While there was a noticeable surge in telehealth usage during the global pandemic, broadband coverage has only increased by about 10%.
A lack of access to broadband internet service among vulnerable populations is a large factor in perpetuating the digital divide that has persisted for years. While there was a noticeable surge in telehealth usage during the global pandemic, broadband coverage has only increased by about 10%.
There is an ostensible perception that this divide is separated by dichotomous "haves" and the "have-nots." However, an underlying factor in defining this form of social determinant of health [SDoH] beyond pure availability is sufficiency. In certain underserved geographies, internet service providers [ISPs] have made limited investments in improving the internet speed for consumers, failing to support the minimum download and upload speeds necessary to bridge the digital divide. This would, obviously, have a large impact on telehealth visits. Slower internet speeds create a barrier in utilizing telehealth, and this example is magnified in lower-income areas. The practice of some ISPs investing less in broadband infrastructure in low-income and marginalized communities is a modern-day form of redlining.
While expedient mitigation is unclear and complex, there is evidence that health plans are uniquely positioned to address the digital divide in a way that not only improves access to care, but also boosts plan performance.
The digital divide continuum
Healthcare’s digital divide isn’t just an issue of access; rather, it represents a continuum of issues that need to be surmountable for populations to experience the digital care benefits. These varying barriers range from lack of digital literacy and equipment unaffordability to limited phone data access.
For example, a household might have access to high-speed broadband, but some (or even all) within the household may not be able to install or understand how to log into Wi-Fi. In fact, digital illiteracy may create a wholesale barrier to any internet access. Many experience rote, persistent, and uninterrupted internet use (or an occasional nuisance interruption), yet there are still 7% of Americans who say they don’t go online at all, including 14% of those with household incomes below $30,000 per year and a quarter of those 65 and older.
There are other barriers contributing to digital healthcare inaccessibility. For example, a household’s lack of minimum broadband speed can encumber and obstruct a telehealth visit. The lack of high-speed internet access is more widespread in rural communities. Conversely, someone might have full broadband access but lack the equipment needed to access digital care.
How health plans can help
Pre-COVID digital healthcare utilization data, published by the National Telecommunications and Information Administration, highlights a strong correlation between income and healthcare access. For example, in 2019, 53% of households with incomes above $100,000 accessed health records or health insurance online. That number was just 14% for households with incomes below $25,000 and 24% for households with incomes between $25,000 and $49,999. Similarly, in 2019, 40% of households with incomes above $100,000 communicated with a health professional online, compared to just 12% of those with incomes below $25,000 and 18% for those between $25,000 and $49,999.
Health plans have an innovative opportunity to address this disparity in a simple way: offer free or reduced-cost broadband as a benefit for its members. It’s surprising the very limited number of plans that currently offer this, especially considering the financial savings that can be generated through telehealth.
Most Medicaid plans, for example, already invest significant dollars each year in SDoH program benefits to incentivize members to take action benefitting their healthcare. As a comparison, providing free or low-cost broadband access is a relatively inexpensive investment that generates a high ROI.
Plans can further bridge the digital divide by investing in programs to improve member digital literacy, enabling a better understanding of how to access valuable programs and services and improving their healthcare experience. Simply put, members equipped with full high-speed internet access, and the knowledge of how to use it, are more likely to engage to improve their health.
A golden opportunity
The digital divide provides an opportunity for plans to build member loyalty and satisfaction by offering, or connecting members to, broadband benefits and equipment providers that support closing the divide. While the most obvious benefit is improving member outcomes through telehealth access, other key benefits for plans helping to improve digital access include:
Investing in member digital access and literacy is an easy solution that mitigates access and utilization barriers, helps improve health outcomes, and drives members to cost-effective solutions. In an industry experiencing zero-sum effects, expanding digital access is beneficial to all members, plans, and providers. Plans win because it helps them improve member health as well as a number of performance measures, including member satisfaction and engagement. Providers benefit since it opens up another channel to engage members, especially when there is a greater focus on value-based care. And, most importantly, members win because broadband can expand healthcare access improving health and outcomes.
Sara Ratner is senior vice president of government markets and strategic initiatives at Icario.