Why telehealth leaves behind the ones who need it most

With help from Darius Tahir (@dariustahir)

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Quick Fix

— How telehealth leaves behind the ones who need it most: Wealthier health systems are making virtual care the norm, but providers are struggling to reach technology-deprived communities — including low-income and minority patients — during the pandemic.

— Cuomo taps Eric Schmidt on health, ed tech: New York governor Andrew Cuomo named the former Google CEO to head a commission to rethink the state’s health and education systems.

— Senate Republicans unveil coronavirus privacy bill: But it doesn’t have any Democratic support.

eHealth tweet of the day, referencing a Reddit post on COVID-19 data governance: Beth Linas, PhD, MHS @bethlinas “This has NOT been discussed enough! If we don’t begin our#data collection efforts with thinking about#datagovernance &#standards it almost guarantees that when it’s time to USE the data we will be even further behind this#virus.”

It’s FRIDAY at Morning eHealth. What’s on tap for next week? Tips go to [email protected]. Tweet us at @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Given the unprecedented public health challenge confronting regulatory affairs teams, the AgencyIQ leadership team has decided to pull research and analysis content concerning the virus and its regulatory implications in front of the paywall. It is available here.


Driving the Day

IT GETS WORSE BEFORE IT GETS BETTER — The pandemic has opened the floodgates for telehealth as federal and state governments rapidly roll back long-standing barriers. But not all patients can get online, and in-person treatment options are dwindling amid lockdown orders. Safety net clinics hit especially hard by declining visits often don’t have the funds to support robust virtual care, and they’re asking for more support from the government — both to pay for treatment and to build out broadband in connectivity dead zones.

... It’s often the most vulnerable patients who can’t access virtual care, said Nicol Turner Lee, a research fellow at the Brookings Institution’s Center for Technology Innovation. “Communities without the means to get online will not benefit from telehealth.”

“People of color and people with low incomes are always the last to get access to any new technology,” said Lisa Cooper, founder of the Johns Hopkins Center for Health Equity. “The disparity always gets worse before it gets better.”

... In addition to connectivity challenges, rural and safety net clinics with razor-thin margins say they can’t afford to invest in telehealth without assurances from the government that temporary telehealth policy will be extended after the pandemic. New Mexico’s Presbyterian Medical Services, a health system serving over 80,000 patients, recently bought video-visit software licenses for just about one-tenth of its 250 providers, which CEO Steve Hansen said will cost over more than $25,000 annually. Licensing all of its providers would cost upward of $400,000 a year in fees. “We can use savings now, but something’s going to have to pay for those additional costs,” he said.

Some clinics are already seeing their most vulnerable patients — who are also often hardest to reach — drop off. “I’ve heard from behavioral health patients who just don’t feel the same way meeting their peer counselor, or meeting their peer group in a Zoom meeting ... so they’re just not joining,” said Eileen Goode, CEO of the New Mexico Primary Care Association.

The clinics that have access to telehealth say it’s helping them reach patients who previously missed appointments because of child care, jobs or lack of transportation.

... Providers said Medicare’s recent decision to pay for phone calls is helpful, but that those can’t allow for the same level of care as a face-to-face video chat, leaving poorer patients at an inherent disadvantage. Cooper of John Hopkins, who is a practicing physician in East Baltimore, said just about about half of the low-income and minority patients she treats can do video calls.

“Talking to someone telling you they’ve got swelling in their legs is one thing, but actually being able to see it, and how bad it is, if they need to come in to the hospital or this is something can be managed at home is another,” she said.

Wicker turns up the heat on broadband: In the Senate, Commerce Chairman Roger Wicker (R-Miss.) is pushing the FCC to move faster on delivering billions of dollars in subsidies for rural broadband instead of waiting until the fall, POLITICO’s John Hendel writes. The FCC’s $20.4 billion Rural Digital Opportunity Fund would give subsidies to telecom providers bidding to serve areas the FCC deems eligible.

“We have been in touch with the FCC to determine if there are smart ways to speed up the process without undermining the success of the auction or the value to taxpayers,” Wicker told POLITICO in a statement this week. FCC spokespeople didn’t respond to requests for comment.

NEW YORK’S BET ON TELEHEALTH — New York’s Cuomo said this week that the 15-member commission helmed by Schmidt is part of an effort to rebuild the state in the aftermath of the coronavirus pandemic, POLITICO New York’s Anna Gronewold reports. He also said health care providers need to use telehealth more effectively and that hospitals across the state should better coordinate to function as one public health system during emergencies.

NEW TACK FOR TASK FORCE — The coronavirus task force will “continue on indefinitely” with a focus on safety and reopening the country, President Donald Trump tweeted this week, a day after saying that the task force would wind down. “We may add or subtract people to it, as appropriate,” Trump wrote, adding that the task force would also be “very focused on Vaccines & Therapeutics.”


Data Privacy

CASSIDY CALLS FOR “EXPOSURE REGISTRIES” — Back in Washington, Louisiana Republican Sen. Bill Cassidy thinks the government should be collecting data on who’s been exposed to coronavirus. In a blog posted to Health Affairs, Cassidy says tracking who’s been exposed to the disease would allow policymakers to target areas for immunization, and researchers to understand how long recovered patients have an immune system response. Cassidy emphasizes that the registry should have strong privacy protections and not be used as a tool for discrimination.

APPLE HEALTH DATA FEATURE IN BETA — Apple is introducing a “Share Medical ID During Emergency Calls” feature to let users share medical information if they call 911 from their iPhone or Apple Watch. The company says the feature will give medical professionals and first responders data about patients’ conditions, allergies and medications. It’s currently part of the iOS 13.5 beta and will be available to customers in coming weeks.

The company highlighted the technology’s security and privacy protections, including that the medical data is encrypted and can’t be read by Apple.

MEET THE COVID-19 CONSUMER DATA PROTECTION ACT — Senate Commerce Republicans formally rolled out a bill they teased last week but failed to secure any Democratic backers, POLITICO Tech’s Cristiano Lima reports. The COVID-19 Consumer Data Protection Act, led by Wicker, would set new standards for companies’ data collection and use as they try to track the spread of coronavirus. (Read the full text of the bill.)

... Senate Majority Whip John Thune and Sens. Jerry Moran (R-Kansas) and Marsha Blackburn (R-Tenn.) are also co-sponsors. No Democrats were listed.

Two senior Democratic aides told Cristiano that liberal lawmakers are unlikely to back the bill as currently written, citing concerns it doesn’t do enough to protect a wide range of personal information or to stop companies from profiting from that data.

FEDERAL JUDGE, PEACE PRIZE LAUREATE, DENMARK’S FORMER PRIME MINISTER ON FACEBOOK BOARD — A new 20-person Facebook oversight board will have final say about handling controversial content such as hate speech, but it’s unlikely to end the social network’s political difficulties, POLITICO Tech’s Steven Overly and Alexandra Levine report.

Facebook said the board’s members were chosen for their expertise and diversity, having lived in more than 27 countries and speaking at least 29 languages. They also include former newspaper editors from the U.K. and Indonesia, former judges from Hungary and Colombia, ex-government officials from Israel and Taiwan, and human rights advocates from Pakistan and West Africa.

Transitions

JOB OPENING AT LYFT — The ridesharing giant and key competitor to Uber is hiring a head of health care policy. Both companies have expanded their non-emergency medical transportation lines over the past couple of years.

What We're Reading

— Tech companies are making their own privacy rules as they rush to help stem the virus’ spread, Bloomberg Law’s Daniel Stoller writes.

— WilmerHale’s Kirk Nahra highlights four key privacy issues brought on by the pandemic for the International Association of Privacy Professionals.

— Google Health Vice President David Feinberg writes in Fortune that tech can help address the mental health crisis emerging amid the pandemic through telehealth services and online tools to help identify possible depression or PTSD.