Moving Medicine Forward: Medical Equity is Possible with Technology

One researcher says Michigan can lead the way for tech revolution in medicine that would connect the most underserved people with the care they need — and these doctors may be proving him right.
Equity in medicine through Telehealth
Illustration by James Wang

Dr. Norman Beauchamp first witnessed disparities in health care when he was a child. He grew up on a farm near Michigan State University, and his mother was a mental health worker in downtown Lansing; through her, he learned how many people there were in need of care who simply weren’t receiving it. When he was in medical school, he told her that one day he would come back and do something about it. He’s now the executive vice president for health sciences at MSU.

“The county that you’re born in shouldn’t determine how long you live, and in Michigan it’s the case that it does,” he says.

Barriers to getting everyone care abound, he says. In some places, like inner cities, it’s a matter of high-speed internet access. In others, like rural areas, it’s the simple fact that the nearest doctor or specialist is two hours away. Sometimes it’s that people don’t know they can or should participate in health screenings. And the fact that the barriers are so wide-ranging is itself a barrier. How, he poses, do you determine what works in Escanaba as well as Detroit?

But, he says, these are solvable problems. The health care industry just needs to catch up.

“In almost every other sector you see innovation — improving business functions…and making [health care] more affordable, making it more patient-centered or customer-centric,” he says.

The answer — or a big part of the answer, he says — is technological innovation. Telehealth, artificial intelligence, wearable technology, 3D printing — new (or sort of new) technologies are being used in health care but haven’t all yet become the norm. Beauchamp is among many in health care who think the time is right for a revolution in medicine via technology. One that could make it easier, and perhaps even cheaper, for everyone, in particular those who have always been hardest to reach or treat.

But right now, the biggest barrier might be the industry itself.

“In health care, technology drives up cost and increases disparities,” he says. As an example, he offers up the PET/CT scanner, which uses small amounts of radioactive material that can accurately detect and show doctors where certain kinds of cancers are.

“Incredible technology. It’s transformative. But what if access to that is limited based on the cost of the scan or the tracers, or where PET/CT scanners, the best technology, is located? And what you’ve done is you’ve brought something in that was incredible, and yet everybody doesn’t have access to that, so it’s increasing the disparity,” he says.

But it doesn’t have to be that way, and Beauchamp believes that Michigan can lead the nation in using technology to overcome those barriers and save more lives than ever.

Medicine Through a Screen

Marie Lee was doing telehealth before it was cool. Earlier in her career, she never would have thought she’d be working in health care at all because, well, what does a background in telecommunications have to do with medicine?

Turns out, a lot.

She’s now the manager of access care technology at Henry Ford Hospital, which started as a one-person department in 2015. She joined as it started to grow in 2017. For her, using technology to connect patients and doctors just seemed to make a lot of sense.

“It’s really interesting because I had been involved in a lot of different conferences and conversations just in general — prior to COVID, obviously — about telehealth being this great tool for rural health, and it’s like, yeah, but we have just as much need in an urban area where people are having challenges. It doesn’t matter if you’re 50 miles away from a clinic or 5 miles away from a clinic. If you don’t have reliable transportation, it might as well be 50 miles or 500 miles,” she says.

But before the pandemic, the idea hadn’t really caught on. Doctors as well as patients resisted.

“When I first joined, my responsibility was to essentially beg people to use telehealth. I mean, I don’t like to use that word, but that’s kind of what we were doing. We were like, ‘Look at this cool stuff you could be doing with your patients,’” Lee says.

Doctors weren’t the only ones who were hesitant. Much of the resistance to telehealth (doctors and patients communicating over the phone or video calls instead of meeting in person) came from insurance companies.

“They just weren’t reimbursing telehealth,” she says, referring in particular to Medicaid. “The commercial insurers follow the federal insurers’ lead on that.”

COVID-19, of course, changed all that. Medicaid had to make a big switch in how it covered telehealth, and after two years of lockdowns and restricted access to medical facilities, telehealth became normal … and, in some ways, preferable — and not just for patients but even for payers.

“We’re showing benefits; there’s not this mass fraud the payers were afraid of,” Lee says. “So that piece we’re trying to lobby to keep in place.”

Robin Wright King is director of consumer-directed health and engagement strategy for Blue Cross Blue Shield of Massachusetts and previously worked for BCBS of Michigan. She says one reason insurance companies were hesitant to reimburse telehealth prior to the pandemic was because employers didn’t think their employees would want it. “But I think we all learned something [during the pandemic] — that telehealth is a very valuable tool.”

Now, Lee says, it’s not so difficult to convince doctors to use technology for things like virtual appointments, especially for routine visits like touching base after a procedure or answering basic questions.

“I think for the most part, they have embraced the idea that they can still provide care at a distance and they can still provide quality care at a distance,” she says.

Investing in Innovation

It’s not only large institutions that are looking to the future. Virtual care and new technologies have helped to unleash an entrepreneurial spirit among product developers — and even physicians.

Dr. Ali Bazzi is business partners with Robin Wright King. Together, they started the company Urban Docz, a virtual care office dedicated to helping young women with sexual and reproductive issues.

Urban Docz was one of eight startup companies chosen by XLerateHealth, a nonprofit health care accelerator headquartered in Louisville, Kentucky, to be a part of its 2022 Flint cohort.

Bazzi is based in Detroit, where he did his OB-GYN residency. It was there, he says, that he noticed how many young women, who had no insurance, needed affordable access to basic reproductive care. While in many cases women would need to come into the hospital (“You can’t deliver a baby without being there,” he says), he also notes that he saw several women come into the hospital who could have had their questions answered over the phone.

“They would come in for the simplest thing, such as heartburn or a contraction,” Bazzi says. “And you have to understand when patients come in without health insurance, they’ve got to be seen. And before I even place a hand on their belly and start the evaluation, that already costs the health care system several hundred dollars. A lot of those complaints could have been answered virtually, … thereby lessening the burden of emergency resources,” he says.

Honor First is another metro Detroit-based company utilizing telehealth as a way of connecting people with limited access to health services. After witnessing the rise of shootings and violence in rural communities, its founders say they saw a need to connect more people with mental health services.

Utilizing telehealth, they connect therapists and patients but also overcome another
barrier that may be unique to less-populated communities. In a world that still stigmatizes mental health, who wants to sit in a waiting room in a small town where you might be recognized by neighbors?

“It’s a privacy thing,” says Dr. Jaschon Proctor, CEO of Honor First. “They’d rather see them online than in their office.”

Reaching Patients Where They Are

Not all doctors have come around to telehealth, Lee says — some doctors still just want to see their patients in person — but COVID has shown what is possible through telehealth, and at this point, it appears that there’s really no going back. She acknowledges that virtual or remote care is not a complete replacement. Sometimes people simply need to go to the doctor. Some exams require physical touch. You can’t do surgery over the phone.

But technology is reducing the need for some visits that would require a doctor’s examination. As one example, she cites TytoCare, a company that makes at-home exam kits you can purchase at Best Buy that allow a doctor to virtually look at a patient’s ears, nose, and throat or listen to their heart, among other things that would typically be done in-office.

Another example of technology breaking access barriers that Beauchamp cites comes from Higi, a health care company that MSU partnered with in 2021. Among other efforts, Higi and MSU have teamed up with Dollar General to put self-serve health kiosks in several of their stores — stores that are often found in rural areas with lower access to health care. The kiosks allow customers to check their blood pressure; BMI; and risk factors for Type 2 diabetes, heart attack, and stroke. If there are any risky indicators, the user can connect with a health professional at the kiosk.

“Again, it’s ‘Where are the people with health needs, and how do you lower the barriers?,’ right?” Beauchamp says. “Everybody has to go shopping. If there’s a way they can connect at a kiosk, they can ask a medical question, they can seek advice, and there’s a way to provide those answers, you then have lowered another barrier.”

Moving Forward

Such inventions are the kinds of things that Beauchamp wants to see continue to grow. That’s the goal of the MSU Grand Rapids Innovation Park, which brings public university researchers and private health industry partners under the same roof.

Typically, Beauchamp says, it takes 15 years to develop a product and take it through all the necessary steps to bring it to the market. As far as he’s concerned, that’s far too long.

Jerry Kooiman is the assistant dean for external relations at the MSU College of Human Medicine at the Grand Rapids Innovation Park where Beauchamp’s vision is coming to life.

“Whether it’s a product or device, pharmaceutical, a process, or an app related to health care and improving health care outcomes, … how do we move that to market more quickly?” Kooiman says of the problem they’re looking to solve.

“While faculty may be really good at discovering, they’re not entrepreneurs,” he says. That’s why MSU works with partners in the health care industry who can recognize the need for, or marketability of, what researchers are developing and work with them to bring it into the world.

For example, if a researcher at the institute developed an app that helped patients monitor their blood pressure, going from having the technology to making it something patients could use can be a lengthy process. If it’s something that would have to be approved by the FDA, even longer. But a company that specializes in apps would be well versed in each of the hoops that need to be jumped through to bring the app to market and, by licensing the product, can become a partner that gets that app out that much more quickly.

“They [industry partners] can bring it across the Death Valley of startups much more quickly than what a faculty member might be able to do, or the university,” Kooiman says. “The university still wins because there’s funding coming back to both the researcher and the university in terms of the licensing agreement [and] potential royalties, depending on how the agreement is set up. And it’s a win for the industry partner because they have a new product or device.”

A similar innovation park, or “health sciences center,” as Kooiman calls it, is slated to be built in Detroit in the coming years. In 2021, MSU announced a 30-year agreement with Henry Ford Health to construct the center, even though many of the exact details — like where it will be built and what kind of research it might focus on — have yet to be determined.

The center itself is, then, much like the rest of the future of health care and technology — unclear at the moment but coming and here to stay.

This story is from the Moving Medicine Forward feature in the October 2022 issue of Hour Detroit magazine. Read more in our digital edition.