How Technology And Platforms Can Help Improve Health Equity

“Techquity” is the idea that healthcare technology can either be a barrier or conduit to more accessible, equitable care, depending on its purpose and design. Techquity as a concept is also the driving force behind a growing number of startups – including, and most meaningfully, healthcare platforms.

Just because the healthcare experience has gone digital doesn’t mean it’s readily accessible or easy to navigate – digitally or otherwise – for everyone, and certainly not equally. Digital inclusion, which some researchers have dubbed a “super” social determinant of health (SDoH), plays an increasingly important role in determining health outcomes – and, depending on a variety of factors, can either exacerbate or bridge gaps in health disparities.

The idea of healthcare technology being either a barrier or conduit to more accessible, equitable care is what’s been dubbed by many in the healthcare industry as “techquity.” Per the HLTH Foundation’s newly created Techquity for Health Coalition, techquity refers to “the strategic design, development, and deployment of technology to advance health equity, and acknowledgement that technology can inhibit advancements in health equity if not implemented intentionally and inclusively.”

It’s an ethos that’s at the core of most value-based healthcare delivery organizations. It’s a principle that’s been baked into the Quadruple Aim, with the addition of equity and inclusion as a pillar. Techquity is also the driving force behind a growing number of startups aiming to improve health equity and better account for SDoH – including, and perhaps most excitingly, healthcare platforms.

Trends in Techquity

Techquity, as both a concept and call to action, took center stage at HLTH’s second annual ViVE conference in Nashville in March, where the Techquity for Health Coalition presented findings from its first national survey on the topic. The National Techquity for Health survey builds on the group’s previously released “The Path to Equity” report, which aimed to bring attention to the care inequities that can stem from health tech that’s not designed with equity in mind.

Among the key findings in the Coalition’s latest techquity survey include:

• 87% of participants understood the concept and how it connected to their role, once the term was
• 66% of leaders say their organizations have initiatives in place to address health equity
• The most popular form of initiative to address health equity was through community-based partnerships

Given the nature and complexity of addressing disparities in health, there seems to be a widespread recognition that driving measurable improvements will not be achieved by any one player, or even any one platform, and certainly not overnight. But because digital health companies utilizing platform business models create value through facilitating connections and aligning interests among different stakeholder groups, they are uniquely capable of overcoming many of healthcare’s systemic issues that directly impact health equity: improving access (by efficiently matching supply with demand), reducing information asymmetry, empowering clinicians (by giving them tools and expanding their career options) and lowering transaction costs (by removing duplicative costs).

Maia Hightower, MD, MBA, MPH and Chief Digital & Technology Officer at University of Chicago Medicine, also makes the compelling case that digital health companies should be addressing health equity in order to make their solutions more attractive to potential healthcare customers. “When digital health companies pitch their solutions to me, I am looking for ways that the technology can be used to address health disparities,” explains Hightower.

Lost In Translation: Platforms Overcoming Language Barriers

According to an analysis on Census Bureau data for 2018, 67.3 million U.S. residents speak a language other than English at home, with one in twelve U.S. patients being unable to communicate in English well enough to understand or be understood by their caregivers. Limited English-speaking and deaf patients are also disproportionately more likely to suffer adverse events, misdiagnosis, or mistreatment, where research even suggests 55% of provider malpractices cases stem from miscommunication.

Language barriers are undoubtedly a significant driver of health disparities and a costly challenge for the entire healthcare system. One company that’s utilizing its platform to help patients, caregivers and providers to overcome issues related to language barriers is Jeenie. Jeenie’s on-demand platform connects providers (and patients) with medically qualified and HIPAA-compliant medical interpreters, available 24/7, in 300+ languages, including American Sign Language and indigenous languages. The company boasts the connections are made in under 30 seconds, on either video or audio, and without using call centers, operators, or “login hurdles.”

Rather than relying on the traditional medical interpreter services model – which consists of a complex chain of actors from vendors (who sell interpreter services) to brokers (who connect them to interpreter service providers) to call centers (who staff and employ interpreters) – Jeenie utilizes a technology-as-platform model that directly connects end users to medical interpreters that have signed up to be part of the Jeenie network. Think of Uber’s model, but instead of riders and drivers, it’s providers / patients on one side and medical interpreters on the other.

Gezzer Ortega, MD, MPH is a professor and researcher on health disparities at Brigham and Women’s hospital (BWH), which uses the Jeenie platform. “The capacity to use Jeenie on any mobile device removes the limitation of providing interpreter services only within the walls of our hospital. We know the vast majority of our healthcare occurs outside of the hospital and Jeenie can be there as well for our patients,” Ortega explains.

Jeenie’s platform model seems to be paying off. CEO Kirsten Brecht Baker notes that the company has grown its market footprint by 400% since its Series A fundraise in February 2022, and now has healthcare customers in all 50 states.

As the company brings on more and more healthcare customers and patients, that increased demand should make the platform more attractive for more medical interpreters, which will be critical to meeting both greater and more diverse language needs. “Being able to support languages like K’ekchi’ and K’iche’, and other rare and indigenous languages, on video and on demand, is a great source of pride,” notes Brecht Baker.

Ortega stresses the importance of interpretation on patient understanding of treatment plans and how this can affect clinical outcomes, and that having a technology platform that can scale to meet BWH’s diverse population is exciting. “Knowing that we have the potential to address this problem for this population, motivates me to work on solutions necessary to provide equitable surgical care,” he notes.

Solving Broader Health Equity Challenges Through Platform Thinking

In addition to language services, other ways that platforms are addressing health equity include:

• Specialist referrals: Similar to Jeenie’s interpreters, healthcare organizations are relying more on platforms to more readily connect their physicians with a network of specialists. RubiconMD, for example, is a physician consult platform that connects primary care providers with specialists. Founded by Gil Addo and Carlos Reines, the company was envisioned as a way to improve patient access to medical expertise, in part based on Addo’s own family experience of how inconvenient, costly and inaccessible it can be for patients who are required to travel repeatedly to see specialists. Currently connecting 8,000 primary care physicians (PCPs) to its network of specialists, RubiconMD empowers the PCPs and patients by giving them trusted access to medical experts while respecting the trusted nature of their PCP-patient relationship.
• Community referral support: Healthcare platforms such as UniteUs and NowPow are providing technology infrastructure connecting patients (and their support system and provider stakeholders) with a wide array of socially-directed services and more holistic care, including support and resources for food insecurity, housing, domestic support, mental and behavioral health, and many other community-based resources.
• Improving tech design/combating bias: Hightower of University of Chicago is an advocate of technology in healthcare, but has seen the risks as well. “Bias in clinical algorithms is a problem. There are algorithms that have widen health disparities and caused harm to black populations,” she explains. To help address this, Hightower founded Equality AI, which provides evidence-based guidance for machine learning in healthcare. Perhaps more importantly, the company also provides collaboration tools to developers and building a community of developers and companies that want to learn from each other.
• Staffing needs: Platforms focused on connecting skilled caregivers and support professionals with patients or other caregivers are also becoming more prominent. Incredible Health built a digital nurse hiring platform that uses proprietary custom matching algorithms to match the best candidates to open roles at health systems and hospitals. Incredible Health’s CEO and co-founder, Iman Abuzeid M.D., CEO noted in 2022 that the company works with more than 600 hospitals and is seeing more than 10,000 nurses join its marketplace every week.

Although we are in the relative early days of the platform revolution in healthcare, and have only begun to scratch the surface on health equity, the power and potential for healthcare platforms is great. Because platforms grow faster, scale quicker, and receive higher valuations than non-platform (pipeline business model) health tech companies, they’re not just a smarter bet for investors, they have a better chance of achieving their intended mission. And for those platforms wisely incorporating concepts of techquity, achieving success means having an impact at the patient and population level.