat when it’s most convenient for them.
The benefits and challenges of digital health tools
The sudden need to use digital health tools for accessing care and support services has changed the overall perception of them. More health care consumers and doctors are now comfortable using these technologies. As we continue to navigate the ups and downs of the COVID-19 pandemic, many will continue to opt for a virtual visit with physicians or providers due to convenience, comfort, or privacy.
The increased use of digital health tools can also help address health equity problems, many of which were exacerbated by the pandemic. Accessing care from home or an office can reduce common barriers to care and support, such as access to transportation, childcare, or scheduled time off work. Barriers such as these and others often result in deferred care or missed appointments. Digital tools may also increase care access in rural areas where a doctor’s office or hospital may be more than an hour away.
At the same time, opportunities for improvement abound. According to a recent RAND report, while telemedicine use increased 20x after March 2020, uptake was higher in counties with low poverty levels as compared to metropolitan areas, and among adults. Moreover, the availability of smartphones, broadband acess, or data requirements needed to power some of these digital tools varies across populations and geography. Currently, legislators and others in our region who serve these communities are considering investments and processes to close this “digital divide.”
We also need to develop strategies for sustaining the use of digital health tools once a post-pandemic normal sets in. Our own data at UPMC Health Plan confirms that while telehealth usage remains strong in behavioral health, primary care, family medicine, and some specialties, it is now far below early-pandemic levels. Some of this is appropriate decline because in-person care will always be a very necessary component of health service delivery. However, we see opportunity for telehealth and digital health to increase as the medical community adapts and understands over time the best ways to deploy these technologies to maximize access and quality.
The future of digital health in Pittsburgh and beyond: Four things to watch
While most would agree that digital health is here to stay, important questions still remain. First, how do we create a comprehensive digital health ecosystem as opposed to one-off solutions? Sustaining and enhancing engagement in digital health tools is best supported through their integration with other supports and services. Only through a seamless flow of information and support between digital tools and in-person care can we enhance the total care experience for individuals.
Second, what is the optimal mix of digital tools versus in-person care? In 2020, we witnessed almost all care and support provided through digital tools. However, certain supports, services, and care may be better delivered one way or the other. For example, we could learn that a virtual annual wellness visit is fine for someone with no medical conditions but not for someone with a condition like diabetes. This exploration of the nuances between digital and in-person experiences is currently an area of research at the UPMC Center for High-Value Health Care.
Third, what is the role of the provider in digital health tool adoption? Our research shows that patients are more likely to use digital tools if prescribed by their physician or provider. At the same time, to prescribe a digital tool, providers want to see evidence-based solutions that are seamlessly integrated into the systems they already use. Together with our UPMC provider partners, we are working to address these issues, especially in the areas of chronic care management and maternal health.
Finally, and perhaps most importantly, how can we continue to ensure that digital health tools are enhancing health care value? We need to adopt solutions that offer the highest quality care and support services at the most affordable cost to our members and communities. I am confident that Pittsburgh-based UPMC Health Plan is at the forefront of learning and innovation in this important area of health care transformation.