Equity must be embedded in the overall health ecosystem
Photo: Mayealie Adams
This past week, Vice President Kamala Harris announced the inaugural federal Day of Action on maternal health, aimed at drawing attention to the country's crisis.
As Harris noted, women in the United States are dying from childbirth-related causes at a higher rate than in any other developed nation – and the risk is far higher for women of color, especially Black women.
Harris put forth a number of strategies to address this, including the launch of a new initiative to design birthing-friendly hospitals and partnerships with nonprofits and private companies to invest in innovative care models.
For Mayealie Adams, managing director of Government and External Affairs at Philips, the federal government's steps on this issue represent movement in the right direction. She sat down with Healthcare IT News to discuss the effect of recent legislation on telehealth and maternal care, Philips' role in getting devices to people who most need them, and what she sees as the top priorities for health IT in 2022.
Q. Given your role at Philips, how do you see recent federal legislation as affecting healthcare – especially telehealth – for historically marginalized populations?
A. I have kind of a two pronged-role here at Philips, which is a great position to be in, because I can see the impact the policy issues I'm working on actually have in communities.
At Philips, our purpose is to improve people's health and wellbeing. And we do that through meaningful innovation. So we very much supported and applauded passage of the bipartisan infrastructure deal back in November, because of the really positive impact it's going to have on improving people's lives, especially those in underserved communities.
That legislation really does a lot, I think, to further telehealth by driving access to broadband service, which is a major barrier for telehealth care delivery, especially in rural areas. Telehealth has been a lifeline for many of us during the pandemic, but for those in rural areas or low-income areas, it hasn't even been an option.
We have more than 30 million Americans who live in areas with no or very limited broadband infrastructure. There's also the cost: Even if you have the option of broadband, can you afford it? The infrastructure bill really did a lot to address the access and the affordability components.
Almost $3 billion has also gone to promote digital inclusion and equity. That was really important for addressing communities that might lack the skills or technologies to take advantage of broadband. Grants are going to be provided to help accelerate adoption through literacy training, workforce development, device-access programs and some other digital-inclusion measures.
It was really important for the legislation to take a comprehensive approach to broadband. Recognizing that, yes, this is a major enabler for telehealth, which also promotes health equity.
The direction that our policymakers are going, at both the federal and state level, is definitely a positive one.
Q. The government has also taken some steps recently to promote maternal healthcare. How do you see digital health tools playing a role there?
A. It's good to see that the federal government is making a concerted effort to link broadband connectivity and telehealth to their continuing legislative efforts around access and affordability, especially around maternal care.
The Build Back Better bill would allocate $50 million to help develop and diversify the doula workforce, which is really important when you think about the cultural context of healthcare delivery.
As a Black woman, that's something that, for me, is very important. Having that support, and having a doula, you can build a relationship where somebody is with you throughout your pregnancy. When I went into labor, my doctor wasn't available. I got a doctor who I had never seen before, and didn't have any sort of relationship with, and we had some communication issues. And that impacted my health during my delivery: My blood pressure was rising. Every time my doctor walked into the room, the machines would go off.
She just wasn't listening to me; she didn't perceive my pain level. I was completely against getting a C-section, right, and I think she walked in there thinking, "You're going to get a C-section," because of an issue that I had during the pregnancy. And so her efforts were definitely nonexistent in trying to eliminate the possibility of a C-section.
I think if I had a doula or an advocate in the room, it might have been a different situation, or at least the experience of having those conversations with her might have been less traumatic. So it's really great to see the attention that's being placed on doulas and training that workforce.
Another piece of legislation that I want to mention is a bipartisan bill called the Data Mapping to Save Moms' Lives Act, which would direct the Federal Communications Commission to use broadband services and data mapping to identify areas in the country where high rates of poor maternal health overlap with a lack of broadband services. Armed with this data, we can better allocate our broadband resources in a way that most effectively benefits communities that need them, especially in the area of maternal health.
This is also an area where we could probably go beyond the maternal health space and use that type of data to help us more specifically target and focus resources to help improve care delivery.
I'm really excited about the activities on the policy side, because I think it's all moving in the right direction.
Q. What, in your opinion, is the conversation around health equity and digital health currently missing?
A. There's a lot in the conversation that I'm excited about. There's a lot of good that's coming out of the discourse that we're having. I've been a part of panels and roundtables over the last 18 months around health equity and digital health, and the consciousness-raising is really igniting positive action.
When we talk about health equity and digital health, we talk about our ability to break down geographic barriers and meet people where they are by delivering access. At the same time, though, I think meeting people where they are also means breaking down cultural barriers, and providing that cultural context and making that connection. That's a huge opportunity to improve patient care and health outcomes that we sometimes miss.
To make progress on health equity, policymakers, health systems, innovators and funders have to recognize the opportunity that we have right now through digital technology and other innovations to really reassess and strengthen those connections with underserved communities. I think sometimes we deploy and design tools without the target recipient in mind. We're kind of generalizing, and we're not looking at the individual that's in front of us.
Another important aspect to that is collaboration between private organizations, government organizations, nonprofits and academic institutions – because no one entity is going to be able to make the change that we want to see on their own.
I think really having our end user in mind as we're designing our innovations is important; partnering with people locally is important. We may not always have the right perspective, so we have to collaborate with folks in the local community who do.
Q. You just outlined a whole lot of key tenets to keep in mind. Are there any other ways that companies like Philips or other device companies can ensure that technologies aren't leaving out groups of people?
A. Health equity is not just about health equity. It's inextricably connected to workforce diversity, equity and inclusion. One thing that we have to keep in mind is we are trying to impact the service and the products that we provide. I think the larger picture of advancing equity can have a positive impact on our employee value proposition, our customer experience, the future of our product offerings and really just the whole value proposition for the organization.
Health equity is not just within the healthcare space, but beyond that. Looking at our workforce – the individuals that are creating these products and delivering these services – is an important connection to make.
Q. What do you see as some of the top priorities for policymakers and health IT innovators in 2022?
A. On the policy side, removing these regulatory barriers to telehealth that we've had temporary relief from during the COVID-19 pandemic is important to maintain. There are more than 40 federal bills and more than 1,000 state bills dealing with telehealth this year. So it's definitely top of mind for our policymakers.
The public health emergency is going to end. And we need to make sure that things like reimbursement for audio-only telehealth services continues. We need to make sure that state licensure waivers that allow providers to provide care across state lines continue. So I think it's important for us to continue the march on removing these regulatory barriers at the federal and the state level.
I also think an integrated care approach is very important. It's easy to create one-off programs or a passion project that may fade over time, but real, systemic, organizational transformation is what's key here. We need to embed and integrate health equity throughout the ecosystem.
I am very heartened by our new CMS administrator Chiquita Brooks-LaSure. In outlining her vision for the agency, she wrote, "For every decision being made, we’re asking ourselves, 'How is this action advancing health equity?'"
I feel like that's a question all of us in the healthcare industry need to ask ourselves, because it needs to be at the forefront of everything that we do. We need to ask, "How is this action advancing health equity?"
It's not a separate project or separate consideration. It's part of the overall strategy.
This interview has been condensed and lightly edited for clarity.
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