Why Digital Platforms Must Be Leveraged to Engage and Improve Care to Underserved and Marginalized Communities

Roughly 20 years ago, I started my professional healthcare journey as a hospital executive in one of the largest and prestigious academic health systems in the country. At that time, as one of the few African American executives in the health system, I hoped to make an impact on how we engaged and improved the patient journey for the large number of black and brown patients in our region. A fellow executive who later became a mentor advised that I spend some time in our emergency room waiting areas as a starting point to better understanding the dynamics and range of healthcare disparity.

What I witnessed in those ERs over two decades ago is still evident today. Primarily low-income families of color who “walked-in” presenting with non-life-threatening issues to utilize the hospital ER episodically for conditions that could have been mitigated with even average primary or preventive care services. In the past ten years, we have used digital technology to optimize care delivery, whenever possible, away from expensive ER visits to more appropriate care settings such as urgent care or retail-based rapid clinics. However, in many ways, this is merely optimizing care delivery costs and resources without addressing the needs of this underserved patient population or developing more effective patient engagement technology to better meet their needs.

The trust factor
According to a recent poll by the Kaiser Family Foundation (KFF) and The Undefeated, only six of 10 Black adults across the country said they trust doctors to do what is right most of the time, compared with eight of 10 White people. Slightly more than half (56%) of Black people said they mostly trust their local hospitals, compared with seven in 10 white people. From the legacy of illegal medical experimentation up to the current and apparently uneven distribution of COVID-19 vaccinations, traditionally underserved populations have always had legitimate reasons to avoid engaging healthcare. The high percentage of chronic conditions such as hypertension, diabetes and heart disease in this population is evidence of their avoidance and our inability to build effective and more trusted on-ramps to care.

Culturally effective patient engagement
While patient engagement technologies have become more “culturally sensitive” they may not be as culturally effective in motivating behavior change. Essentially, we have become adept at how not to insult people in their language. Unfortunately, we have not become any better at differentiating patient engagement and patient journeys by population to address trust or care disenfranchisement issues.

The impact of mobile on digital platforms
There is one thing that is very different in ERs now than 20 years ago. If you walk into an ER waiting room today, you see over 80% of the patients with their heads down operating their mobile device — regardless of income or population type. It has become impossible to chart the impact of mobile device proliferation on healthcare. What is certain is that we now have the mobile technology to connect with increasing underserved populations in a personalize way through a device that is often well-integrated into how they view almost all experiences.

In fact, a 2019 survey of 400 patients at six Federally Qualified Health Centers (FQHCs) and free clinics found that smartphone use in underserved populations grew rapidly over the past few years. Of the patients surveyed, 91% reported having a smartphone, as compared to a 2014 version of the survey where 67% reported having a smartphone.

Current mobile technologies bridge the gap between the patient, their EHR data and the provider in a way that can begin to mitigate key social determinants of health, access to care and historic disparities in how care is delivered to underserved and marginalized communities. Given the recent strides in interoperable mobile solutions, all health technology professionals should consider this to be the best time to engage their underserved communities within proven mobile solutions in motivating patient/consumer behavior and rebuilding or increasing trust in these communities.

Bruce Kennedy is chief marketing and client officer at MobileSmith Health.