Editor’s Note: The John A. Hartford Foundation is collaborating with ASA to advance equity in aging by supporting ASA RISE, a 20-week social justice and leadership program for rising leaders of color in aging, and via the development and dissemination of equity-related, partnership-based thought leadership through ASA’s Generations platform. This blog post from an ASA RISE Fellow is the first in that series.
The COVID-19 pandemic laid bare the alarming inequities in our healthcare system, prompting state and federal policymakers to talk in meaningful ways about eliminating disparities in healthcare access and health outcomes for underserved populations. While the Medicare-eligible population is no exception to experiencing such inequities, much of the discussion around eliminating health disparities has not included older adults. In a post-pandemic world, policymakers must use the lessons learned from the COVID-19 pandemic to improve health outcomes and eliminate gaps in healthcare delivery.
Here are a few lessons policymakers can take from the COVID-19 pandemic to eliminate health disparities for older adults:
Lesson 1: Deliver Care Where Older Adults Are
When long lines were forming at vaccination sites across the country, SCAN Health Plan (my employer), partnered with the care management platform MedArrive to deliver COVID-19 vaccines directly to homebound SCAN Health Plan members. With MedArrive’s technology, we were able to use EMTs to deliver vaccines. As a result, we substantially reduced vaccination disparities among Black, Latinx and low-income members. Healthcare stakeholders must forge unique partnerships like this to meet the needs of their patients to receive care where they are.
Similarly, throughout the pandemic, many older adults use the expanded telehealth services authorized by the government to receive virtually appropriate care at home. In considering post-COVID Medicare policy, Congress should make these temporary telehealth expansions permanent so that older adults and others without adequate access to care can continue to benefit from this technology.
Lesson 2: Increase Access to Technology
While leveraging technology, policymakers must be mindful of bridging the digital divide that prevents many older adults from accessing the care they need. Homebound older adults, for example, would greatly benefit from telehealth services. Still, lack of access to devices, Wi-Fi or technological know-how can pose a life-threatening barrier to care.
'Lack of access to devices, Wi-Fi or technological know-how can pose a life-threatening barrier to care.’
As providers moved to virtual appointments, SCAN recognized this technology gap and launched HealthTECH, a tech support line to help members “attend” virtual visits with their doctors. This benefit has evolved. Now we dispatch teams to members’ homes to set up and give in-person instructions on using various technologies. This is an example of how those without resources can be supported.
Lesson 3: Lean on Data in New Ways for More Informed Policy
Data relied upon to shape policy should present a complete and accurate understanding of the unique disparities of diverse populations. For example, in January 2022, the Centers for Medicare & Medicaid Services (CMS) announced, via comment request, its intention to pilot the collection of race and ethnicity data on Medicare Part C and D enrollment forms. This pilot should reach beyond collecting data on beneficiaries’ race and ethnicity and include sexual orientation and gender identity data, too. Doing so will provide a clearer picture of the unique needs of different populations so that more effective strategies can be developed to meet them.
Lesson 4: The Way to Health Equity Is Via Cultural Competency
As the older adult population grows, healthcare stakeholders must focus on building trust with diverse groups by connecting with them in culturally competent ways. This includes making sure that community-based organizations receive the funding necessary to continue to provide the wraparound, high-touch services so valued and effective in their communities.
When SCAN found a glaring disparity in medication adherence rates among its Black and Hispanic members compared to White members, adherence in these populations significantly improved. First, when culturally competent materials were developed, and secondly when members were paired with care navigators to whom they could relate linguistically and culturally.
Lesson 5: Medicare-eligible and Homeless Populations Should Be Included in Policy Discussions on Mental and Behavioral Health
COVID-19 amplified mental health and substance use issues across all populations. Yet, the bipartisan effort to address mental health issues has not yet included older adults. While working to address mental health and substance use in younger generations, policymakers need also to ask how they can support the many older adults struggling with these issues. And because mental health disorders and substance use are primary drivers of homelessness, these discussions will need to address the fact that older adults are the fastest-growing segment of the homeless population.
Healthcare stakeholders must build trust with diverse groups by connecting with them in culturally competent ways.
Congress can look to building sustainable models like SCAN’s nonprofit medical group, Healthcare in Action (HIA). Launched earlier this year, HIA works with health plans to dispatch multidisciplinary teams to deliver healthcare to plan members experiencing homelessness where they are, such as in encampments and on city streets. HIA’s model is to offer ongoing medical care, with a strong emphasis on substance abuse and mental health support, to older adults experiencing homelessness.
COVID-19 revealed the enormous inequities in our healthcare system—and some valuable lessons on how to fix them. As Congress grapples with how to reduce these disparities, COVID-19’s lessons around health equity, data and mental health and substance use can be the guide on the path to a more equitable healthcare system for all.
Ryann Hill, MPH, is senior policy advisor at the SCAN Health Plan in Washington, DC, and a member of the inaugural class of ASA RISE Fellows.