Opening the digital front door for health equity

• COVID-19 exposed “pre-existing” conditions of health inequity that exist in the US within minority communities and globally. This is a “Hurricane Katrina” moment in pandemic form. 
• The National COVID-19 Resiliency Network (NCRN) platform took on health inequity by being “of the community, for the community”; the first platform of its kind at scale.
• NCRN is a beachhead to creating access to healthcare both for COVID and beyond for underserved communities with higher disease prevalence, higher barriers to access, and worse outcomes.

COVID-19 has affected us all. But it’s had a disproportionate impact on certain groups. I’m talking about ethnic and racial minorities, Indigenous communities, those with low incomes, people with disabilities, those living in rural areas, and the elderly. People who already experience a lower standard of healthcare and a higher prevalence of chronic conditions.

These circumstances are not surprising. Health inequity has been a historic problem in the US, something that my parents and grandparents had to deal with. Some have even drawn parallels between the health inequities of the current pandemic and the influenza pandemic of 1918.¹ These inequities also played out during Hurricane Katrina back in 2005 when the needs of minority communities were not factored in to advance disaster planning. As a result, thousands of people ended up at under resourced “shelters of last resort” such as the sports stadium and convention center in New Orleans. Katrina was a social and public health disaster² and it should have been a turning point on this issue.

Yet a little more than a century after the last global pandemic, and 15 years after one of our greatest natural disasters, here we are once again dealing with the same fundamental issue of equity. In the U.S., Pacific Islanders, Latinx, Black and Indigenous peoples all have a COVID-19 death rate of double or more compared to White and Asian Americans.³ This isn’t just an U.S. problem. Globally, there is also concern about the impact of COVID-19 on minority communities,⁴ Indigenous peoples,⁵ refugees, and migrants.⁶

When disasters strike and the issue of health inequity is magnified, there is much attention paid to the issue but after the crisis abates, it gets put into a proverbial drawer and forgotten about. Two years from now when COVID-19 has hopefully faded away will we still be talking about the topic of health inequity as intensely as we are now? And if history is repeating itself, surely something different must be done this time – and perhaps the hope lies in our collective resolve and in something we didn’t have before – the technology to maybe do something about it.

Some organizations are taking action now. In Atlanta, Morehouse School of Medicine’s (MSM) mission is to improve the health and well-being of individuals and communities, increase the diversity of the health professional and scientific workforce, and address primary health care through programs in education, research, and service. With emphasis on people of color and the underserved urban and rural populations in Georgia, the nation, and the world, the school’s vision is to lead in the creation and advancement of health equity. It is doing just that with its National COVID-19 Resiliency Network (NCRN). With funding from the US Department of Health and Human Services, Office of Minority Health, the school is partnering with more than 50 national, state/territorial/tribal, local public, faith and community-based organizations to mitigate the negative impact of COVID-19 on racial and ethnic minorities, Indigenous populations, rural, and other socially vulnerable groups. In effect, the NCRN is a solution built for a problem, by the people experiencing the problem.

“Through its partnerships, the NCRN is a digital front door for individuals and families in underserved communities to access COVID-19 related resources that are culturally and linguistically appropriate,” says Dr. Dominic Mack, MD, MBA, Director of the National Center for Primary Care and Professor of Family Medicine at MSM. Partnerships are a crucial part of the solution, as Dr. Mack explains: “We’ve partnered with community-based organizations because they have a presence and a reach locally, understand why community members don’t come forward, and, through their credibility and trust, they can link communities they serve to critical health education information and care options.”

The NCRN is a platform that engages communities at the zip-code (postal code) level, communicates in 11 languages, and connects people to the information and resources they need to get health education resources, connect to primary care providers, and get connected to their state’s vaccine distribution pipeline. This provides health systems access to sometimes hard-to-reach communities by empowering them with information on how to navigate the system, manage cases, and assess demand and supply for services and vaccines – all ultimately to improve community health access and outcomes.

As someone who’s worked in healthcare my entire career, with a strong focus on IT, I’m passionate about tech’s potential to improve access and care quality. While technology has always had great promise for society, it has traditionally ignored underserved communities. I see how healthcare technology is too often built with design principles that have privately-insured, privileged users in mind.

At KPMG in the U.S., we have been working with Dr. Mack and the MSM team to support underserved communities. After carefully listening to the theory and model outlined by the MSM team, we embedded this as a first design principle. “The NCRN has been created for the community, by the community to ensure the diverse needs of our nation are understood and addressed,” says Dr. Mack.

The NCRN is an engagement and relationship management platform built on the re-purposed cloud technologies of KPMG alliances, which typically serve in customer relationship management and communications channels. The platform is seen as a living, breathing thing that will evolve based upon continual feedback. What’s working can be measured, and appropriate adjustments can be made based on platform metrics. Each local community can share best practices to maximize the engagement of its citizens. The hope is that in capturing the voice of the traditionally voiceless, these insights can be used in the platform’s continuation post-COVID – to promote health at the community level. As you’d expect from healthcare tech experts, we’re also using analytics to evaluate usage, with feedback loops and continual data analysis. 

Dr. Mack and I know the problems of health access and inequity will persist after COVID, so we don’t consider it the end of the NCRN platform, but merely that COVID is just its first use case. By creating a community-centric platform, we hope to engage underserved communities where the incidence of chronic disease is much higher, primary care engagement is far lower, and people experience more barriers to achieve optimal health. Thanks to the inroads that are being made with community-based organizations through this platform, the hope is that primary care relationships will be kept after the crisis to help get community members re-connected to health care providers, receiving preventative care, and ensuring their medications are up to date.

At a broader, public health level, this kind of technology can be used to plan for the next pandemic, or indeed other disasters, as Dr Mack explains: “Whether it be the emergence of a pandemic, or hurricane, we can use the early warning signs of data along with our connection to the communities through this platform to take action on early warning signs by intervening sooner – it may very well save lives.”

Of course, a digital platform isn’t going to single-handedly solve the enormous problem of health inequity. But it’s a bold step towards creating a sustainable change that’s inclusive of tech but, ultimately, goes way beyond tech. The magnitude of what’s been achieved shouldn’t be underestimated. “I don’t believe that anything like this – a nationwide digital platform to address health inequity for minority populations – has been attempted before,” says Dr. Mack.

Pandemics are great at triggering mass panic and swift action. The problem with health inequities is that they are more subtle, pernicious, and do not have the direct impact on those with the power or resources to change this issue. To break the cycle, that very same sense of urgency and commitment to a “cure” needs to be created.

The test of a society’s character is how it treats its most vulnerable citizens. Out of COVID, the world came together to tackle the greatest health crisis in a century, but the question is: once coronavirus is eradicated, will the inequities of society linger long after? Barriers and records were broken to produce the world’s fastest vaccines – the question is: will society come as quickly together to cure our systems of inequity? With enough determination, changes in mindset, and a little bit of technology, I believe we can.

• There’s major return on investment in addressing health inequity and access. It doesn’t take much to have big impacts with populations that tend to be disproportionately affected by disease and disasters.
• Make the users part of the design from day one. Not only does this help build better products with improved user acceptance and outcomes, it also builds platforms on a foundation of trust.
• Digital platforms are only part of the solution to address health access and equity. Real change has to come from fundamental modification in care delivery with engaged communities and commitment from leadership.

For more on the National COVID-19 Resiliency Network

_{This content outlines initial considerations meriting further consultation with life sciences organizations, healthcare organizations, clinicians, and legal advisors to explore feasibility and risks.}