Five Lessons for Building a More Equitable Post-Pandemic System

It didn’t take long for public health experts to realize that COVID-19 was having a devastating effect on lower-income and marginalized communities of color. By the end of May 2020, researchers knew that the pandemic was infecting, hospitalizing, and killing African Americans, Latinx, and Native Americans at much higher rates than other groups.

Sadly, these trends have persisted. Even now, members of these groups are roughly three times as likely to undergo hospitalization for COVID-19, according to the CDC. They are twice as likely to die. And while vaccination rates are improving across the US, African Americans and Latinx Americans have received disproportionately fewer shots than the total population.

While the pandemic was not the source of the disparities, it did shine a glaring light on problems that have long prevented the healthcare system from helping underserved people maintain good health. And, as founder and CEO of ConsejoSano, it has taught our organization how to build a stronger, more equitable healthcare system.

Leaders from health plans and health systems can all take a page out of this playbook—because forgetting the lessons of the pandemic is one of the greatest mistakes we can make.

1. Telehealth works for all communities, including underserved populations

At ConsejoSano, we help health plans and providers engage culturally diverse populations, who speak dozens of different languages. The goal is to connect patients to care, so they can build lasting health. In just the first two months of the pandemic, we delivered 6 million messages regarding COVID-19, which resulted in more than 35,000 telehealth appointments. As the pandemic went on, those numbers skyrocketed. As of early this year, we generated more than 50,000 telehealth visits for federally qualified health centers.

I’ve always known that patients prefer to interact with a healthcare system that shows them that who they are matters. The pandemic drove home how important telehealth can be to those people.

Studies have since found that telehealth suffers from some of the same obstacles that block access to in-person care. Don’t let structural barriers stand in the way. People, generally want access to virtual care—and that includes lower-income communities.

If we’re to build a more resilient healthcare system, we need to bridge the digital divide and fend off restrictive reimbursement requirements that, for example, pay providers less for audio-only visits. Now is the time to expand telehealth’s pandemic-aided rise.

What if we used this data-driven approach after COVID-19? The data could tell us where and in what language to reach patients. We would know who’s at risk—and how to step in.

2. By failing to address health disparities, we all face a greater risk

From the outset, health disparities have threatened to derail the US pandemic response.

As hospitals buckled under the weight of COVID-19, longstanding social determinants of health—from low-paying jobs and cramped housing, to insufficient access to preventive care—risked sending more people from underserved communities into the emergency room. Now, insufficient healthcare access and historical distrust in the system are working together to produce lower vaccination rates in underserved areas.

No one wants COVID-19 to become a disease that lingers within underserved communities, but these conditions could enable the spread of the virus to continue unabated. If communities act as reservoirs for the virus, there’s no telling whether they will give rise to a vaccine-resistant variant. Should that happen, we will all be at risk.

3. Race, ethnicity, and language data can strengthen healthcare’s foundation

We can’t solve a problem that we can’t see.

In the early days of the pandemic, few states reported COVID-19 data tied to race, ethnicity, and language. When they began doing so, we quickly saw who was in trouble, and that information helped healthcare leaders respond to the crisis. The same challenge marred nascent vaccine distribution efforts, as just 17 states were reporting race, ethnicity, and language data as recently as three months ago. Today, the CDC has these critical demographic stats for less than 63 percent of fully vaccinated people.

Throughout the pandemic, the more data we collected, the better prepared healthcare leaders were to unlock resources. We knew who to engage, what broad challenges they were facing, and which solutions might help.

What if we used this data-driven approach after COVID-19? Healthcare organizations could leverage race, ethnicity, and language data to understand when, for example, African American women, ages 65 and up, were experiencing higher rates of diabetes. The data could tell us where and in what language to reach patients. We would know who’s at risk—and how to step in.

But none of that is possible if we fail to gather the data.

4. Healthcare can’t revert to old ways of thinking

During the pandemic, the government waived the Telephone Consumer Protection Act, which was a vital step in empowering healthcare organizations to reach out to their members in the ways they prefer, namely through text messaging, without prior explicit consent. As a result, our health plan partners saw greater engagement and more members in the clinic. Now, thanks to a recent Supreme Court ruling, healthcare organizations are free to continue to engage members and patients via text. But will they?

We in healthcare have a tendency to play it safe. That’s understandable—after all, lives are on the line. But being cautious is not the same as forgoing opportunities to improve the health of our stakeholders.

As the pandemic fades in the US, we’ll need to decide whether to embrace innovation or revert to the status quo. It’s wise to remember that the status quo contributed to the health disparities that prevented many people from receiving the care that they deserve, all while costs rose by $93 billion per year. There’s every reason to pursue a new path forward.

5. Change starts with listening

When we need to understand what members want, we should ask them. Their input should drive everything we do. For that same reason, we employ health navigators who speak the languages and are from the communities we serve. There’s no stand-in for lived experience.

This philosophy of listening gets a lot of lip service in healthcare, but many organizations don’t seem to be following through. How else did we end up with a system that’s among the most expensive and ineffective of all wealthy nations? The pandemic furthered Americans’ dissatisfaction with the US healthcare system, with 35 percent saying they felt their care was below average.

If there were ever a time to start anew—to listen to the people whom we serve—it’s now. We might not like what we hear, but gathering raw and honest feedback will provide the opportunity to build back better.