How to use technology to advance health equity

Alexis Anderson:

Hello, everyone. Thank you so, so much for being here today. We're excited, grateful to have this Techquity Ground Zero talk, and we're going to see slides come up here in a moment. My name's Alexis Anderson, and I'm a principal at Ipsos Healthcare. I know some of you are joining the talk today having worked in techquity your entire career, the majority of your career, others you've heard the term, you're wondering what it is, you're wondering how we can move the industry forward, and for some of you, this techquity term is completely new, and so I welcome all of you to this ground zero discussion, where we're going to level set on what techquity is, why it's important. You'll hear from some of the wonderful panel members here in a moment, who will share some examples of what this looks like in practice, and how we can move forward as an industry.

Alexis Anderson:

We all know that the healthcare landscape is changing, I mean, that's the point of ViVE, we're seeing this integration of healthcare and technology, making it possible to do things we've never done before as an industry. We're seeing that emergence of telehealth, the virtual care, wearables, patient portals, it's all making it possible to do new things. While this has the opportunity to do that revolution of healthcare, we're seeing new opportunities to improve patient outcomes, improve patient safety, new methods for innovation. We also do have to acknowledge that this emergence of technology in healthcare, this integration, also has the potential to diminish or harm health prospects, particularly for vulnerable, underserved, or marginalized communities.

Alexis Anderson:

I think, now more than ever, this topic is more important. We think about COVID-19, and for some of the folks in our communities and our population, they seamlessly transitioned to this remote working world, they transitioned to virtual care. We have to acknowledge that for some folks that transition to virtual care during COVID-19 wasn't possible, and that digital divide was only widened. While technology is intended to be that connector between people and the healthcare system to their lived environments, for some people, it only served as a barrier, and so that's tech equity.

Alexis Anderson:

We partnered with the HLTH Foundation to help explore what techquity was, and to help put forward some ideas for the industry, and we did three main things as part of that. We have the industry perspective, and you'll hear from some of the wonderful panel members here in a moment, of course, really important to understand techquity from the patient perspective as well, and so we have an ethnography video we'll be showing here in a moment, and third, we have to acknowledge that techquity is not a new topic. There are folks who have spent their entire careers focused on this. Secondary research was a huge part of what we did to help integrate in some of the learnings that already exist.

Alexis Anderson:

There's two tools that are available for you today, the first is The Path to Techquity, it's a white paper or a report that's available on the ViVE platform, and on Ipsos website. Secondly, it is that patient ethnography video, which is available to you. It's an exploration of what these challenges look like from the patient perspective. You might be wondering at this point, "Okay, what is techquity?" Techquity is the strategic design, development, deployment of healthcare technology to advance health equity, and it encompasses this notion that healthcare technology can either support or inhibit advancements in health, if it's not implemented in an intentional and inclusive manner.

Alexis Anderson:

There's three main things I want you to keep in mind as we have that discussion in the panel about techquity today. There's three main components or building blocks that are all essential to techquity, the first is access. You may be thinking, "Someone who has that wearable, or that mobile health app, are they able to get it in their hands? Is it accessible? Is it affordable?" The second piece is that initial use or uptake, does it have the right features, settings, to enable use that might look like personalization? It might not look like that, language setting, as I mentioned. The third piece, it's a little less tangible, but that person's gotten the device in their hands, it has the right settings to enable them to use it, but do they trust it? Do they feel that that healthcare tech will actually help them to achieve those better health outcomes, and will they use that tech in the long-term? That last piece is sustained engagement, so keep these in your mind as we're having this panel discussion here.

Alexis Anderson:

Together, we do have this joint responsibility to ensure that as we are integrating technology into the healthcare system, we are not leaving folks behind, we are meeting people where they are at, and we are making it possible, inclusive, equitable, accessible for them to use that technology. Before we hear from the industry perspective, I think it makes to start with the patient perspective. As we think about how we're going to help them, it's going to involve a collaboration, transparency, inclusivity, that commitment to transformation, and so without further ado, let's hear from the patients themselves. Thank you all. We're ready to launch the video.

Marsha:

Yeah.

Alex:

Now we're recording.

Marsha:

Ooops.

Alex:

You're losing ...

Marsha:

It's Knuckles.

Alex:

How tech savvy would you say you are, dad?

Jim:

Hmmm ...

Marsha:

[Inaudible 00:05:39].

Alex:

Okay.

Marsha:

I was playing a game, and the cat sat on the keyboard and it blew everything all up really big, and I couldn't figure out how to get it to go back down.

Hisbon:

My name is Hisbon. I live in the United States, in the state of Michigan. I'm married. I have kids. Because I'm a truck driver I spent five years working for my city community school, and I usually, every morning, just woke up, take my car and drive, go work, and go shopping.

Josh:

I live here in Western North Carolina, in the Smokey Mountains with my wife, and my cat. The area has actually gotten a little bit popular because of the pandemic. A lot of city folks have moved out here to realize that the internet does not work very well. We do have internet via satellite, if we do need to use the internet for anything, we usually have to go to town. It is a challenge.

Jim:

I can't remember.

Speaker 8:

Do you want me to try?

Jim:

Yeah. When I had my eye infection, I was paying for all of my medication. They wanted a $100 to see me.

Marsha:

We drove two and a half hours just to see the doctor, and we didn't have the $100 because we spent 80 of that just getting gas, and ...

Jason:

I was incarcerated in 1998 at the age of 18 years old, as you can see, I was a fresh-faced baby. When I got out, I was given an iPhone, and I didn't really know how to use it, so I had my 14-year old niece kind of show me the way. Later on, down the road, when I had problems with medical issues or things of that nature, I was able to look things up on the internet prior to going to a doctor. I didn't have health insurance so I couldn't just go see a doctor for anything that I wanted, so when I was, I would go on places like Google, look for community health centers, places where I could go cheaper.

Josh:

We'd benefit greatly if we were able to go ahead and contact our doctors, and deal with our insurance company.

Marsha:

But they use a lot of times your Social Security Number, and your driver's license number as a way to identify you, and when hackers break into different things, they can get that information.

Jason:

I went and got a COVID test, you know, this is the era of COVID, and they gave me a website that I would have to log into, but I just felt that it was kind of creepy that all this other stuff is on here that I don't know about. I was kind of like, "Hey, I don't even remember any doctor telling me that."

Marsha:

So you sign in, you have to log in, and then you're having difficulties because you can't read this stuff, or you're not understanding, you're thinking, you're looking for your for you x-rays, and we call them x-rays, now they call them radiology. I've just tried to stay away from dealing with that part of it. I'd rather talk to the person. I'd rather have the paper sitting in front of me.

Starlina:

I do not have any health applications on my phone because I feel that if my phone were to be compromised, so will my health information.

Hisbon:

My wife, she has a barrier with language sometimes, she doesn't use it a lot. I'm the one who use it to make an appointment, to schedule everything. I don't do the video meeting with doctors, not yet, it's better for me because you might be answering things behind the screen, but it's different than being in front of someone.

Starlina:

We've lost the contact, we've lost interactions with a human being, with that being said, I feel that technology throughout the years have changed, and have improved our way of living.

Josh:

We definitely are missing out on a lot of stuff, and also our ability to just operate as a 21st century individual, considering that technology is so imperative to everything that we do now.

Reena Sooch:

Hello, hello, how is everyone doing? Enjoying Miami? Well, welcome, thank you for being here, thank you for being at this, what I would consider a very important session on techquity. My name's Reena Sooch, I'm the Head of Digital and Connected Health at Ipsos, which is a global market research and insight agency, and it is my absolute pleasure to introduce this esteemed panel that I have with me here on my left. Firstly, we have Carlos Nunez, who is the Chief Medical Officer of ResMed. We have Nwando Ola ... I knew I was going to go stumble.

J. Nwando Olayiwola:

Olayiwola.

Reena Sooch:

Thank you so much. Chief Health Equity Officer and Senior VP for Humana, and I'm Michael Currie, who's the Vice President and Chief Health Equity Officer of Optum and United Health Group, warm welcome to all three. To open, we've seen some authentic patient video around the experiences around technology, and we've looked at definition through my colleague Alexis, Nwando, I want to come to you first. COVID disparity, and the role of technology, could you open up to give some context of what some of the challenges have been?

J. Nwando Olayiwola:

Sure. Thank you so much for having me. Wasn't that a great video, to just contextualize some of our conversation today around what patients actually experienced? I really appreciate you all for putting that together. I'll start by just sharing a story. Earlier on in the pandemic, prior to my role at Humana, I was the chair of the Department of Family and Community Medicine at the Ohio State University, and my role was responsible for getting all of our physicians, and our clinicians, and our residents, and everybody kind of ready to respond to the pandemic in its early stages. What that meant was that we needed to do what everybody else had to do across the nation, which was to get people ready to use telehealth and to use it pretty quickly.

J. Nwando Olayiwola:

We had been inching towards more and more telehealth use for virtual visits for our patients throughout central Ohio. But what happened during the pandemic, because obviously, as you know, we accelerated that work tremendously, and so it meant quickly upskilling, training people to be able to use these different platforms, teaching people how to do a culturally competent, language appropriate, literacy appropriate virtual visit, and preparing our workforce to be able to deliver on that. What happened was we did it, and we did it pretty quickly, and we felt pretty good about ourselves, and we were pretty proud of what we'd accomplished, but people weren't using it. We would have these ... we'd have visits, and you have your schedule full of people that were lined up to see you for either a video visit, or some sort of electronic visit, and a few things would happen, and particularly in our racial and ethnic minority populations, and our lower income populations.

J. Nwando Olayiwola:

We found out later that close to about 70% of our patients who were in those groups did not feel comfortable actually using the technology because, one, they didn't have necessarily the right hardware or software, or the broadband access to do it. It wasn't one of those cases where we'll build it, we'll train, we'll have everybody set-up, and they'll just ... people will start using it. Then there were also issues around language, and so you would see people consuming the care virtually that were not racial and ethnic minorities, and that were not lower income, they were people that were higher income groups that were consuming it, and the others were not. What happened is that these are folks that were already disenfranchised a little bit from care, and then you continue to widen some of those gaps with the technology by not caring for some of those other needs that people had, that were more structural and social, that impeded their ability to get care.

J. Nwando Olayiwola:

You kind of knew that that would happen, but when you saw it happen in real time you would have ... I'd have a lot of patients that would say, "Well, I'll just do a phone call. I'll just talk to you on the phone. I don't have all that smart stuff to do it, but I could talk to you on a regular phone call," and that didn't necessarily allow us for the same level of visit. I think that was an appropriate ... an important thing to realize that we can do a great job of bringing the technology to bear, but if we don't make it accessible for people who typically cannot use it, or give them the resources to be able to use it's still a waste.

Reena Sooch:

We will come to practical applications of what do we do about that a little later, but we're still kind of looking through some of the issues. So Carlos, I'm going to come to you.

Carlos Nunez:

Yes.

Reena Sooch:

What do you think are the three most important things the industry needs to really think about when it comes to techquity?

Carlos Nunez:

The three things that come to mind are, to me, they might seem a little simple and straightforward, but number one, this concept of disparity, and the fact that technology can help close these gaps, it's real. It's very real. Number two, you have to acknowledge that it exists. The other thing that the industry and organizations need to do, is also acknowledge we can do something about it. It is not a lost cause or something that is hopeless, and then the third thing is, we have all of these tools in this digital armamentarium. Outside of healthcare, you can look and see how other companies connect with people, make it easy for them to do things online. My 82-year old mother found it much easier during the pandemic to order groceries that showed up on her doorstep in two hours using an app, than it was to do a video visit because of a language, or a technology or an understanding barrier.

Carlos Nunez:

Why is an app like the Amazon app, or TikTok, so easy and engaging for people? But then healthcare drops the ball when it comes time to provide that on ramp. I think what Nwando was saying is so appropriate, you can lay the foundation, and put all the technology out there, but if it's not designed to connect with people then nothing will happen. I think those are really the three big things, it's just recognize ... I mean, it's almost like almost any sort of issue or problem, recognize that there is one, choose to do something about it, and then look at the world around us, and understand how are some technology platforms so successful at connecting with people and healthcare is still having an issue.

Michael Currie:

If I could layer in on that one. The two pieces to add, the first is when we think about the technology, I want you to think about three components. Technology is one, there is the patient engagement or utilization of whatever the technology is, and then there is the provider interface associated with that technology. The example I would give you, think about Bluetooth blood pressure cuffs. That's a wonderful technology to be able to remotely monitor patients, but the technology itself, or the Bluetooth-enabled blood pressure cuff that's sitting on someone's table, that they don't use for whatever reason they don't use, negates the technology. If they did use it, and there was no backend monitoring of their results from a provider perspective, we're still not leveraging the technology to its fullest extent. So I would ask you to think about those three together.

Michael Currie:

The last thing I would leave you with, associated with this that we're talking about now, and everything that we'll talk about, I'm going to leave you with an acronym, and the acronym is CPR. In order to do any of this work it requires C-suite alignment and buy-in, that's the C. P is persistence, because we all know health disparities didn't start last week, last year, two years ago, or 10 years ago, so it requires a persistence. With that C-suite alignment, and understanding that there is a persistence that goes along with this, then there are resources that need to be brought to bear to address these disparities, and bring forward this lens of health equity in its most fullest way.

Reena Sooch:

Thank you. Carlos, you want to add?

Carlos Nunez:

Just a quick ... I think that's a great example, and I don't have to mention the product, but there is a connected medical device on the market that when they decided to make it connected they said, "No Bluetooth, no wifi," because people have to figure out how to connect it. It uses cellular radio, so the moment you turn it on it just connects to the near cell tower, and the device is connected, and the person doesn't have to worry about their knowledge of that. So that's a great example, we have to design technology so that it is sort of bulletproof for anybody to be able to use it, regardless of their tech savviness, their socioeconomic background, or the amount of money they have to be able to pay for it.

Reena Sooch:

Right. What's the commercial imperative to get to the CPR? Because we want C-suite level adoption, and then there's a bottom line argument, we want to sell more devices, and we need to think about how we evolve our product to make it to mass market, so what's the commercial argument for doing it? Michael, I want to come to you.

Michael Currie:

A few things, whenever we're looking at any product or service that's going to roll out, I'm not going to start with ROI, we all know that ROI is somewhere in there, but there are adjustments, and accommodations that can be made to ROI. It doesn't always have to have a two to one, three to one, four to one, sometimes break even, sometimes a loss on something that is doing what it should and could do in some of these other areas that I'm going to mention. Obviously, when you think about the commercialization of anything, you want it to have impact, so whether it's associated with access, care access utilization or outcomes, you want to see what kind of impact it's going to have. There is ... Let me say it a different way, customer and patient demand also plays into commercialization. There is something called NPS, which is net promoter score, and it really has to do with the satisfaction, how people feel about whatever it is they're doing in your company. So NPS, and how it relates to NPS is another critical factor.

Michael Currie:

The last one I'll mention is regulatory or other requirements and obligations associated with what it is we're trying to do, whether we're trying to respond to some sort of federal regulation, or some sort of business requirement, or contract, or obligation, all of those play together in the commercialization. Some will weigh differently depending on what it is, or what line of business we're focused on, whether it's a commercial business, Medicaid business, Medicare business, but you always see those factors swimming in the pool together.

J. Nwando Olayiwola:

Could I just pile on Michael's comment? I think it was great to think about ... we're, Michael and I, both representing managed care organizations and large payers, and so I think it's also important to think about the total cost of care. Health disparities, health inequities are actually expensive and costly, and so if you're not thinking about how do you actually ... every time a patient misses a primary care visit, or goes to use an emergency department that's not ... for something that's avoidable, or is hospitalized when that's avoidable, and when you look at that data and how that plays out by race, ethnicity, and so many other demographics, and you see the differences, those things actually are costly. From where we sit, we're not in the ... we're not making devices or [inaudible 00:21:46], but from where we sit we're paying for care, and so we need to keep people healthy from that perspective as well, and reduce those disparities as well.

J. Nwando Olayiwola:

I have a quick question for our crowd, because Michael said something that made me think about it. So, raise your hand if your company, on your scorecard, has a health equity measure on your scorecard, your C-suite scorecard. Okay, so there are about four or five hands that just went up. I think, to Michael's point, about C-suite level accountability, you don't really move to the P and the R that he is talking about, unless you get that buy-in. The way you get buy in a lot of times in corporate organizations is what is on the scorecard, if it's not on the scorecard it probably doesn't matter. We need to center techquity and health equity a little bit more

Reena Sooch:

Go on, Carlos.

Carlos Nunez:

Yeah, just to add on to that. No, I think it's a great ... it's a really good point, and coming from a different part of industry in the market, something that is quite in vogue right now in board rooms, in C-suites, is this concept of what we call ESG, environmental and social governance, and a lot of investors, and Wall Street are interested in what companies are doing. I think it's an interesting way in which you can include health equity regardless of the company, but if you are talking about environmental and social governance at your company that includes things like health equity. It's not just about reducing ... I mean, it's important to reduce your carbon footprint, and renewable sources of energy, recycling all of your materials and things, but also making sure that not just the people in your company, but the people around the world benefit from this push towards ESG in the world of corporate America.

Reena Sooch:

We do love an acronym, don't we though? These things, simpler language. We're talking about equity, and I think we all can get trapped as well sometimes in the corporate world, in the acronyms, and the kind of things that we put through, but I do think there is business case here. If I look at diabetes care, and the rate of diabetes in the South Asian population, a number of people in my own family that have it, and the care and the outcome, and how much the adherence factor comes in, and the cost to their care, and having a remote monitoring tool like FreeStyle Libre was incredible for my grandma. It really transformed her care, but she needed help for every step of that journey. She needed someone to help her on board on the product. She needed someone to interpret the product for her. It shouldn't be like that, that's really the goal of the panel, to kind of explain today.

Reena Sooch:

Nwando, I'm going to come to you about the practicalities. You spoke earlier about how we must bring this to charge, what are some of the things that you're doing in your organization on a practical note?

J. Nwando Olayiwola:

A few things. I was in the American Medical Association luncheon earlier, and they were unveiling the full health program, and the importance of leaning into AI, and looking at how you can use artificial intelligence to actually promote equity as opposed to widen inequities. I'll share maybe two examples of what we're doing at Humana, which I think are important in this context. Probably everyone in this audience is familiar with a number of different predictive models, but one of the most commonly used predictive models in healthcare that sets up predictions on who will need higher level of care management services upon hospital discharge, and a massive major study that came out a couple years ago showed that just one ... a couple of flaws in that algorithm really disadvantaged African-American, Latinx populations, significantly from being able to receive services that were important.

J. Nwando Olayiwola:

The way we're thinking about it at Humana is that as large payers, with millions of lives that we're responsible for, we have to make a lot of decisions that are informed by intelligence. We can't necessarily get every single person to tell us every single thing, and so we're using a lot of predictive models to figure out where do we channel resources, what programs do we need to build, what do we need to expand, what do we need to avoid, and we rely heavily on predictive models to do a lot of that work. We've taken the ethical AI pledge, which a lot of you probably have done as well, to make sure that we are looking at all of our models and examining them with a health equity lens.

J. Nwando Olayiwola:

As we're looking at the way we build that technology, we are thinking through where are the potential places where we might be ... it's one little, and I'm not by any means a data scientist, but one little error in a model can magnify a disparity exponentially, and steer your resources away or towards certain groups. So that's the first one we're doing, there's a lot of work around really an equity lens into all of our technology-related activity, but specifically in the AI space.

J. Nwando Olayiwola:

Another one is really around thinking through the social determinants of health, and the structural determinants of health, things that affect people's health, regardless of their actual interaction with the healthcare system, but most of their lives outside of that. Thinking about things like broadband access and access to data, to be able to engage in the healthcare system as a social or structural determinant of health is really important. We're leaning into that a lot too at Humana. Some of our ... We have two pilots going on right now, where we're looking at this exact problem we talked about earlier, if you don't have the means through a broadband issue or data issue to be able to access us, how are you going to do it? So we're piloting a couple of markets, one where we are actually paying for broadband access, and we're saying, "If we can do that, will we get our patients to engage more? Will we plug them into primary care more? Will we be able to get care managers to engage with them more?"

J. Nwando Olayiwola:

The second one is it's still very early, but it's a pilot looking at how could we actually resource data, covering data on members' plans for them to actually have access to our work as well, and we'll see. Because I think if we recognize that these are things that ... just as we're paying for food, we have a healthy food card, we're helping to support things like transportation and housing, if we think of that as another social determinant then we can actually test and see. We don't know if this will solve all the problems, but that's a way to really get at some of those inequities, technology related.

Reena Sooch:

Thank you. Thank you for sharing that. Carlos, I want to come to you from a med device company perspective. What are some of the practical things that you are doing to be saying that you're kind of championing techquity?

Carlos Nunez:

I've got two examples as well, one is ... one I'm very proud of, we do a lot of research. I lead the Medical Affairs team, and part of that job is to do the research that gets products approved by regulatory agencies. Excuse me. We do a lot of respiratory equipment, which means we do a lot of masks that fit on people's faces. If you have ever had to sleep with a CPAP machine, or use a non-invasive ventilator, the mask is the key. We had a database with all sorts of human faces, and heads, and shapes, and sizes that leaned very, very heavily towards, what you would imagine the typical sleep apnea patient looked like, an overweight, middle-aged, white man. No offense, that's me probably partly, but it didn't represent the faces, and the heads, and the shapes of everybody on the planet.

Carlos Nunez:

One of the things about sleep apnea is there are a billion people that have it, and that typical middle-aged, white man is not the typical patient. There are young girls, there are children, young people who are thin, from all races, and so we've taken on an effort to make sure that our database, because it's what's used to train algorithms, it's used to create new products, represents the planet, not just the population that we had accumulated over years of the typical CPAP user, because everybody deserves that care.

Carlos Nunez:

Then the second example is when we design our devices, I mentioned ... it was our device that we put a cellular radio in because we wanted it to be easy to use. We've done research with all the data that we've accumulated, and we found out that if I give you a CPAP device, you'll probably be 50% adherent to therapy chances. If I connect that device to the cloud seamlessly, and your doctor can see the data, your adherence jumps to 73%. If you download an app, and you can see the data yourself, your adherence jumps to 86%. I guarantee the two payers here know, in the United States medication adherence is roughly 55%, maybe 60%, an 86% adherence rate to a therapy that is this intrusive is incredible. It's all because the technology is easy to use and easy to access, so very proud of those two things.

Reena Sooch:

Well, I think they're really great practical examples. How easy or difficult was it for the organization to come behind that? I mean, was it the idea of extending your research, and really being intentional about design? Was there a challenge or did it just kind flow?

Carlos Nunez:

No, we were very fortunate, there's a few ResMed folks here sitting at the table, they can nod their heads in agreement, from the very top, the tone at the top at our organization, starting with the CEO and the board, is people matter first. We make ventilators, so during the pandemic you can imagine we were extremely busy during the early days of the pandemic. We created a model, an epidemiologic model, to distribute ventilators in the most humane way possible, not to the governments paying the most, but to the countries that people needed them the most. You know what? At the end of the day we all do well by doing good, so it was no resistance whatsoever.

Reena Sooch:

That's good to hear, and I saw the nods. Michael, coming to you, what are the United Health Group doing in a practical sense on this topic?

Michael Currie:

Carlos just spoke to the C-suite commitment, so that's that C in that CPR. Very similar to what Nwando presented from Humana, we're doing work within AI and predictive modeling. There's Optum virtual care plan that we rolled out. You're going to see some of the same things from the payer side. What I will mention about the AI piece that Nwando touched on is the funnel, and the funnel is associated with who is modeled for service, and that's why it becomes critically important. You get, I don't want to call it bad data, you get not the best data in, then the funnel of patients and individuals that you get an opportunity to serve, and do good for, it gets altered, and that's why it absolutely needs to be correct. We think about some of the focus or focus areas within United, as I mentioned AI is one associated with predictive modeling, S2H work, being able to better identify where there are needs in a more proactive way rather than being reactive based on a patient engagement. The Optum Virtual Care Plan.

Michael Currie:

The one that I'll mention that's relatively recent is aligning. Carlos mentioned sustainability, and social responsibility, and ESG, and how we best align health equity work with sustainability, it's not an initial natural tie. Historically, when you think about health equity, you don't quickly ... those of us who've been in this space for a while, you don't immediately think of sustainability, but here is why it's important. Number one, it has the opportunity to give it the kind of stickiness and longevity that this needs. That's one, and number two, when you think about for profit organizations, not always, but Wall Street has some impact on what we do, and what we don't do, and sustainability is one of those areas that the Street pays attention to. So, in so much as you align health equity, you could even think about diversity, equity, and inclusion as well, aligned with sustainability, to not only give it the stickiness in your organization, but also make it a continued talking point. When you're going through your financials with those on the Street, we think that has an impact so we're going to see how that goes.

Reena Sooch:

I think making it stick is a really important point because this ... we don't want to be here in a year's time having the same conversation. You want to see the needle move. You want to see actual practical applications of this. As payers, how much do you observe what companies authenticity is to the items that they want to bring to market? Are they actually ... How much do you look into the fact that they do have the data sets that you're saying that it should be the data that should be collected? How much are you looking at the messages that they're putting out in terms of having and making sure that the product is accessible to different community groups? Where's that in terms of perception?

J. Nwando Olayiwola:

You mean as for payers looking at folks who are bringing products to us? Okay. Well, I can go. I think that authenticity is really important in this space, as Michael said, this is a moment that everyone is kind of hipped to health equity and tech equity, and we're trying to figure out how this tide will change, and if it will at all. While we have attention on it, we need to be really thoughtful about how we deliver on kind of the vision of achieving health equity. I would say that if you're coming to us and you're saying, "We've got a great product that we think will do these things", we have a whole process that's looking at capabilities, and ROI, and investment that will be required. But increasingly, what is [inaudible 00:35:00] to equity? What kind of data do you have so far? How are you stratifying and disaggregating that data by different demographic groups, and by social risk factors? How easily it will be able to be adopted in our environment? I think it's important.

J. Nwando Olayiwola:

I don't know how to tell you to be authentic, just really mean what you're saying, and do the work that you intend to do, and show that you can, and that you've already been thoughtful about it. I think when you talk about ... You've got 40 publications a year that are really drilling into all the data, and all the different groups, and all the different potential for products, I'm not saying you have to do that, that's just what we were talking about behind stage, but I think that being able to show that you a commitment to collecting, and using, and retooling your product based on the data that you're collecting is really important.

Michael Currie:

Reena, what I add to that is here's the difference in the now versus, let's just say two, three years ago, vendor, customer, whomever shows up with program, services, product, whatever it is, two, three years ago, the question about, or maybe even part of the criteria of the program, service, or product around, "Does it work? Or can you demonstrate? Or can you tell us how this work, this program, this service, this product, addresses health disparities?" Maybe it was included, maybe it wasn't, it was considered more of a nice to have. Now, today, there is no product, program, or service, that we have conversation about where one of the main criteria is, "How does this program, service, or product identify, and best address health disparities?" It's moved from nice to necessary.

Reena Sooch:

That's brilliant, and that's exactly what I was hoping to hear. I don't think the companies which don't have a stake in the ground in this, I don't think they'll survive in the future, that's my personal opinion. We look at sustainability and what's happening across consumer goods companies, in the nutrition world, and other parts of the industry, for sure in healthcare it's going to be the same. We have to have intention, and we have to move the needle forward. Carlos, I'm going to come to you around design, you gave a wonderful example of the work that you're doing. How can we design solutions and products that really do serve, or what's your take on that?

Carlos Nunez:

That's a great question, and I did touch on some of those things, but for those of you who are involved in product design or solution design, there are lots of concepts like designing things for manufacturability, making it easy to build this thing the way we've designed it. Designing for safety. We also need to design things just with human beings in mind, and a lot of that has to do with the way that they interact with the technology. Unfortunately, one of my sons is a human factors engineer, and he works for a different medical device company, and I look at the work that they do to try to make things usable, and approachable, and easy. We've got to get better at that in all facets, because as I mentioned before, a person can pick up a smartphone and certain apps that are really popular, there's no instruction manual, they just pick it up, start poking at it, and the next thing you know they're on there an hour or two hours a day. How does medical technology become that engaging, that connecting with people?

Carlos Nunez:

Then, I'll throw in one last thing. This goes beyond healthcare. This truly is a human question about techquity. We've all seen the headlines for the last 10, 15, 20 years, how the United States has slowly fallen behind in things like science and engineering, and math education for our kids, and we see other countries continuing to outpace us. We need to make sure that everybody graduates from high school or whatever, with at least the basic types of knowledge of how technology works, not just for healthcare, but so they can make sure they preserve their privacy online, and understand how things like the technology they use every day, whether it's games, social media, or health technology, can affect them in positive and negative ways. We need an educated consumer, and we can't continue to just not teach people about science and technology in the basics of their education.

Reena Sooch:

Thank you.

J. Nwando Olayiwola:

Can I make a comment really quickly? Because I think that both of my colleagues have mentioned something about that human centeredness, and the importance of really making sure that we're centering people on the work. I just wanted to share something that came to my mind as you were speaking. Earlier in the pandemic we did, at Humana we did about six million screens of members across the nation trying to understand their social needs, and social challenges at the height of the pandemic. What we found was that we have a large Medicare advantage population, and so a lot of our seniors were, while they had things like financial strain and food insecurity, they also had a significant percentage of our members that had social isolation, and reported low digital literacy.

J. Nwando Olayiwola:

When you think about some of the solutions that we had after that, some of those things were like, "Okay, we're going to empower you with an iPad so you can connect to our digital health services," or, "We're going to equip you with smart devices to be able to interact." You could still provide those, but they wouldn't have done a lot for some of the other problems that people were complaining about. What we realized, and started to [inaudible 00:40:31] was, "Could we connect people with people?"

J. Nwando Olayiwola:

You've got the technology, and that's important. I don't don't want to leave our conversation only talking about technology, because we started a couple people with the community health workers in this program we have called Papa Pals, which pairs college-aged students with seniors to help them learn how to use these devices. Community health workers helping them understand how to use the things that they have access to, understanding the dimensions and domains of literacy that they have, and health literacy, and then responding to that. It was a combination of the technology responding to the technical need, but also the human being responding to the human need at the same time. I think we should just be sure to keep those two things together in our conversation.

Reena Sooch:

I totally agree, and I think the ethnography had that element too where people were saying, "I want to speak to someone." If we look at one of the more successful examples of digital transformation, financial banking comes up time and time again. I can't remember the last time I physically went to the bank. It just hasn't happened, but within that, they did lose the human touch, and they struggle with the app use is really high, and there's telephone, but people get really frustrated. The other thing that came out really strong in the ethnography was the whole role of data privacy, and how do we build trust, because in equity and access, and all those things, a lot of that is entrenched in the concept of trust, how much can you trust the provider, trust them with your data. What's your perspective on that?

Carlos Nunez:

I have one. Actually, the word trust gets thrown around a lot inside of ResMed because we are asking a lot of patients, their devices are being connected to the cloud, and they are sending us a lot of data. We use that data to do research, and they need to trust in us, and so the concept is really important because, and this is not ... I'm not slamming anybody from the traditional, sort of big tech companies, we've learned a lot about how data can be misused, and how people can lose their privacy, their anonymity, and their security online very easily, and so healthcare needs to do better. We often get ... People will say, "Oh, healthcare is 10, 15 years behind other industries like finance or whatever, or consumer electronics." That might be a good thing in this instance because it gives us a chance to take a step back, see where things like privacy and trust have faltered in the tech world, and make sure we do it better in healthcare.

Carlos Nunez:

I need to make sure that when someone trusts ResMed, trusts us to connect that device, that we're doing something that's going to make their lives better. We're not going to serve them banner ads. We're not trying to take their information, and sell it to a data broker. We're doing research to make that device better, that mask more comfortable, the therapy more successful for you, and they have to trust that that's true.

Reena Sooch:

We're coming close to the closing of the session so I'm going to move to the future, and your call to action that you would give. There's already some intention here in the room to come here to listen about this, there's a lot more people out there who are not listening to this, so what is it? So, Michael, I'll come to you first, if there was a message or a call to action you would give to the industry or to ViVE about how the conversation should continue, what would it be?

Michael Currie:

I think there needs to be intentionality around doing the disparities analytics that allow you to identify where to go. When we talk about doing those disparities analytics there's usually five domains that we should be intentional about having as just part of the foundation, and bedrock of doing disparities analytics, age, gender, geographic location, or address, language and race and ethnicity. The fact that there are some areas where good sound race and ethnicity, so self-reported gold standard, race, ethnicity data doesn't exist, we shouldn't let that be a barrier. I understand some of the realities associated with using inferred, or imputed, or estimated race ethnicity data. But even with those barriers, there still has to be intentionality of doing the disparities analytics that includes race and ethnicity, so that we can do the most comprehensive work that we can to identify where the disparities exist. So that we can then move to the secret sauce of doing something about it, leveraging technology, and anything else that we're going to leverage to mitigate or eliminate what we identify.

Reena Sooch:

Thank you. Nwando, I want to come to you.

J. Nwando Olayiwola:

Yeah, I thought of two things. One, would be I was thinking about reflecting earlier in my career. I used to be a chief medical officer of a large FQHC, Federally Qualified Health Center network, and earlier in my career we were doing a lot of work trying to convince our doctors, our nurses, our clinicians, about quality improvements. That was earlier when Deming, and Berwick, and IHI were pushing quality improvement in healthcare, and you would think ... if you think about it now it's like, "How could you not have been thinking about quality improvement in healthcare? How was that novel at any point in any of our generations?" But it was, but now no one would ever say, "Well, let's hold off before we do quality improvement. Let's think about if we really want to focus on quality."

J. Nwando Olayiwola:

As technologies became more available to patients, particularly in primary care which is ... I'm a primary care physician, where I sit, quality and technology also became important. So, I feel like the same thing needs to be kind of the way we think about health equity, and ultimately tech equity, or techquity, is that it shouldn't be that ... Every scorecard would have something on there that's related to that, and every conversation that we have in healthcare should be thinking about what is the equity component, just like we do with the quality improvement. You can't necessarily, and studies have shown that you can't necessarily demonstrate global improvements in quality without continuing to have disparities, if you're not actually explicitly focused on health and equity, so that's the first one.

J. Nwando Olayiwola:

The second thing I said, I said it earlier, but I just want to say it again since this is my last time to make a comment, is that if it's not on your scorecard it's probably not a priority for your organization. I just want to keep on saying that, because I think for those of you that have the opportunity to lead, or to influence the leaders in your organizations, in your companies, try to figure out how you get some of this work on whatever that scorecard is. Whatever you are using as your benchmark for performance that allows you to decide if your company is doing well, try to get it there, because if it's not there it will still be, as Michael said earlier, kind of good to have, but not important to have. I would just lean in on that.

Michael Currie:

If it's not measured, it doesn't matter.

J. Nwando Olayiwola:

Don't matter.

Reena Sooch:

Absolutely. Carlos.

Carlos Nunez:

I guess I would like to leave everyone with one thought. I'm a little bit biased, but there probably is no more human industry on the planet than healthcare, and whatever we can do to include all people in a functioning healthcare system, making all of society more healthy, it seems like a no-brainer. When society is healthier, the economy is more robust, companies can actually save money, and then people are happy, and they get to lead and live their best lives. What's more admirable, what's more human than that?

Carlos Nunez:

If we can find a way to use technology to make that happen ... I'm a big sci-fi fan, and you think of sci-fi like Star Trek in the future, everything is shiny and beautiful, and happy, as opposed to sci-fi like Blade Runner where everything is dark and dystopic. Even though Blade Runner is my favorite movie, I would love for it to turn out like Star Trek, where we have found a way to use technology to improve every human being's lives. I think that's where I'll leave it for the group. Don't forget, when the pandemic is over we still have a lot of work to do.

Reena Sooch:

Yeah, by doing good, by measuring right, by opening up the doors for everyone, we make healthcare better, and we reduce that number that gets shown on the screen around wastage. We reduce that number that gets plugged up about how much we lose due to people not accessing their treatment appropriately, they're not getting the right support. There's all this fantastic work that a lot of you do that doesn't get into the hands of people. With that in mind, the HLTH Foundation, and Ipsos, are today launching initiative, which is a techquity industry benchmarking survey. This is for the industry to be held to account. The design of this will be done with feedback. We don't know the answers, but we have experts, and we have all of you to engage with on that, but if you want to really have a stake in the ground, then get involved. We're looking for advisory committee members to be part of it. There'll be data that will be shared at the next ViVE conference in Nashville, and the goal is that we start to measure ourselves, because what you measure gets done.

Reena Sooch:

Thank you so much to this panel. Thank you for sharing your thoughts, and thank you so much for attending.