Without broadband connectivity to the last miles of America, neither the nation's health citizens (taxpayers, all) won't fully benefit from the promise of digital health technology.
U.S. taxpayers have already underwritten $35 billion on the HITECH Act, part of the American Recovery and Reinvestment Act of 2009 (the Stimulus Bill). HITECH provided economic incentives to hospitals and physicians to purchase and implement electronic health records systems (EHRs). As health care has nearly universally adopted EHRs over the past several years, venture capitalists and other financiers have funded investments in hundreds of digital health ventures. Most of those that have survived the start-up phase haven't yet moved the needle on improving health care or lowering costs.
One key ingredient missing from digital health nirvana is the deployment of broadband connectivity in every community in America.
Most of my work as a health economist and advisor to the health industry in the past twenty-five years has been largely focused on the coasts, between Boston and Washington, DC, and in Northern California. But over the past several years, I've had the opportunity to extensively travel throughout the U.S., meeting with health providers in the heartland, from Alabama to Wisconsin, Arizona to Georgia, and states in-between. I've been spreading the word about new health care consumers in the new health economy, brainstorming the challenges and opportunities with hospitals about patients now paying more for health care out-of-pocket in high-deductible health plans, newly-insured health citizens, and Millennials seeking healthcare served up in I-want-it-now retail-style environments like they find in Amazon (especially Prime) and Uber.
As I listen to hospital administrators in rural and exurban areas, I'm humbled by what I'm hearing: rural hospitals are under threat of closure. In the meantime, rural Americans need care across the continuum: prevention, primary care, acute care, and chronic care for health citizens diagnosed with conditions they can manage at home.
Rural and exurban health care providers are diligently working to reinvent themselves, re-imagining new ways to deliver care and innovate under dramatically economically constrained environments. The one infrastructure investment that will be a lifeline to these organizations and for the patients and people they serve is broadband, which underpins a health provider's ability to deliver care virtually and scale care at a distance in geographic areas with sparse population concentrations.
My realization, listening to CXOs leading rural hospitals, is that broadband is now a social determinant of health. Without connectivity to Internet clouds, data platforms, and telemedicine channels to specialists, rural health care providers and others in under-served communities will not be able to provide evidence-based care in ways that can scale in economically sustainable ways using 21st century digital and telehealth technologies.
Healthcare costs in the U.S. reached $3.4 trillion in 2015, we learned from the Centers for Medicare and Medicaid Services (CMS) earlier this month. There is a growing evidence base for connected health's role in helping expand health care services and lower per capita health care costs in America. But among the limiting factors to adopting telehealth in the U.S. are huge gaps in broadband access, noted by the FCC in a recent report on the state of connectivity in the nation.
Democratic Presidential candidate Hillary Clinton's platform on technology for the nation features a recommendation for growing broadband in America to 100% - that is, to the proverbial "last mile. " This week, Senator Al Franken (D-Minn.) introduced a bill to help cut the costs of health information technology in rural areas, calling out the importance of broadband services in connectivity-underserved areas of the U.S. Maggie Elehwany, vice president of government affairs and policy for the National Rural Care Association, said, "Not only do you need the appropriate internet connection, you need the appropriate bandwidth to do various types of telehealth."
Only a portion of the public's health -- a consensus pins it at 20% -- is attributable to genetics. The other significant health impacts come from lifestyle choices (50%), environmental factors (20%), and access to health care (10%). Broadband connectivity crosses lifestyle, environment, and health care access. That's why broadband connectivity in the 21st century is truly a social determinant of health.