Health care delivery has been increasingly moving into telemedicine and the Berks County Alliance wants to make sure everyone has access to it.
While available before COVID-19, visiting a doctor remotely and sharing medical information online has become commonplace since the pandemic.
However, people with chronic illnesses, physical impairments, behavioral health challenges, age or language issues face increased barriers to accessing care due to a lack of internet service or the knowledge of how to use it.
The Berks Alliance – a collaboration o institutions formed in 2015 — wants to ensure broadband is available to everyone in the county and provide education so they can access the care they need, said spokesman David Myers.
To that end, the Alliance brought several organizations together Oct. 20, including the U.S. Department of Health and Human Services and the Federal Communicatons Commission, to look at internet connectivity as a social determinant to health. The Alliance hopes the information will provide ways to ensure everyone has access to virtual health care.
Much like the impact the pandemic had on schools when students had to learn from home, many in the health care industry are finding people without access to internet have a harder time accessing health care options, Myers said.
“It is critical to ensure digital access for everyone to ensure that all individuals and communities, including the most disadvantaged, have access to and use of information and communication technologies,” said Desha Dickson, Tower Health vice president, Diversity, Equity, Inclusion, and Community Wellness. “Digital inclusion can enrich the lives of residents and communities, ensuring no one is left behind.”
Raymond Prushnok, associate vice president, Program Development, UPMC Center for Social Impact, said research has shown there are areas where the internet is not accessible and therefore, people have limited options when seeking care.
“Many rural areas lack the infrastructure, they are digital deserts,” he said. So even if someone can afford a phone, computer or tablet, they may not have a way to use it.
Other issues, Prushnok cited are older adults who don’t know how to use devices or fear for their privacy when using them to discuss health care issues.
Natasha Khouri, associate vice president, TeleHealth Solutions, UPMC Health Plan, agreed saying that while virtual health care is available, when people have no access to the internet, are unable to afford it or know how to use it, they are left with having to travel to the doctor in person.
After looking at the effects of COVID on education, “One of the things that was evident was the moving to online education presented challenges for every school district in the county, Myers said.
“For example, the Reading School District found that about a quarter of its students did not have the resources to participate online. They found that many students did not have access to affordable, reliable high-speed Internet service, lacked the technology or training required to use the service. “
Armed with that information, the Berks Alliance is seeking ways to overcome barriers on health care.
“One of the things that the county consultant did was to push out a survey about Internet access. That survey asked whether the respondents had access to reliable service, the cost of that service and several other factors,” Myers said.
The survey also offered an Internet speed test which more than 2,500 Berks residents, across the county, took, he said.
“The results indicated that there were places where there was no Internet access. Many of these areas were rural parts of the county, but the survey also indicated that there were pockets in areas that historically would have been called being served that were not in fact being served,” Myers said. “And the speed test indicated that there were areas where the speed and reliability of service were also a challenge.
“This confirmed an assumption that both of our work groups had. And it also was ratified by one of the larger Medicare and Medicaid insurers in the county,” Myers said.
UPMC offers UPMC For Life Medicare and Medicaid plans in Berks County. While Prushnok and Khouri’s work covers the whole network, they said Medicaid and Medicare recipients often lack the knowledge to take advantage of virtual services.
This can be important, they said, when faced with a chronic illness that can be monitored virtually, eliminating the need for recurring office visits.
Myers agreed. There are populations for whom Internet access is a challenge. This includes people with chronic illness—like diabetes or COPD; people with behavioral health challenges; the elderly; people whose primary language is not English. Many of these individuals will need equipment and help in navigating the service.
“To help meet the needs of everyone in the community, Tower Health Medical Group Street Medicine program has provided a telemedicine kiosk at the Hope Rescue Mission since 2021,” Dickson said.
According to UPMC, the highest percentage of users of telehealth are those with behavioral health conditions. In fact, its studies showed that 70% or more patients suffering behavioral health issues use telehealth.
To that end, UPMC has started a program in Pittsburgh called Fabric Health where community health workers are in laundry mats to help people access care while they wait for their laundry. Prushnok said other locations like barber shops can also be used. The pilot program can be established across the state, he added.
Because of the need for services, “We had been having discussions with people from the FCC and the U.S. Department of Health and Human Services,” Myers said. .
An FCC spokesperson said the FCC’s C2H Task Force’s studies and findings show a strong relationship between broadband access/adoption and health and health outcomes in communities.
The lack of Internet access affects the ability to provide health care for disadvantaged populations, which include rural residents that live in areas with no hospitals or hospitals that are located at a significant distance, he said.
“The importance of telehealth was demonstrated during the pandemic when most people could only seek care remotely,” the FCC spokesperson said.
There currently are several ways to access the internet, Myers said. There are 41 internet providers operating in Berks County and the Alliance hopes to work with them to improve access.