{"id":27758,"date":"2016-03-01T12:16:05","date_gmt":"2016-03-01T18:16:05","guid":{"rendered":"http:\/\/news.medill.northwestern.edu\/chicago\/?p=27758"},"modified":"2016-03-01T12:16:29","modified_gmt":"2016-03-01T18:16:29","slug":"apps-and-technology-help-low-income-people-access-healthcare","status":"publish","type":"post","link":"https:\/\/news.medill.northwestern.edu\/chicago\/apps-and-technology-help-low-income-people-access-healthcare\/","title":{"rendered":"Apps and technology help low-income people access healthcare"},"content":{"rendered":"

By Amanda Koehn<\/p>\n

A patient goes to a primary care appointment and the doctor notices a spot on the patient\u2019s arm. Maybe it\u2019s a mole, a cyst\u2014even a zit. The doctor isn\u2019t sure so the patient needs to see a dermatologist.<\/p>\n

The new appointment comes with a six-week wait, not to mention the time and monetary expenses of getting to the doctor. Then there’s the possibility that the spot will disappear by the time of the appointment. In that case, the patient will be sent home, only to repeat the whole ritual if the spot flares up again.<\/p>\n

But some patients going to the Cook County Health and Hospitals System, which covers most of Chicago, avoid this whole process by using telehealth technology and software called eConsult.<\/p>\n

<\/p>\n

\u201cWith eConsult we can get a picture over to the dermatologist,\u201d said John Prendergast, operations director of patient support at CCHHS. The dermatologist gets the picture immediately and can decide whether the patient needs an appointment in person, a prescription, or nothing at all.<\/p>\n

This kind of health tech may seem costly and unattainable by doctors serving low-income populations. Many telehealth apps and web services are paid out of pocket or with specialized insurance. However, more and more apps for both physical and mental health are becoming available for another population: people who can\u2019t afford traditional healthcare. In fact, the patient Prendergast described used Medicaid.<\/p>\n

CCHHS is testing a pilot program where nearly 35,000 Medicaid patients and their doctors have access to eConsult. It lets primary care doctors and specialists chat and send pictures back and forth. Thus far, Prendergast said an online dialogue can prevent the need for an appointment in 30 percent of consultations. The specialist then has more time in the schedule to see the remaining 70 percent who require an office appointment.<\/p>\n

\u201cWe can\u2019t have patients waiting in queues and waiting to be seen.\u2026when it\u2019s just a question, let\u2019s get the questions answered,\u201d Prendergast said.<\/p>\n

Although CCHHS works with just the eConsult web service right now, telehealth apps are expanding around the U.S. and more and more let patients chat with doctors themselves. Researchers, developers and Medicaid coordinators are just beginning to explore how apps can shift the way patients at all income levels experience healthcare.<\/p>\n

Smartphone adoption transforms telehealth<\/strong><\/p>\n

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Telehealth, a term coined in the 1970s<\/a>, refers to any healthcare overseen from a remote location, using technology. Many people\u00a0 assume telehealth is for people in rural locations who can\u2019t visit a local doctor or therapist, Prendergast said. But the near-universal adoption of smartphones and hundreds of thousands of health apps are bringing telehealth to everybody.<\/p>\n

More than two-thirds of Americans have a smartphone with a data plan. Nearly 20 percent of all people with Internet access have it only on their phones. Lower income people, who once lacked Internet access, often fall into that category.<\/p>\n

\u201cWe\u2019ve seen these populations kind of do the jump over to technology. It was the case 10 years ago when people were working mostly on desktop computers that you saw a big digital divide between different [socioeconomic groups], where people just didn\u2019t have access to computers,\u201d said Stephen Schueller, a clinical psychologist and Internet interventions researcher at Northwestern University.<\/p>\n

Access to healthcare has historically posed a problem for people on Medicaid, said Keri Christensen, a project manager at Medical Home Network. MHN is a nonprofit, accountable care organization in Chicago that bridges a healthcare system between patients, doctors and social services. MHN gives Medicaid patients a central healthcare resource and often works with CCHHS.<\/p>\n

\u201cWorking a very low income hourly wage type of job, [it] can be a real problem for a patient to need to take off at a specific time, that they do not get to decide, for a medical appointment, \u201c Christensen said. \u201cIf that\u2019s the only appointment available in two months, they need to take [it], but that may cause problems at work.\u201d<\/p>\n

People on Medicaid often live far away from high-quality health services, so they may have a long bus or train ride to a doctor\u2019s office. In Chicago as elsewhere, wait times for specialists are long because only a limited number of providers accept Medicaid, or even Medicare, patients. However, apps help bridge the gap. Christensen said that since CCHHS started using eConsult, patients can get an appointment with a specialist in a week instead of 60 days.<\/p>\n

\u201cThe physicians really like it as well,\u201d Christensen said. Tests are arranged in eConsult and completed at the primary care facility prior to the appointment. Specialists can then spend more time talking to patients instead of gathering tests.<\/p>\n

Dr. Charles Edoigiawerie is a family physician and medical director at the Englewood Health Center, which receives around 15,000 patient visits per year. He shared the story of one patient who he noticed had an enlarged prostate, which could be a sign of prostate cancer. Typically, this patient would have to anxiously wait weeks for an appointment with a specialist. However, with eConsult, Edoigiawerie\u00a0 consulted with a specialist within an hour. The specialist quickly confirmed that the patient would indeed need a specialty appointment and was seen within a couple days.<\/p>\n

Edoigiawerie said the eConsult system has been vital, \u201cjust so many times.\u201d<\/p>\n

Prendergast said using eConsult also takes pressure off the patient, since the primary care physician can better manage appointments and tests for the patient digitally.<\/p>\n

\u201cWe are willing to add providers, which we have never done before,\u201d Prendergast said. \u201cA good problem that we would have is to add a dermatology provider just for eConsult,\u201d he added.<\/p>\n

Video chatting apps and mental health<\/strong><\/p>\n

\u00a0<\/strong>A report from 2015 estimated there are about 165,000 health apps<\/a> on the market today, with varying levels of evidence to support the benefits of their services. While a large percent of apps on the market are primarily for wellness, nearly 15,000 apps are for a specific ailment. Of this group, apps for mental health, diabetes and blood and circulatory disease are the most numerous.<\/p>\n

Nearly a third are devoted to mental health. The Breakthrough web service, based in Redwood City, California, provides a video interface for clients to meet with therapists online.<\/p>\n

In 2014, Breakthrough\u2019s services became covered by Medicaid in Illinois, Nebraska and Florida. Breakthrough is now testing an app that offers the same services as the website. Ashley Gibson, vice president of product at Breakthrough, said an app is easier for clients to use because everything they need is in one portal.<\/p>\n

\u201cAs long as they can download that app, once you are in that app, you are in that experience,\u201d Gibson said.<\/p>\n

But few states cover teletherapy for mental health conditions under Medicaid. Neeta Crawford, vice president of marketing at Breakthrough, said companies do not decide whether to accept Medicaid\u2014it\u2019s usually at the hands of lobbyists to push the state to require or block coverage for mental health services. Breakthrough is covered by Medicaid because they had a good relationship with managed care organizations that were looking for a provider, Crawford said.<\/p>\n

\u201cIt\u2019s definitely one of those areas where everyone realizes it\u2019s a huge opportunity, but we are just starting to dip our toe into it right now,\u201d Gibson said. \u201cAnd also adoption is a challenge, because you are dealing with a very conservative market.\u201d<\/p>\n

Medicaid patients often face a greater stigma associated with going to therapy than their higher income counterparts, for a variety of social and economic reasons. \u201cI certainly think more affluent markets are more accepting of mental health and therapy. Certain demographics, it\u2019s almost, like, expected,\u201d Gibson said. \u201cTelehealth really helps with that because it gives you privacy\u2026you don\u2019t have to wait with a bunch of random people in a waiting room.\u201d<\/p>\n

Implications of infusing tech and healthcare<\/strong><\/p>\n

While providing telehealth to low-income patients increases care and makes interacting with a doctor less of a hassle, challenges involving implementation and adoption remain, said sources from both Breakthrough and CCHHS.<\/p>\n

\u201cIt\u2019s really tough to grow a business in healthcare because of the complexities. You have to make revenue and even if we gave this away free, it would still be tough because of the rules and regulations,\u201d Gibson said, specifically in reference to treating Medicaid clients.<\/p>\n

Tech companies can typically make the same, if not a larger profit with their already-existing markets: young, generally healthy people who either pay out of pocket or through employer-based insurance.<\/p>\n

For example, the HealthTap app provides a WebMD-like search engine, online chatting and video consults with doctors, and a personalized feed of health information. Doctors can also prescribe medicines digitally. While use of the search engine is free, consults and the personalized feed are only offered to people who either pay out of pocket, or those with employer insurance that covers HealthTap specifically.<\/p>\n

Jarod Hector, head of marketing and communications at HealthTap, said the app service hopes to eventually branch out to patients on Medicaid or with private insurance but it\u2019s not in the foreseeable future.<\/p>\n

\u201cWe want the people who have the most difficult time accessing [healthcare], to have an easy time accessing. And that varies on multiple factors, age, education level,\u201d said Hector.<\/p>\n

Leaders at HealthTap agreed that getting top physicians in the network is a good way to stand out from other health apps. Schueller also said apps should be \u201cvetted\u201d by major healthcare companies (Kaiser, Aetna) for further ease of access for consumers.<\/p>\n

Schueller questions whether the tech sphere is the right place for the telehealth shift to happen, as opposed to hospitals and research institutions. He says the goal of tech companies is usually to make a popular product, but they are a step removed from fully understanding the complexity of healthcare access. Apps should first, solve issues for those with the most difficulty accessing healthcare. For this reason, researchers may be better suited to create and test apps because their incentive is to mend a dysfunctional healthcare system, which they see on a day-to-day basis.<\/p>\n

\u201cI think you are going to need people who are dedicated to that cause, because I think a lot of tech companies are kind of focused on revenue as opposed to the public good,\u201d Schueller said.<\/p>\n

Schueller became interested in behavioral intervention technologies during a postdoctoral fellowship at the University of California, San Francisco. \u201cWe had a very kind of humanitarian bent with the kind of work we did online,\u201d he said. \u201cWe really saw Internet interventions, mobile apps, as a way to make healthcare a universal right for people.\u201d Now living and working in Chicago, Schueller says he has seen mental health services for people on Medicaid shut down in part due to the budget crisis. Wait lists are typically four to six months long.<\/p>\n

Schueller said researchers often talk about models where a mental health app offers some paid services and some free services. That way, the paid services bring in money to fund the overall venture and people who can\u2019t afford to pay can access the other components of the app. Schueller is among those who believe research institutions should host the apps.<\/p>\n

However, the tech industry is not likely to give up its seat. Gibson said that Silicon Valley companies are becoming more and more interested in telehealth because they see the inefficiencies of the healthcare system and think their innovations can improve it. Prendergast agreed.<\/p>\n

\u201cFollow the money\u2014all the different companies have a piece of it\u2014Google is interested, Microsoft is interested\u2026everyone is collaborating and the venture capitalist in all of them are getting a piece of the action,\u201d Prendergast said.<\/p>\n

Apps for all<\/strong><\/p>\n

In the case of CCHHS and other telehealth services covered by Medicaid,<\/p>\n

Christensen said it\u2019s important to address who Medicaid patients really are. Young adults who became insured by Medicaid under the Affordable Care Act are one such group, Christensen said. Like most young people, they are tech savvy, even if they don\u2019t own computers and only have internet access on a smartphone.<\/p>\n

Schueller\u2019s Northwestern research team is testing the mental health benefits of giving iPhones to homeless youth. Using the phones, the youths receive cognitive behavioral therapy to treat anxiety and depression.<\/p>\n

Each month in the study, the young adults will have three appointments with a therapist via the app. Between appointments, they can check in with the therapist through the app as often as they like, or can text or call. Based on preliminary data from focus groups, the researchers expect their mental health will improve substantially. The study will take around a year to complete.<\/p>\n

\u201cWe can\u2019t expect that they are going to be able to come into our brick and mortar psychological services, so we need to think about ways to be more flexible to create services that they might actually be able to access,\u201d Schueller said.<\/p>\n

For Prendergast and CCHHS, the next step is installing retinal screening cameras at primary care facilities. Retinal cameras are used to screen patients for retinopathy, or eye damage related to diabetes that can lead to blindness. This way, patients don\u2019t have to wait until an ophthalmologist has an open appointment for the test\u2014primary care doctors can just send along the pictures via eConsult.<\/p>\n

\u201cWe are in our infancy, but we are still plugging away,\u201d Prendergast said. \u201cAs the industry expands we want to expand with it.\u201d<\/p>\n

Photo at top: A start-up office isn\u2019t normally what we think of when we think about healthcare. But that\u2019s changing. (Amanda Koehn\/Medill)<\/div>\n","protected":false},"excerpt":{"rendered":"

By Amanda Koehn A patient goes to a primary care appointment and the doctor notices a spot on the patient\u2019s arm. Maybe it\u2019s a mole, a cyst\u2014even a zit. The doctor isn\u2019t sure so the patient needs to see a dermatologist. 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