The Future of Rural Health Equity | Deloitte US has been saved
By Neal Batra, principal, and Bill Fera, MD, principal, Deloitte Consulting LLP
Health inequalities have long existed in rural communities. People who live in rural settings can face geographic isolation, lower socioeconomic status, have limited access to health professionals, and endure long travel times to medical appointments.1 They also might have connectivity challenges due to a lack of 5G/broadband. Moreover, people who live in rural areas are less likely than other groups to have employer-sponsored health coverage.2
Next week is Global Health Equity Week (October 24-28). As we move closer to The Future of Health that Deloitte envisions, we are optimistic that technology will make health care more accessible and equitable to rural populations. Here is a fictionalized version of how that might look (see this animated slide deck for more detail):
Rural health in 2035
The year is 2035. Max Anderson, 65, is a retired farmer who was recently diagnosed with cardiovascular disease. (Max’s father died of a heart attack at the age of 66.) Max has always been interested in tinkering with machines—from the combines he once used to harvest corn and soybeans to the small plane he used to dust the crops. Today, he is waiting for a different kind of machine—a drone. Max’s smartwatch recently detected an atrial fibrillation and he alerted his physician. Since Max lives several hours from the nearest hospital, his physician—Dr. Hassan—dispatched a drone to deliver prescription drugs, a smart bathroom mirror, and a pair of high-tech earbuds. The medication and devices will help address Max’s heart condition and allow him to proactively manage his health.
This was not Max’s first experience with the health care system. Five years earlier, Max scheduled a virtual health visit after his family noticed he was losing weight and didn’t have much energy. Using a mobile device, Max explained his symptoms to Dr. Hassan, who works for a major health system 200 miles away. The doctor explained that Max’s smart toilet can analyze his urine for key metabolites. The toilet, which is connected to Max’s wireless network, analyzed a sample and transmitted the results to Dr. Hassan. With the help of advanced artificial intelligence (AI)-powered algorithms, the doctor was able to quickly diagnose kidney disease as well as the exact stage of that disease. Max was shocked. She explained that many adults don’t realize they have kidney disease. Fortunately, Max was in an early stage of the disease. While Max sat on his porch, his doctor sat in her office and carefully explained the treatment plan, including the medication and lifestyle adjustments, that Max would need to follow.
Over the next five years, Max worked side-by-side with his physician and care team to manage his kidney disease. He saw the positive impact that prescribed lifestyle adjustments had on his health, which increased his trust in both Dr. Hassan and the broader health care ecosystem. After his coronary artery disease (CAD) diagnosis, Max and his care team developed a new treatment plan, which incorporates a digital care champion and new high-tech tools. Although unfamiliar with this new technology, Max trusted Dr. Hassan’s recommendations after the relationship they had built. His doctor scheduled the drone delivery the next day.
While scanning the news on his mobile device, Max’s smartwatch buzzes, reminding him that the drone (with his medicine, earbuds, and smart mirror) is on its way. The drone sets down near the porch and Max brings the package inside as the drone flies off. In addition to blood pressure and statin medications, the mirror and earbuds are designed to help Max continually manage his blood pressure and stress—to help prevent a heart attack or progression of his kidney disease. Twenty years ago, Max remembers his father driving several hours to meet with his doctor or to pick up a prescription.
Max logs into his health portal and connects with Jamie, his virtual care champion. Jamie is powered by AI and uses advanced algorithms to empower patients to navigate their own health. This virtual care champion is programmed with empathy and can understand regional colloquialisms to help provide individualized on-demand patient support.
Jamie projects holographic images to help Max see how to set up the smart mirror, which is equipped with a small camera. The camera captures images to assess Max’s stress levels in the morning and evening when he’s in the bathroom brushing his teeth. The earbuds will monitor Max’s blood pressure. The data generated by the devices are processed in real-time using AI-enabled analytics and are automatically added to Max's care records, which Max can access from his mobile device. Jamie collects and analyzes data through its state-of-the-art CRM (client relationship management) software. Max’s care team can monitor these results in real time and are alerted to any abnormal changes.
After setting up the devices, Jamie asks Max how things are going and how he's feeling. Jamie is programmed to assess the drivers of health (also known as social determinants) and it takes a holistic view in supporting Max as he navigates retirement. That holistic view of the patient is enhanced by Jamie’s knowledge of Max's family and the people who live in his community.
Dr. Hassan played a critical role in promoting innovative care delivery models and new technology to Max’s community. While her practice is far from this rural area, she provides services to much of the population here as a trusted advisor. Many people who live in the area rely on her recommendations when considering new technologies.
A few months ago, Dr. Hassan heard about a forum that allows physicians to learn about—and remotely observe—new health technology in the metaverse. It was through this forum that Dr. Hassan learned about the blood pressure-monitoring earbuds that she recommended to Max. During the monthly event, technology companies debut their latest devices. This gives physicians an opportunity to see the products in action and ask questions. They can then help promote adoption of this technology to their patients. These technology companies often partner directly with primary care physicians (PCPs) to continuously monitor patients’ health. This makes it easier for PCPs to promote health and well-being rather than only responding to patients when they are sick. By segmenting the population, these technology companies can individualize care at the local level to improve care management. As a part of such a partnership, Dr. Hassan identifies patients that would be good candidates for new devices. She provides crucial input to the tech companies, which helps them to improve the devices and enhance the patient experience.
Max’s digital care champion, along with the other devices, helps him take on more ownership of his health conditions. This means he doesn’t need to have as many interactions with his doctor or the care team. For example, as soon as Max is alerted to abnormal changes in his blood pressure or stress levels, he can adjust his diet or exercise routine.
Max understands he has many of the same health conditions that his father had, but he also knows that health care has undergone substantial improvements over the past 20 years. He trusts that new technologies, virtual access to his doctor and care team, and always-on sensors can help to ensure that he has many healthy years ahead.
Max’s story is not far off from the way technology is currently being used in health care. The adoption of health technology in rural communities has the potential to improve outcomes and patient experiences. In addition to these important benefits, data and technology could significantly increase access to health care services. While the role of physicians is likely to change, they will likely continue to play an important role in helping patients understand and trust technology. The Future of Health could make health care more accessible and equitable for rural populations, and it is closer than we think.
Acknowledgements: Anthony Neves, David Figueroa, Ben Hettrick, Jenelle Chiang
Endnotes:
1 How far Americans live from the closest hospital differs by community type, Pew Research Center, December 12, 2018
2 Measuring America’s people, places, and economy, US Census Bureau
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