Biden’s well being fairness efforts begin with broadband push

BUILDING NEW LINKS: As Washington eyes new fixes for the nation’s crumbling infrastructure, the prospect of billions of dollars in broadband investment could also mean tackling the next frontier of health equity. And advocates in and beyond Congress think infrastructure talks could be their best bet for linking millions of Americans up to digital health.

“We’re not going to effectively deliver health care without telehealth and telemedicine,” House Majority Whip Jim Clyburn said in a recent interview. “We just aren’t going to do it.”

“We just have to make a decision into whether we’re going to make this kind of investment in communities, in people and what it will do for families all over this country,” added the senior Democrat, a close ally of President Joe Biden. “Because if you don’t, I think you can’t measure the loss that takes place.”

Students and instructors at an engineering camp gather on a video call | AP Photo

AP Photo

Broadband is a key part of Health and Human Services Secretary Xavier Becerra’s plan to address disparities — urban and rural — and to preserve access to digital health after the pandemic, he testified during a Senate confirmation hearing. HHS has a small telehealth grant program, and the Federal Communications Commission has doled out hundreds of millions of dollars to support internet service and devices for virtual care through its own telehealth fund. Lawmakers have demanded more transparency from the FCC to ensure the money’s distributed equitably, especially to tribal nations.

“Everything from a child’s education, to being able to call for an ambulance, to being able to have a telemedicine consult to just being able to find information that might be vital for what you need is really dependent on the quality and the basic access…of your connectivity to the internet,” says Nancy Barrand, senior program officer for the Robert Wood Johnson Foundation. “We all take Zoom for granted, but there are people who didn’t have Zoom to connect to their families.”

Even though telehealth visits skyrocketed during the pandemic, broadband dead zones and lack of high-resolution video technology, expensive smartphones and unlimited data plans means virtual appointments are still out of reach for many patients. Some have had no option but to consult their doctors over the phone instead of video-chat — or to forego care all together.

Policymakers are pursuing multiple paths to confront these concerns.

Massive investments as part of Biden’s infrastructure plans would hook up parts of the country that don’t have fast internet service. Biden himself referred to the importance of “technological infrastructure” during his news conference last week. Top congressional Democrats, led by Clyburn and Sen. Amy Klobuchar (D-Minn.), recommend a $94 billion investment in building out broadband internet and supporting digital equity.

These efforts build off last year’s pandemic relief packages, where bipartisan lawmakers set up billions in emergency subsidies to aid low-income households with broadband bills as well as the FCC’s Covid-19 telehealth grant program. Commissioners on Tuesday said they were advancing a second round of telehealth funding, which comes to a quarter-billion dollars.

Top officials say that the ongoing public health crisis adds urgency to moving these fixes.

“Many are coping with mental health issues that have been exacerbated by this ongoing pandemic, particularly in communities of color,” Democratic FCC Commissioner Geoffrey Starks said during a government webinar last week, touting the “life-saving mental health care” at stake in launching a new round of telehealth grants.

Congress, meanwhile, needs to focus on both the current and long-term struggles posed by lack of connectivity, said Klobuchar, who expressed openness to advancing bigger broadband infrastructure investments under budget reconciliation if need be — a key procedural tool that would let Democrats skip negotiating with Republicans, who have been leery of multi-trillion-dollar price tags.

“One of the ways we get through the pandemic is through having equal access to broadband,” she told POLITICO. “We can’t keep perpetuating this inequity of some haves and have-nots when it comes to the internet.”

Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback: @dariustahir, @ravindranize, @ali_lev, @katymurphy.

Paul Kedrosky @pkedrosky “Briefly looked into a vaccine scheduling in California, and encountered a hodge-podge of bots, a poorly-designed [centralized] site, and various pharmacy sites, and felt a kind of keening, existential despair.”

Q&A: We talked to Margot Savoy, a family practitioner in Philadelphia and a faculty member at Temple Medical School, about how she deals with patients who — before, during, and presumably after the pandemic — come in with misinformation from social media. Her response? She takes the time to tell them how to be more discerning — and tells them that she Googles stuff too. Here’s a condensed slice of her conversation with POLITICO’S Joanne Kenen.

How common is it for patients to present you with what they saw on social media?

“People frequently come in with what they’ve heard last on social media or what their own personal influencers are — and sometimes the influencers aren’t even necessarily people who you would consider a social media influencer but for you, it’s a person you like, you trust their judgment, they’re your people. To you, they are famous. And that happens with lots of things around COVID. It’s been a double edged sword.”

Margot Savoy, MD

Temple University

Do you steer them away from that?

“In some cases you can actually use the platform to help people get their questions answered and explain what’s going on and help them normalize things. But on the other side you do have some groups of people who are putting out information that just isn’t true. It’s not accurate, it’s misleading or just doesn’t show the whole story. So you’re having people make very emotional decisions on what they think is evidence, but it’s just things that are made up.”

How do you get that across?

“I like to correct people gently and help lead them to information that’s a better resource. I talk to them about what I consider strong evidence. What’s coming from a reliable source of information and whether someone can back up their statement, can they show you evidence or data. Or whether they are telling you upfront, ‘I have no data to support that whatsoever. It’s just how I feel’… You need to think that through.”

THE OTHER INFRASTRUCTURE PUSH: PUBLIC HEALTH: Democrats’ might include public health in the infrastructure package — and overhaul its rusting data foundations that left the country scrambling to understand where the coronavirus was spreading.

“We need EPIDEMIOLOGISTS! Thousands more and public health informaticians and data scientists,” Janet Hamilton, the executive director of the Council of State and Territorial Epidemiologists, wrote in an email summing up what she’d like to see in a big bill.

The travails have been well-documented. Public health departments saw huge cutbacks in the decade leading up to the pandemic. Shortly after the virus arrived, disease hunters had to rely on faxes to trace the contacts of potential coronavirus patients, and lately, coordination between the various vaccine logistics and scheduling systems have been weak. Missing data, especially regarding the race and ethnicity, have made it hard to target resources.

But investing in information technology needs to be a “well-coordinated buildup,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials. Plescia is worried indiscriminate funding may result in each state or jurisdiction building separate systems that don’t talk to one another – and won’t get maintained if the money dries up. Plescia said investments are also needed to digitize lab and case reporting, which are often done in paper.

Medical records giant Epic is also on board. “[Public health] infrastructure isn’t ready to take in modern, real-time data,” said Nick Frenzer, an executive with Wisconsin-based company, who also stressed that any funding boost is well-coordinated.

As states ratchet up their own investments in systems, they’re starting to make divergent requests, which increases work for health systems and risks incompatible systems. Frenzer thinks “collaborative agreement” is necessary to ensure everyone’s on the same page.

(ICYMI Joanne did a deep dive into the future of public health in POLITICO’s new state-focused policy series, Recovery Lab).

UNINSURED HAVE LOWER VACCINATION RATES: Counties with high levels of uninsured people have significantly lower Covid-19 vaccination rates compared to the national average — an indication that health leaders should make it really really really clear that the shots are free, according to preprint study from biomedical artificial intelligence company nference.

The link was especially pronounced in counties with higher proportions of white residents, the study finds. “This is not an insurance issue — it’s more a public health messaging opportunity,” nference’s Venky Soundararajan tells POLITICO’s Mohana Ravindranath. (nference’s previous analyses with Mayo Clinic led the Centers for Disease Control to add loss of smell to its list of Covid-19 symptoms.)

The analysis, which covered more than 1,500 counties and more than 200 million people, also found counties with high levels of uninsured people also had the highest incidence of the virus this month as compared to December, when vaccine rollout began.

HEALTH TECH DEAL UNDER THE LENS: Antitrust regulators are scrutinizing a $13 billion health IT merger amid concerns it would create a vast library of data that UnitedHealth Group could use to its advantage in negotiations with doctors and hospitals, POLITICO’s Darius Tahir and Leah Nylen write.

Optum — owned by UnitedHealth, the nation’s largest health insurer — announced in January it would acquire Change Healthcare. Both companies operate networks that help connect health care providers to insurance companies, and handle the flood of reimbursement claims to insurers.

The deal’s critics think the merged entity would have greater access to information like negotiated rates and contractual terms than other insurers have, and could also use that data to influence patient care to boost profits. Not everyone agrees, but the complaints mark rising concerns about consolidation of power in the health market.

The acquisition is part of a trend that’s seen insurers acquire providers and support services, like pharmacies and pharmaceutical benefit managers, to streamline care and reduce costs. Antitrust enforcers looked closely at some of those since-completed deals, including the merger of Aetna and CVS and Cigna’s acquisition of Express Scripts.

Optum last week disclosed the Justice Department asked for more details on the transaction, issuing a so-called “second request” for information that will lengthen the deal’s antitrust review.

It’s not the first time that someone connected with the Biden administration broached anti-trust concerns.When HHS Sec. Becerra was California’s attorney general, he brought and settled an antitrust suit against California hospital giant Sutter Health for closing down competition between providers.

HEALTH DATA AND NATIVE AMERICANS: The National Institutes of Health and Native American groups are joining forces to increase representation of American Indians and Alaskan Natives in All of Us — the federal project to collect and study the health data of at least 1 million Americans to better understand diseases and treatments.

POLITICO’s Adriel Bettelheim writes it’s a noteworthy step considering how some past efforts to use genetic research to understand tribal health concerns have collided with prohibitions on collecting DNA samples on Native lands. The Navajo Nation in 2002 issued a moratorium on such work, in part on religious grounds. And the field of study is still clouded by a 1990s effort to collect blood from members of the Havasupai nation to look into genetic causes for diabetes that turned into a tempest when samples were loaned out without consent for other research.

After two years of consultations, All of Us leaders committed not to recruit participants on reservations or disclose individuals’ tribal affiliations without a tribe’s agreement. The program also will hold back the data and samples of self-identified American Indian or Alaskan Native participants from researchers for six months, to give them time to decide whether they want to remain or withdraw.

Test tubes are pictured. | Getty


Program leaders in initial discussions rejected one suggestion from tribal leaders that participants be allowed to opt in and out of individual studies using All of Us data, saying it wouldn’t be compatible with the program’s “data passport” model, which is designed to encourage broad use of the dataset and enable thousands of studies across different health topics.

“We know tribal leaders have many different views about participation in research, and that’s why we’re committed to a robust consent process and encouraging all members of tribal communities to speak with tribal leaders,” said Michael Hahn, who leads tribal engagement for All of Us.

The Wall Street Journal reviews the pros and cons of sleep tracking devices.

Bloomberg examines the future of vaccine passports and international travel.

The Financial Times asks if the online at-home fitness boom will last.

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