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How an ecosystem approach can bridge the digital divide contributing to health disparities

Regulatory change is impacting opportunities to improve health disparities caused by the digital divide and enhance public and private partnerships.

In brief
  • A lack of broadband access put many on the wrong side of a digital health divide.
  • As health care providers look toward better care delivery options, others in the ecosystem and new regulations can help provide support.

Over the past few years, life in the United States underwent a dramatic digitalization in almost every industry beyond anything seen since the birth of the internet. In health care, the rise of telehealth and consumer apps marks an industry-wide shift toward “anytime, anywhere” care models that aim to divert patients from overburdened clinics and hospitals, cut service delivery costs and engage hard-to-reach patients. But lack of critical broadband access among marginalized and underserved communities is leaving those families and individuals on the wrong side of a growing digital divide and threatening the successful transformation of 21st century health care.

Now, two legislative and regulatory watershed moments are creating the conditions to change this dynamic. First, the allocation of $65 billion of funding from the Biden administration’s Infrastructure Investment and Jobs Act is available to states to improve broadband access in underserved and unserved communities, administered through the BEAD (Broadband Equity and Deployment) program. And second, a federal mandate from the NTIA (National Telecommunications and Information Administration) now outlines required statutory outcomes for state-level digital equity plans, including health care.

That arrival of federal funding, mandated requirements for action and monetary deployment programs now signals an unprecedented opportunity for health care providers to drive real progress in access to telehealth which can create better patient outcomes and cost savings. Providers, of course, cannot do this alone – and a true ecosystem of public and private partners aligned around a singular mission will be critical for change. Let’s take a closer look at what that means.

Understanding the current health care inequities landscape

Despite improvements over the past decade, 6.5%¹ of the US population still lacks broadband access. That’s especially significant given the world we live in. While the shift to internet-based services has been underway for a number of years, the pandemic accelerated both technological change and consumer acceptance in all walks of life from grocery deliveries to health care services. But it also exacerbated racial and socioeconomic disparities, highlighting the difficulties vulnerable communities and individuals face when attempting to receive medical care. For some patients in underserved communities, a doctor’s office visit, for instance, requires missing work and traveling to a clinic which can place greater financial strain on already burdened individuals and families.

As the health care sector and providers now look to care models that engage patients beyond the clinic – home testing and diagnostic wearables, e-reminders and online visits – key infrastructure needs must be met. The installation of broadband is an essential first step in increasing data speeds from 25 Mbps to the proposed federal minimum of 100 Mbps² – a mandated requirement of the Biden administration’s Bipartisan Infrastructure Law. But so, too, is assistance for families to pay internet service bills to access broadband, the necessary hardware for residents to use and digital literacy and skills training for those who need it. All of this requires the alliance of ecosystem partners.

The incentive for health care providers to help lead change

As the cost of providing care rises, and especially in hard-to-reach communities, there is enormous incentive for providers – in the form of grants – to progress efforts in their own states for delivering personalized, at-home health care in every community. Broadband is the gateway to that change, which can usher in wearables and diagnostics that allow patients to better monitor and report blood sugar, blood pressure and other ongoing conditions or symptoms via remote patient monitoring and/or online portals to their care teams.

Better access will also mean improved communications with doctors, prescription reminders and telehealth visits that can deliver preventative care and help lower costs. As technological platforms mature and both cloud-enabled services and consumer apps create a new care landscape, it’s time for health care providers to work with and be supported by the state and local governments, hardware manufacturers and internet service providers needed to effect change.

While many of these players are already working to identify community-level disparities with varying degrees of progress, success can only come from a concerted, combined alliance. This effort must include accountable strategies, organizational action, public policy and funding, private sector investment, and most critically, a keen awareness of the cultural and social climates within underserved communities that can impact success.

Investing in health care transformation to realize care, community and cost benefits

Despite best intentions and a desire to transform care models, many health care providers still face challenges when it comes to embracing new technology delivery systems. The shift requires organization-wide learning of new technologies that are not always intuitive and require time for implementation. But investing in telehealth services for all and working with local ecosystem partners will bring considerable benefits:

Roles and responsibilities for ecosystem partners

As health care providers look to embrace better care delivery options, others in the ecosystem have roles to play in effecting coordinated change. Payers can help with policy change needed to assure reimbursement parity for telehealth and traditional care delivery to help incentivize adoption amongst providers. And payer investment in broadband infrastructure development, in the geographies they cover through their community benefit and philanthropic efforts, must continue. Local regulators too must be appropriately focused on the issue of access and telehealth service models designed with input from vulnerable populations.

Effecting operational and collective change to address health care inequities

As service providers in a changing health care world, providers and payers must, ultimately, accept more responsibility for driving equity initiatives among ecosystem players. Accelerating the shift toward value-based reimbursement models: seamless anytime, anywhere care involves focus, commitment and practical action steps.

The transformation will require operational and technological change, including the identification of at-risk communities that will benefit most from telehealth services, the provision of mobile-first telehealth services considering community availability of smart phones vs. computers and the involvement of physicians in understanding which patients have access challenges.

Providers and payers must enact more sophisticated data management practices, too, to better identify patient equity issues and monitor initiatives to drive greater tech and health care inclusivity. Being able to monitor progress and demonstrate success will be essential to motivating and incentivizing other ecosystem players to get involved and drive change.

It’s by no means either an instant or an easy lift to address the health care inequities created by limited technological access. But bringing coordinated public policy, funding and private sector initiatives together with improved telehealth service provision is going to be an enormous win for underserved communities across the country. This work will require a solution that goes beyond technology, and it will need to factor in cultural awareness and improved education, integration and communication for communities. Ultimately, success is not about one provider or organization; it must involve an entire collective ecosystem effort that can deliver urgently needed change to bridge the digital health divide.

Jaymee Lewis-Desse, Lauren DeMel, Ashley Williams, and Edie Goutier contributed to developing this article. 


Providers and payers should take more responsibility for driving equity initiatives to address the digital divide in health.

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02 Jun 2023 Yele Aluko + 2