Podcast: Providing Accessible Healthcare for All in a Digital Age

Shawna Watley: Hello, thank you for tuning in today to our Holland & Knight Public Policy & Regulatory group Eyes on Washington podcast. Today we are talking about health for all in the digital age. Our special guest is Tanisha D. Hill, who is the senior U.S. medical director of the digital health portfolio of products at Teva Pharmaceuticals, and the president and founder of the Digital Health for Equitable Health Alliance, which is a nonprofit organization with a mission to improve access to care in underserved populations using digital health. I am so thrilled to welcome you here today Tanisha. During this podcast, we will focus on the evolving story of digital health across sectors and technology and how the government can be involved in digital health transformation to achieve equality in healthcare. So, Tanisha, welcome. Can you describe your role at Teva Pharmaceuticals as well as Digital Health for Equitable Health Alliance?

Tanisha's Background and Current Roles

Tanisha Hill: Sure. Thanks, Shawna. I'm so excited to be with you all here today. So let me first thank you for the invitation and the opportunity to have this important discussion. So I have two very separate roles, although both have some relationship to digital health. So my role, at Teva, is to generate evidence, develop education and medical communications support of our respiratory and digital health products. So among other things, I currently lead seven clinical studies to understand the effectiveness of our digital inhalers in real world settings. And I also lead implementation studies and healthcare provider education around digital health. I've been involved in digital health at Teva for over six years from the FDA launch approval to the launch of our currently fully sensored integrated digital inhalers, which is where I developed the passion for digital health and the subsequent desire to start the Digital Health for Equitable Health Alliance. So my goal was that no one be left behind in the rapid and global expansion of digital health. So Teva and Howard University College of Medicine were the first organizations to partner in the development of Digital Health for Equitable Health Alliance, which we call DHEH or the Alliance. And the member organization has quickly grown to include 12 members, and we're still growing. And what's unique about DHEH is our focus on policy to improve access to care, using digital health technologies, and the fact that unlike other similar groups that we've seen, DHEH includes representation of the people that we're aiming to serve as members. As a matter of fact, our organization's bylaws are structured where the board composition must contain representation from the community. So as the President of DHEH, my role is to continue to build the organization, oversee programming execution, and that includes drafting of comments in support of policy and to develop sustainability. And I'm excited to work with a group of amazing members from various sectors who have all committed to making a difference in access to care in underserved communities.

So as the President of DHEH, my role is to continue to build the organization, oversee programming execution, and that includes drafting of comments in support of policy and to develop sustainability. And I'm excited to work with a group of amazing members from various sectors who have all committed to making a difference in access to care in underserved communities.

Making Health for All in a Digital Age Happen

Shawna Watley: Wow, that sounds amazing. So this is really a passion kind of project for you. And given your background in what you do on a day to day, I can't think of a more important person to pursue this and really to stand up this organization. Can you explain to us, for our topic today, kind of what does health for all in a digital age look like and how do we make that happen?

Tanisha Hill: Yeah. So first I have to state the obvious Shawna, which is that we currently do not have equal access to healthcare for all even today in the current, quote unquote, digital age. So, the 21st century is often referred to as the digital age. And in the 21st century, we've seen the rise of a global economy. We've seen significant advances in digital health, like the evolution of the continuous glucose monitoring, the introduction of digital therapeutics. But as recently as 2021, 11.8% of African-Americans and 23.6% of Hispanics still have no healthcare coverage. They're not insured compared to just 7.5% of whites. The rates of uninsured Black and Hispanic people are higher than the national average as well. And so we see already that there's inequities. This unfortunate reality is that health inequities exist across the U.S. healthcare system. And these are often driven by a number of factors which include social determinants of health and racial and ethnic health disparities can actually cost a lot, can cost as much as $309 billion annually. So you're essentially, were asking me how do we move from health inequity to health equity in a digital age? Well, I believe we can start the movement by utilizing the digital technologies that have made this digital age. We need to maximize on the growth of digital health. But, now consider how these technologies can help everyone as we develop the technologies, as we implement the technologies. And even as we evaluate the technologies. So, for example, if I'm developing a robotic pill dispenser, I have to ask myself, will my 80 year old grandmother really be able to use this if I develop a new app? I should ask someone who speaks Spanish or has low literacy levels be able to read or use this app? And the government can be involved in this supportive access to all. Similarly to its current involvement in diversity in clinical trials. So if there are new technologies, for example, that require FDA approval, the government can also consider access to all of these new technologies for everyone and ensure that there's diversity in the trials of the new technologies or ensure that the language used was appropriate in terms of literacy levels. So what DHEH is asking the government for is for various policies to ensure access of digital health tools for everyone, that includes broadband reimbursement access and clinical trials, data safeguards and interoperability.

We see already that there's inequities. This unfortunate reality is that health inequities exist across the U.S. healthcare system. And these are often driven by a number of factors which include social determinants of health and racial and ethnic health disparities can actually cost a lot, can cost as much as $309 billion annually.

Role of Community Stakeholders in Supporting DHEH

Shawna Watley: Wow, that sounds like a big bite. But, you know, I am excited to see an organization like the alliance come to fruition to bring these issues to bear on Capitol Hill and the administration, doesn't matter Democrat or Republican, these issues need to be tackled and we need to do it as a community. So what are some of the things that community stakeholders can do to support the work that the alliance is doing?

Tanisha Hill: Well, the good thing, Shawna, is that many diverse stakeholders in the digital health industry are already coming together, including some community stakeholders, to accomplish this goal. So, for example, when I attend various digital health conferences like ViVe or the American Telehealth Association or hands conferences, there's a focus on diversity and equity. And it's amazing to see all the work that each group and all of the invited speakers from various industries like pharma, managed care organizations like Walmart and Google and IBM, they're already doing quite a bit in this space. I think the key, though, is to have one organization lead the charge as it relates to policy change, and that's why we established DHEH. And policy is actually one area of unmet need that most groups aren't covering. When I hear what people are doing, there's a lot of activity in diversifying clinical trials, there's a lot around COVID-19, there's a lot of focus on interoperability and even data safeguarding. But, you know, there's still and there's a lot around education as well, health literacy, what we call digital literacy. But I do hear, when I go to these conferences, there's so much focus and people are doing such great work in those areas, we figure we wouldn't recreate the wheel, but focus on an area of unmet need where there's still a gap, and that's around policy. So that's where we think DHEH will play a significant role.

We figure we wouldn't recreate the wheel, but focus on an area of unmet need where there's still a gap, and that's around policy. So that's where we think DHEH will play a significant role.

Types of Digital Health Technologies Paving the Way

Shawna Watley: And what are some of the issues or, for instance, you know, on Capitol Hill, you have so much turnover. You do have like healthcare experts who see themselves as policy drivers. But, you know, for instance, when you talk about digital technologies, like what are you speaking of like if you were talking to a health staffer who handles healthcare, what is it about digital technologies or can you provide examples of digital technologies that really could be transformative for underserved communities?

Tanisha Hill: Yep. So it could be anything. And it's a really great question that you're asking, because I think one of the challenges that we do have, and I'll talk a little about this later, is how do we even define these digital health technologies, right? And so there's this terminology in terms of "Internet of Things." Basically, anything that you can connect digitally to kind of help support the development and the advancement of healthcare. So for example, there's telehealth, right? So where you're just getting on, you're doing sort of a teleconsult where you're getting something like what we're doing today, a Zoom, we're sort of interacting, we're not in the same location, but it allows now a healthcare provider and a patient, for example, to have a very similar communication, a bi-directional, real time communication about that person's healthcare. And we say telehealth because telehealth could also mean mental health consults. It could be a teleconsult where a physician is actually doing, believe it or not, doing a physical exam where you can get the patient to grab a remote technologies to check their breathing or check their blood pressure. And you can collect vitals that way. I think the advantage of that type of technology when you are doing a teleconsult, is that you can see the individual, the patient's surroundings as well. And that's important. I don't think people realize how important a technology, digital health technology that gives you a window to a patient's world is because it helps you to identify some of the social determinants of health that impact patient care. So now you can see where the patient's living. If they're an allergist, for example, you can see if they have 20 cats in the back that are smoking when they should be around those allergens. And so there are other types of technologies, right? So there's technologies where you can collect vital signs remotely. There's just so much. And there's over 300,000 apps, I think was the most recent number that I saw in terms of healthcare apps. So healthcare apps are also considered digital health. There's a full gamut. And I think that that's why it's so important right now to maximize on this growth of digital health technology, to improve health equity. There is a lot of noise. Like I said, there's over 300,000 apps. But I do think that there is opportunity still and we can focus our attention on what works. There are several groups like Howard University College of Medicine, for example, has established a project called the 1867 Project, and that initiative is actually pilot testing some of these digital health technologies in underserved populations. So now we will have research, we will have data to show that these types of technologies, whether it be telehealth or a robotic pill dispenser, do work in these underserved communities and can actually make a difference in health outcomes.

I don't think people realize how important a technology, digital health technology that gives you a window to a patient's world is because it helps you to identify some of the social determinants of health that impact patient care.

Getting Involved and Elevating the Digital Transformation of Health

Shawna Watley: Well, that's amazing. It just seems like there's just so many opportunities just to be helpful, that can really help individuals who are struggling with healthcare and having access to be able to access a doctor or a practitioner from their own home where we didn't have those capabilities previously. Can you talk a little bit about how to elevate the issue of digital transformation of health and bring more people and organizations into the conversation to generate greater understanding?

Tanisha Hill: Yes, sure. So, you know, for me, the best way to do it was the approach that we took with DHEH, because I had not yet been exposed to all the work that everyone was doing pre-COVID around this topic area. And unfortunately, Shawna COVID came with quite a few negative impacts in the country that we're all too familiar with, like the number of deaths in the millions. And, you know, the global impact economically, it's just been so much that's been negative. But between the COVID-19 impact and the incident with George Floyd in terms of social unrest, the issues around health equity and health inequity, I should say, have been elevated. It's the first time that I have seen and my dad is 87 years old. We have these conversations all the time. And he has been through, I mean, so much historically. Also, the first time he has seen the conversation around transforming health and diversity and inequities be to this level. We've never had this opportunity. And this is probably unfortunately the only, you know, a positive that came out, if we're going to think about a silver lining in the cloud. It would be the opportunity to do something like this. We would not normally have been having this conversation on a podcast today. We wouldn't see as much in terms of conversations among groups, among different organizations. And people are so passionate about change that I don't think we get a chance to see how passionate so many individuals, but also companies, members, organizations are so passionate about making a change in terms of the digital transformation of health and also around health inequities. And so, you know, again, the DHEH was an effort to start talking more around these topics. I have never gone to as many conferences, I've been doing this work probably, I don't know, probably at 30 years now at this point for so long. And I have never seen so many people making the time to put a conversation about digital health, digital transformation or health equity and diversity on an agenda. I'm so proud of the work that we are doing. It's going to be slow, but we have to be steadfast. And I think as long as we continue to elevate those conversations, just having them alone is making a difference. When I go to these conferences and I talk to people. I'm not only impressed with what they're doing, but I get the opportunity to talk to them again. Right, it doesn't end there, it doesn't end at the conference, and sometimes we partner when we can actually do something. So I know that conversations may not seem like a big deal, but it is. It's the start and sometimes it's the finish. And so I think that that's really what we need to do. We need to just keep talking more and not be so afraid to have conversations that are uncomfortable around, you know, digital health because a lot of people don't know about it or like, you know, just asking questions, like you asked, what is a digital health technology exactly? As well as having conversations that might not be comfortable around diversity, racism, inequities and hopefully getting to a conversation about equity in healthcare.

I'm so proud of the work that we are doing. It's going to be slow, but we have to be steadfast. And I think as long as we continue to elevate those conversations, just having them alone is making a difference.

Shawna Watley: I couldn't agree with you more, you know, it's so important, as you stated, for us to have these courageous conversations and in some cases and that, you know, folks are much more comfortable now addressing these issues. And I agree. Coming out of COVID the summer of 2020 with George Floyd, it has pulled the scab off the sore. And we are starting to address where the needs are. And I'm excited to hear and see so many large organizations that have the resources they're willing to invest the time and the brain capacity to really bring stakeholders together and thought leaders together to figure out how we tackle some of these tremendous challenges as it relates to health inequities. So I couldn't agree with you more, and I thank you for your leadership in the work that you are doing, because it does take a lot. You're absolutely right. And it starts one conversation at a time to move us forward. And I know you have a full time job and this is something in addition to what you do on a day to day. So we really appreciate your leadership and just bringing your experience to the table and your relationships to build something that can last and really have a transformational impact in the community. You know, I just have a few more questions. One of the things you talked about when you talked about your dad, you know, I look at my parents and, you know, they're really good now at taking their own blood pressure or getting the oximeter to measure their oxygen levels when they had COVID. And then the telehealth piece, where they can call up their doctor when they're not in the same city, but they're not feeling well, but they can still have access to their doctor. So these are things that I don't think that we will go back to prior to COVID. Like pre-COVID, they weren't doing these things. But since COVID has taken place, now they're starting to use technology when they hadn't used it before and really didn't know about it. And I know even on the Hill, you know, there's legislation now where telehealth was being covered temporarily, but now they're pushing for that to be covered, period. That should just be a part of, you know, folks' insurance. And so I think we are making progress, and that COVID did expose a lot as well. And I'm glad we have now the alliance to be able to go to the Hill and talk to some of these members as to why telehealth should be covered fully under Medicare or Medicaid. So thank you for the work that you're doing in that space. Is there anything you know, as we share this discussion, is there anything that you would like potential organizations that could join the alliance to know? Why should an organization join the alliance?

Joining DHEH

Tanisha Hill: Yeah, like I mentioned, I think the alliance is for an organization who has the likeminded spirit to make a difference in access to care, specifically using digital health. So I know I rattled off earlier quite a bit of areas of focus that we have. There's really only six. But in order to really make a difference, Shawna, I think we have to, and you alluded to this, is take small bites at the elephant. Access to care in the United States is impacted by so many factors underlined by discrimination, of course. But there's you know, there's the built environment that's a challenge, there's education and inequities in income. All of these are things that we just can't, as a few members or individuals or even a country today overcome, that would eventually impact inequity in healthcare in a good way. But if we start small and we focus on certain areas like digital health, which is growing exponentially, which allows us to touch people in ways that we have not ever been able to do. If there is an organization that wants to do that with us, that wants to take that technology and really try to bridge the gap in terms of access. Those are the folks that we would want to invite to be members of the DHEH. Knowing that we have very certain areas of focus that are all very important, that could have a significant impact in terms of social change around access. And that's like I mentioned, it's around reimbursement, broadband, clinical trials, data safeguarding, interoperability, you know, just to name a few. And there's so much, you know, within all of those topic areas that we have the opportunity to make an impact year over year. So we would invite members that want to have an impact on underserved communities in underserved populations, using new ways being novel and impact that's sustainable by way of policy change.

We would invite members that want to have an impact on underserved communities in underserved populations, using new ways being novel and impact that's sustainable by way of policy change.

So DHEH is really, we're not here to reinvent the wheel. And we're lucky, I would say fortunate to have Holland & Knight and the team that we're working with, because the group is identifying existing policies that we believe align with our mission and really fit well with our policy statements. So we've already identified so many opportunities that we can support. We need multi-sector groups, multi-sector organizations to be a part of that conversation. You know, we talked about conversation earlier, and we need that because so many people, so many member organizations have various perspectives that all will have an impact on changing healthcare access to all. So for example, I come from a pharma background, I'm also from a clinical background. I've led private practice. I've worked at the Centers for Disease Control for a number of years, so I've been all over and I was talking to a member group, a potential member organization about the DHEH. And I'm thinking access to telehealth, right? I'm thinking, okay, 80% of Hispanics, blacks and whites all report having a cell phone, but does everyone have broadband? Turns out only about 25% of people actually have broadband in the African-American community. And so I'm thinking these are the things we need to address. And he said to me, you know, Tanisha, this would be ideal for us, we have such an area of focus because we work on lab testing and oftentimes people of color, while they may get a chance to see the doctor, they may not be able to get the labs done. They may not be able to get their radiologic testing completed because it's so expensive or they don't have access to it. And I didn't even think about that, Shawna. So we invite multi-sector stakeholders from all walks of life, from all representations, whether or not you're the Amazon Web services of the world or the trade associations or other pharma companies, especially people who are representing the people of color who we want to serve. So patient advocacy, physician advocacy, these are all intended members for DHEH. So we invite anyone who is aligned to our mission.

We need multi-sector groups, multi-sector organizations to be a part of that conversation. You know, we talked about conversation earlier, and we need that because so many people, so many member organizations have various perspectives that all will have an impact on changing healthcare access to all.

Shawna Watley: That's awesome. Well, I commend you for the work that you're doing. I can't thank you enough for joining us today. What a robust discussion. I've certainly learned a lot and I admire the work that you all are doing and we look forward to partnering with you. And we hope this discussion has shed light on the challenges and barriers that must be addressed in order to ensure equitable access to healthcare for all. Thank you again for joining us today.