Op-Ed: Internet and Telehealth Access: Key to Health Equity for Elderly Californians Enrolled in Medi-Cal – State of Reform
Last year, Sylvia, a low-income senior living with diabetes, faced a difficult choice. Confronted with an episode of hyperglycemia, she weighed a costly trip to the emergency room against the risk of potentially exposing herself to COVID-19. She chose to undergo treatment, which likely saved her life, but with proper management of the diabetes, she could have avoided the visit altogether.
Today, Sylvia is enrolled in a managed care program that has helped her obtain and learn to use an internet-connected tablet. With this, she also had access to a telehealth doctor. By working with a healthcare team to control her diabetes, she is no longer at high risk of needing emergency services. She considers herself lucky, but most low-income seniors with chronic illnesses lack the resources and knowledge to access telehealth services on their own.
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Telehealth requires affordable internet access, which is a civil right of the 21st century. As we saw during the pandemic, telehealth can improve and save lives. But far too many older people cannot afford Internet service and a device, and often need computer training. Now is the time to fix this problem: California is embarking on a massive effort to reform Medi-Cal and improve service delivery through the California Advancing and Innovating Medi-Cal (CalAIM) initiative. We urge the Department of Health Services and Medi-Cal Managed Care Plans to invest in long-term solutions that expand access to quality digital and broadband devices – a smartphone, tablet or laptop – so that seniors like Sylvia can better manage their health using telehealth options.
The pandemic has highlighted deep health disparities that in part reflect limited access to the internet and the devices required for robust telehealth services among California’s population 65 and older, low-income communities and individuals. colored. A recent survey by the California Emerging Technology Fund (CETF) and the University of Southern California found that less than half of Californians aged 65 and over (44%) had used telehealth services using ‘a computer or smartphone, and 24% had consulted health services. professionals on a landline phone without video capability. Additionally, access to telehealth is disproportionately biased in favor of non-Latino white individuals. More than half of Asian and Latino respondents and 44% of Black respondents indicated that they had not used any telehealth service.
The lack of access is even more glaring for high-risk Medi-Cal-eligible people over 65. The Partners in Care Foundation (Partners) found in a small survey that half of those Medi-Cal eligible respondents did not have internet access at home, 70% did not have a device that could connect to the internet. and 73% did not have a device with video capabilities. Highlighting the need for training, two-thirds of respondents did not feel comfortable with the technology.
At the same time, many Medi-Cal patients are housebound, making it difficult to access in-person appointments and have complex and chronic medical needs. There is strong evidence that telehealth extends access to health care and the ease of care – by making the internet and devices affordable and by forming essential ingredients for health equity. Healthcare providers can message patients through online patient portals and offer video consultations, monitor vital signs (e.g. blood pressure) using remote devices, ensure that patients take their medications and check the home environment of their patients. During the pandemic, mental health services have proven to be particularly effective when delivered virtually. Behavioral health professionals have reported that having an online option increases patient participation rates by 90-100%, as detailed in recent CETF co-sponsored telehealth survey conferences. , partners, the Corporation for Education Network Initiatives in California, and California Primary Care. Association.
We appreciate that state leaders in this legislative session have taken significant steps to increase the availability of broadband and telehealth to low-income residents of our state. Now we need the state to build on its commitment by working in concert with the recently signed infrastructure bill to provide additional subsidies for broadband services for this population. And, as California strives to improve Medi-Cal service delivery, state leaders must include sustainable telehealth solutions. Access to broadband is a key social determinant of health equity that influences the quality of care we receive. For Medi-Cal patients, often those with the highest medical needs, it’s time to close the gap.
June Simmons, President and CEO of the Partners in Care Foundation, has pioneered the development and scale-up of innovative, evidence-based interventions for home medication management, chronic disease self-management, coordinated care to improve health outcomes and care transitions.
Sunne Wright McPeak, President and CEO of the California Emerging Technology Fund, heads the state-wide nonprofit foundation whose mission is to bridge the digital divide by accelerating the deployment and adoption of the top debit. CETF has helped position California as a national leader in promoting digital inclusion for the past 15 years.