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Telehealth's future depends on bridging the digital divide: Hospital CEO

Anjalee Khemlani
·Senior Reporter
·7 min read

As the coronavirus pandemic forces people to work, shop, and go to school online, it’s highlighted the deep disparity in access to broadband internet — and in turn, health care. As hospitals and doctors’ offices closed their doors amid lockdowns to help curb transmission of the virus, many health care providers shifted to telehealth.

But just as not everyone can work from home, not everyone could immediately plug into digital health services. According to the Federal Communications Commission, “Approximately 19 million Americans—6 percent of the population—still lack access to fixed broadband service at threshold speeds. In rural areas, nearly one-fourth of the population —14.5 million people—lack access to this service. In tribal areas, nearly one-third of the population lacks access. Even in areas where broadband is available, approximately 100 million Americans still do not subscribe.”

Dr. Stephen Klasko, CEO of Jefferson Health in Pennsylvania, told Yahoo Finance that more equitable access to the internet is key to growth of telehealth and other digital health services.

“We should look at broadband like we look at electricity and plumbing,” he said.

Treating broadband internet like a regulated utility is not a new idea. Malaysia, for example, recently mandated that all future developments in the state of Penang be high-speed internet ready. But in the U.S., there’s more of a public-private approach.

Pandemic response

Pew research shows that telecom companies have been focused on the problem, with pressure building in the last several years, with the pandemic accelerating the push in order to facilitate online learning. But there are technical and financial challenges.

Some of the largest internet service providers either waived fees, continued connections even if bills were not paid or increased the speeds available to homes who were paying for cheaper internet packages. Plans ranging from $9.99 to $19.99 were offered for limited amounts of time, with speeds ranging from a decent 25 mbps to as fast as 200 mbps.

The actions were encouraged by the FCC’s “Keep Americans Connected” pledge, signed by chairman Ajit Pai. The American Communications Association (ACA) Connects, the trade group that represents independent internet providers, also issued a call to action for its members.

Connecticut-based Charter (CHTR), parent company of Spectrum, has provided 450,000 students, teachers and their families 200 mbps download speeds for 60 days at no cost, kept 700,000 homes connected and forgave $85 million in overdue balances. And the company has not imposed data caps, usage-based pricing or early termination fees, according to a Charter spokesperson.

Colorado-based WOW!, meanwhile, signed on with ACA Connects to help school districts and states provide Internet access for students in low-income homes.

The program offers 30 mbps download and 5 mbps upload speeds for $9.99 — which is adequate for a small household. The FCC recommends a minimum of 25 mbps for good broadband.

Broadband provider Lumen (LUMN), formerly CenturyLink, has offered discounts for qualifying customers, but spokesman Mark Molzen said the company is also looking to expand or enhance services where economically feasible.

“Sparsely populated areas are difficult for any communications provider to serve due to the costs of building and maintaining the network infrastructure,” Molzen said.

“We’re always looking at ways to expand or enhance our broadband services, which includes working closely with policymakers on creative public-private partnerships that encourage broadband investment and bring high-speed internet services to more homes and businesses,” he added.

Klasko said he understands the desire to avoid becoming a utility, but the reasons being given are no different than when the health industry pushes back on price control efforts, which is why he thinks public-private partnerships could be a feasible compromise — especially if the government works with collaborators rather than single entities.

“The pandemic has proven Bernie Sanders was 100% right about the problem (in health care) and 100% wrong about the solution,” Klasko said, referring to the popular Medicare for All proposal lead by the Independent senator from Vermont.

Dr. Michael Murphy chats by video in this Thursday, March 26, 2020 photo about how he sees patients at Central Counties Health Centers in Springfield, Ill. In a new twist on house calls, Murphy, who is immunosuppressed, treats patients from his home via a telehealth procedure to avoid being exposed to the novel coronavirus. Health clinics like Central Counties, required by federal law to treat all patients regardless of ability to pay, are seeing only patients who are in pain or who have other immediate needs and have canceled routine visits to stop the spread of the novel coronavirus. That has cut significantly into their income. (AP Photo/John O'Connor)
Dr. Michael Murphy chats by video in this Thursday, March 26, 2020 photo about how he sees patients at Central Counties Health Centers in Springfield, Ill. In a new twist on house calls, Murphy, who is immunosuppressed, treats patients from his home via a telehealth procedure to avoid being exposed to the novel coronavirus. Health clinics like Central Counties, required by federal law to treat all patients regardless of ability to pay, are seeing only patients who are in pain or who have other immediate needs and have canceled routine visits to stop the spread of the novel coronavirus. That has cut significantly into their income. (AP Photo/John O'Connor)

Ongoing efforts

But some companies have been actively building out lines to harder-to-reach areas, which meant being better prepared for the pandemic. Chicago-based TDS (TDS), for example, said it costs about $1,500 to $2,000 per home to build out a fiber network, which it has been actively doing.

Other providers said the cost could be as much as $50,000 to build out fiber connections to more rural areas.

Illinois-based Consolidated Communications highlighted a project in the past year in Chesterfield, NH, which relied on municipal bonds to build out a network.

A spokesperson said the 20-year bond was issued for $1.8 million to connect 2,000 homes. The end users pay a monthly fee in their bill, which gets sent to the town to pay back the bond.

AT&T (T) spokesperson Jim Kimberly said the company supported expanding government involvement, noting the telecom giant has invested more than $125 billion from 2015-2019.

“We understand the need to close the gap that exists in access and affordability to high-speed internet and we encourage legislators and policymakers to act ... through a mix of public subsidies for low income households and smart policies that incentivize new infrastructure investment in unserved areas,” he said.

TDS spokesperson Andrew Petersen said the issue is on the radar and “discourse and dialogue will continue at both the FCC and on Capitol Hill, and some of the states that we serve, and I think it's an important dialogue to have.”

Growing industry

Beyond the basic needs of the average American, the digital divide also stands in the way of creating a robust digital health industry. That’s a significant potential loss for the overall nearly $4 trillion health care industry, which appears ready to embrace greater reliance on technology.

Former U.S. Centers for Medicare and Medicaid Administrator Andy Slavitt said during the JPMorgan annual health conference this week that when a digital health company brags about its market penetration, the denominator, or unreached percentage, include those who will never be able to have access for various reasons include affordability, access and homelessness.

The trillions spent on health care annually is “all horribly spent money, because it’s spent; it’s not an investment in people’s health,” Slavitt said.

For example, he noted large spends on massive health technology conferences, like that of Healthcare Information and Management Systems Society (HIMSS), for being extravagant yet having little impact.

“This 50,000 person HIMSS conference every year — which is an extravaganza, it’s an industry, it’s a universe, it’s bigger than the country of France, practically— and they haven’t figured it out. So we have this massive industry that puts on a good show, but ... some of the very very basics still aren’t able to ... get sorted out,” Slavitt said.

‘It’s time for the country to think differently’

The solution, Jefferson’s Klasko said, is simple. It requires more collaboration and using federal funds for those collaborations — rather than just providing grants and funding to individual entities to solve the problem.

Several telecommunications companies agree — and believe the incoming Biden administration will help better address the issue.

Verizon’s (VZ) senior vice president of public policy told Yahoo Finance there are numerous good ideas to help close the gap of digital inequality. (Note: Verizon is the parent company of Yahoo Finance).

“Today, too many people don't have broadband service because they can't afford it, they don't have access to broadband networks in their area or lack the digital literacy skills to use the service,” Donna Epps said.

“It's time for the country to think differently,” she added.

Thinking differently, Klasko says, also requires a deeper look at the money pouring into digital health startups.

“We have to hold technologists and founders [to hold their] feet to the fire,” and ensure they are “not just making the wealthy healthier,” he said.

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