COVID-19 has claimed the lives of over a million Americans — and even that number likely underestimates the pandemic’s true toll. As a primary care physician in Ohio who also served on the White House Office of Public Engagement’s Health Equity Leaders Roundtable Series, I’ve seen firsthand the hardships of the COVID-19 pandemic. And what I’ve seen is troubling. Despite strides by both the Biden administration and Congress to improve vaccine distribution and education, deeply ingrained health care disparities continue to limit the effectiveness of national efforts.
For instance, racial and ethnic minority groups are at a higher risk of getting sick and dying from COVID-19. The US is also seeing a higher burden of uncontrolled diseases among these communities: hypertension has gotten worse and uncontrolled blood pressure is more common.
Inequitable barriers to health care — including access to local providers — have long been a problem for millions of Americans as well as those who care for them. The pandemic has made life even more challenging for communities our health care system already overlooked.
Steps need to be taken to ensure COVID-19 does not permanently hardwire inequities into our health care system, further widening America’s health care gaps in the years to come.
In-Person Interactions Remain Crucial
We must continue the work of improving core interactions within our health care system. At the top of my list is connecting with patients in person and not just through a screen.
The types of patients I see at the clinics I serve throughout Ohio, and that my colleagues see throughout the country, are often battling multiple chronic conditions such as diabetes, hypertension, and chronic obstructive pulmonary disease (COPD) sometimes along with underlying issues involving mental health or housing insecurity.
While telehealth has proven useful for many of these patients, in-person patient-provider relationships can allow us to more reliably assess physical and mental wellness. In-person appointments can encourage more meaningful connections over time, which in turn can lead to more consistent visits long term and improvements in patients’ mental health.
There is – and will continue to be – an important role for telehealth in providing quality care for chronically ill, resource-limited patients. But if patients are unable to make follow-up telehealth appointments because of technology hurdles or cannot be fully present during these virtual visits, I’ve seen outcomes worsen. I remember a day I had 5 appointments on my schedule and none of my patients managed video calls because they lacked the required technology.
While I was grateful to have an opportunity to connect with these individuals at all, health care services can be more effective when clinicians can see patients in person.
Health Care Providers Can Change Operations and the Tides
Health care providers and federal lawmakers can be a positive force for change and help close equity gaps in American health care. The first and most immediate step is shifting away from traditional “fee-for-service” health care systems — which compensate providers for the quantity of services rendered — to a framework that instead rewards providers for the quality of care delivered and the complexity of patients cared for.
Rather than a piecemeal approach to patient health, this type of structure (known in the industry as value-based care) enables doctors and other providers to integrate their services. All in one place, providers can offer patients the primary care patients are already used to, as well as mental health support and other services designed to combat social determinants of health such as food and housing insecurity.
This comprehensive approach is critical in communities where most health care providers lack the opportunity to establish detailed care footprints. For example, consider a patient who not only presents with urgent health concerns such as diabetes, asthma, or COPD, but also faces behavioral health challenges such as long-standing nicotine dependence or a socioeconomic challenge like housing insecurity.
Without ample and easily accessible care, this patient may struggle to refill and take medications or may miss important appointments because doctors are difficult to reach, even when needs are handled virtually. These roadblocks increase the likelihood of the patient needing more drastic and costly interventions in the future and decrease the likelihood of staying out of the hospital.
Value-based care untethers providers from antiquated reimbursement methods that limit the resources spent on preventative care. The health care model permits providers to leverage integrated resources, including thoughtfully deployed telehealth options, and to intervene in communities where patients may require more complex care. It also offers care teams greater flexibility to adjust their approach based on each patient’s needs and changing conditions, without the burden of a standardized visit to meet billing criteria.
This approach pulls more health care levers at once, supports patients and clinicians, and provides Americans with a better vision of health care systems capable of reducing historic inequities in our country.
Olaoluwa Fayanju, MD, MSc, is regional medical director at Oak Street Health in Cleveland, Ohio.