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Broadband Not Enough to Close Health-Care Gap (Contributed)

Federal funding for broadband intended to expand telehealth will go a long way toward getting more people the care they need, but communities must create strategies tailored to their needs to make the most of it.

Doctor makes notes on a tablet
<a href="" target="_blank">Shutterstock/Guschenkova</a>
U.S. senators want to make $2 billion available to communities, including urban cities, to facilitate deployment of broadband and telehealth together. Sen. Brian Schatz, D-Hawaii, is lobbying — along with Sens. Lisa Murkowski, R-Alaska, Angus King Jr., I-Maine, and John Boozman, R-Ark. — to allocate this money to the next COVID-19 relief bill for broadband expansion. The goal is to append the funds to the amount that’s currently controlled by the Federal Communication Commission’s Rural Health Care (RHC) Program. In Congress, representatives are pushing for $86 billion for high-speed broadband as part of a five-year infrastructure investment. 

Directly and indirectly, a lot of federal money is going to telehealth. But are communities capable of fully leveraging those federal grants so that telehealth reaches its potential? Is there enough strategic thinking to drive effective decision-making within communities? 

Telehealth is much more than just video consults with doctors, and broadband strategy has to be more than dropping off a bunch of fiber to the nearest hospital and declaring victory. Both can be complex and should be developed in tandem to achieve maximum results. 

To make the most of all this funding, communities must have strategies in place that will set them up for success. For example, the OpenCape public fiber network team in southern Massachusetts started planning its network months before the federal government included funding for broadband expansion as part of the 2009 stimulus package. “We were defining the network, determining how much it would cost, and so on,” said John Campbell, OpenCape’s chairman of the board. “Start planning and acting now.”

Laying out the telehealth strategy

Telehealth uses broadband and an intranet to facilitate the entire continuum of care to prevent, treat and hopefully cure any type of sickness, injury and ailment in the body or the mind. A continuum can be simple as a one-time video chat with the doctor or can involve various specialists, medical staff and health-care resources. 

My three years of research determined that telehealth strategies can narrow the health-care gap, that divide between those who have access to affordable quality health care and those who do not. A strategy to close the gap requires the full range of telehealth options, plus lots of broadband, political willpower and money. 

A comprehensive telehealth strategy can achieve six objectives:

  1. Reimagining the doctor visit
  2. Home care to facilitate chronic care
  3. Enhancing emergency response and trauma care
  4. Mental health care
  5. Improving senior health care and aging in place
  6. Reimagining hospital care
The health-care gap affects the underserved or unserved in both rural and urban communities, and these objectives can impact huge numbers of people. Pursuing them can impact broadband spending. 

Consider focusing on reimagining the doctor visit. Twenty-eight percent of U.S. men and 17 percent of women don’t have a personal doctor or health-care provider. But an analysis by the Kaiser Family Foundation shows worse rates for minorities; for example, 33 percent of Hispanic women and 31 percent of African-American men don’t have personal providers. 

Increasing the number of homes with broadband will increase telehealth access and change the nature of doctor visits, as is being shown in dealing with the coronavirus. By converting community social or business locations such as barbershops into hypertension testing centers using telehealth and wireless broadband, people who don’t have primary care doctors can get screened. 

Telehealth could also take off in K-12 schools offering general and specialized doctor visits. “The top two medical issues children face is acute care for things such as earaches, cold, congestion and the like, and those needing specialty care, in particular behavioral health,” said Rena Brewer, CEO of nonprofit vendor Global Partnership for TeleHealth. It may be time to significantly increase the number of schools funded by the FCC’s eRate grant program as a way to increase telehealth deployments that can help those top issues. 

Telehealth strategies must be comprehensive

Communities must develop telehealth plans that are tailored to their unique needs.

For example, chronic diseases such as cancer and lung disease are leading causes of death and disability. The U.S. Health and Human Services Office of Minority Health reports that African-American adults are 60 percent more likely than non-Hispanic white adults to have been diagnosed with diabetes by a physician. And since 2005, colorectal cancer death rates remained about 50 percent higher in black men than in white men, according to the American Cancer Society. 

Telehealth targeting chronic diseases such as these through home health care requires broadband and can be augmented with Internet of Things and smart home technologies, like sensors that can detect a health crises before it happens, remind patients if they missed taking a pill or guide someone through rehab routines are a part of the next frontier. 

Mental health is another area where telehealth can make a real impact. 

“There are 65 million Americans that have a diagnosable mental health illness, but we have less than half of the psychiatric providers needed to meet that demand,” said Encounter Telehealth CEO Jennifer Amis. “When you look at many of the rural areas, we may have less than 20 percent of the number of providers needed.” Increased investment in both broadband and telehealth services can improve those numbers. 

Carly McCord is director of clinical services at the Texas A&M Telehealth Counseling Clinic, which partners with seven rural counties in Texas’ Brazos Valley to offer behavioral health services and treatments. In addition to telehealth, McCord believes communities should consider using broadband to offer distance learning to train people currently living in rural areas in mental health-care skills so they can help their own neighbors. 

“All of my counselors right now are advanced doctoral students,” McCord said. “We are training the next generation of health professionals for work in underserved communities and for work with telehealth.”  

The counties served by McCord’s clinic provide different types of physical spaces — a clinic, a school, a hospital — where patients can meet staff online and/or in person. “I believe that we need both virtual and physical environments,” McCord said. “There’s a whole host of reasons why people need to go to a place to be seen. For some people, they may not be safe where they are staying.” Comprehensive health care means giving patients choices so they can opt for what best suits their specific needs. 

COVID-19 has turned the world of health care and telehealth on its head. The United States cannot afford to continue to throw money at health care, even in the name of telehealth, and hope the gap heals itself. Ultimately, all health care is local. Communities need to develop local telehealth strategies that meet their unique situations.

Lauren Harrison is the managing editor for Government Technology magazine. She has a degree in English from the University of California, Berkeley, and more than 10 years’ experience in book and magazine publishing.
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