Health tech for people who need it most. But Fitbits aren’t particularly useful if you’re homeless, and the nutrition app won’t mean much to someone who struggles to pay for groceries. Same for emailing your doctor if you don’t have a doctor or reliable internet access.
“There is a disconnect between the problems of those who need the most help and the tech solutions they are being offered,” said Veenu Aulakh, executive director of the Center for Care Innovations, an Oakland-based nonprofit that works to improve health care for underserved patients.
At most digital health “pitchfests,” it’s pretty much white millennials hawking their technology to potential investors.
A small but growing effort is underway to do just that. It’s aimed at using digital technologies — particularly cellphones — to improve the health of Americans who live on the margins. They may be poor, homeless or have trouble getting or paying for medical care even when they have insurance.
Health advocates say it’s important to tailor digital health technologies to lower-income people not only to be fair, but because they’re more likely to have chronic illnesses, like diabetes, that are expensive to treat.
Health-care providers have incentives as well. They are being rewarded financially under the Affordable Care Act, Medicare and Medicaid for keeping patients healthy, and this goes beyond simply performing medical procedures and prescribing drugs.
But Jane Sarasohn-Kahn, author of the California Health Care Foundation report, says investors are getting more interested in digital health initiatives for low-income patients simply because there are so many of them.
Investors are eyeing the “fortune at the bottom of the pyramid,” she said, much as Walmart profits from selling low-priced items to millions.
“It’s now sexy to scale,” she says. “If you can have impact [on many people], inexpensively, you can make a lot of money. If we get it right, we can do well and do good.”
To adapt the program, the company made it available in Spanish and English and lowered its reading level from 9th grade to 5th grade. Bilingual health coaches were hired, and the educational materials now acknowledge potential food access, neighborhood safety and economic issues that participants may face, said Eliza Gibson, Omada’s director of Medicaid and safety-net commercial development.
The scale doesn’t require a wireless connection, and the patient just needs to be able to access the internet for one hour each week, Gibson said.
Omada is enrolling 300 community clinic patients in Southern California and rural Washington in a year-long clinical trial of Prevent, in hopes that the program can demonstrably slow the progress of diabetes.
Among the people trying out the program is Susy Navarro, an elementary school substitute teacher who lives in the Spring Valley community east of San Diego. After being diagnosed with prediabetes, Navarro, 28, set an ambitious goal to lose 100 pounds. In the meantime, she is taking medication to stave off Type 2 diabetes.
“You name it, I’ve probably tried it — Weight Watchers, low-fat, low carb, pills, injections, acupuncture,” Navarro said. “The first time I try things it goes very well, I feel like I’m very successful, then I wean off and I’m not successful. This program focuses more on life choices that are going to help us out long-term, not just for a little bit.”
Navarro described the scale she was given as “sophisticated looking — all black, flat, digital.” It has been programmed to her weight profile — she is considered obese — and transmits her weight every morning to the program’s counselors.
The program, with its daily weigh-ins, helps her pay attention to what she eats, and her blood sugar levels are declining, Navarro said. She also appreciates the ability to connect online with fellow patients on her “team.” “It’s very awesome — you get to know the other members and feel like it’s a team effort.”
As they continue to explore digital health possibilities for underserved patients, developers are learning more about what works and what doesn’t, says Sarasohn-Kahn. For example, apps chew up a lot of cellphone data, so many community clinic patients prefer lower-cost text messaging.
At the Petaluma Health Center, a network of community clinics in Sonoma County, Calif., staffers offered free, simplified “loaner” digital devices to patients after a hospital stay to help them avoid complications that could land them back in the hospital.
They first offered an Android tablet to allow for a video visit with a health professional, but patients were reluctant to take it, saying it was hard to hide and could be stolen, said Dr. Danielle Oryn, the network’s chief medical informatics officer.
Then they tried iPhones, in which everything was locked down except the ability to call 911 and a single button triggering the video visit. Those were more acceptable. Still, there were challenges. Would patients, some recuperating at homeless shelters, have access to electricity to charge their phones? Oryn said they had to learn by trial and error. She was surprised and pleased to see seniors accepting the technology. Every loaner iPhone was returned to the clinic.
Oryn’s advice to the captains of the digital health industry?
They should “not necessarily come in with too many assumptions. They should come with an open mind and a willingness to listen,” Oryn said. “Safety-net people are very excited to have these companies interested in them and to share their experiences.”