Identity-Aligned Interventions

A more inclusive healthcare system is emerging. It’s time to accelerate the change

Obvious |
Illustrations by Ula Sveikauskaite

A global pandemic, wildfires, hurricanes, and political unrest. The past 18 months have forced us to face an overwhelming wave of concurrent challenges. Many simmering for far too long, we’ve collectively watched in horror as they’ve boiled over.

The fragility of our healthcare system, it turns out, is in the same club. We’ve watched, listened, and felt the strain of a legacy healthcare system drowning in both rising costs and preventable casualties. As the cracks seemingly widen by the day, the clear inequity in access, resources, understanding, and outcomes across demographics has become impossible to ignore.

Today, there exists a clear opportunity for a new wave of both healthcare providers and diagnostic/care delivery platforms to better integrate patients’ lived experiences, personal profiles, and psychosocial needs into their course of care. Through such personalized, human-centric offerings, innovative operators will be able to demonstrably improve outcomes while bringing down the overall system costs—a win for patients, payers, plan sponsors, and providers alike.

We can collectively agree that underserved patient populations—be they Medicaid beneficiaries, women, people of color, or members of the LGBTQ+ community—deserve more. From a lack of access and a history of misdiagnoses to shortcomings in clinical understanding and inherent bias in treatment, wide segments of the population have been left behind for too long in the ongoing healthtech revolution, which has, in many ways, continued to affirm existing clinical biases.

Today, Black women are still three times more likely to die of pregnancy-related causes than white women. Approximately 29% of transgender people report that healthcare providers have refused to see them because of their gender identity. And women remain 50–75% more likely than men to have an adverse drug reaction because of their exclusion from or underrepresentation in clinical trials.

We must do better.

We at Obvious see the potential for an emerging class of identity-aligned healthcare providers to transform the ways in which we diagnose, treat, and engage with a broader base of patients. Propelled by greater societal awareness of healthcare disparities, the ACA’s ongoing implementation of expanded Medicaid eligibility, expanding insurance offerings for targeted populations, and heightened cultural engagement across a wide range of social justice movements, there has never been more momentum supporting such a shift.

As we evaluate what it takes to catalyze this change, we’ve identified the following emerging areas as beacons of hope:

1. Digitally-native clinics for distributed patient populations
Despite the almost $4 trillion allocated to U.S. healthcare expenditures annually, many millions of Americans are consistently denied adequate care due to both geographic barriers and problematic degrees of bias from providers themselves. The internet has empowered people to find like-minded communities all over the world—should it not also help them connect directly with healthcare providers who meet their needs as humans? Today, digitally native clinics tailored to specific patient populations can drive better outcomes though human-centric, value-based approaches that invite in previously disenfranchised patient populations and communicate with them in a language (and via alternative offerings) that resonate. From Folx, a virtual health clinic focused on the queer and trans communities, to Main Street Health, a value-based care platform designed for rural Americans, we’re already witnessing an emerging class of providers rising to meet patients’ needs as multifaceted humans, not simply textbooks brought to life.

Looking ahead, what role must payers play in accelerating and incentivizing such innovation through outcome-oriented and/or risk bearing reimbursement practices? To what extent must legacy treatment protocols, which far too frequently retain a degree of bias and/or a predisposition towards acute interventions, be transformed to effectively meet both the physical and psychosocial needs of these diverse patient panels? And to what degree will in-person extensions of such offerings—be they standalone storefronts, joint ventures with local health systems, or at home appointments facilitated by contracted clinicians—be needed in order to deliver comprehensive, end-to-end care?

2. Remote diagnosis and treatment
We have long been told that data doesn’t lie, but we’ve historically under-collected and under-analyzed treasure troves of information from the populations that stand to benefit the most. Flawed diagnostic and trial designs (did you know that women were not required to be included in clinical trials until 1993?!) have left doctors guessing, leading to delayed or altogether incorrect diagnoses, improper treatment, and suboptimal outcomes. Fortunately, new technologies ranging from remote patient monitoring to metagenomic sequencing can exponentially improve our ability to effectively detect, diagnose, and deliver care. We’re already seeing innovators like Evvy*, an at-home testing company decoding the vaginal microbiome, and Pair Team, an automation and remote care platform for Medicaid primary care, leveraging the use of patient data to better inform and influence clinical interventions.

Moving forward, what systems and infrastructure—be they biometric monitors or care coordination platforms— are needed to ensure that data capture and integration extend beyond biohackers to reach the millions of Americans whose lives will be meaningfully enhanced by such monitoring and interventions? How might payers and health systems incentivize and incorporate the use of longitudinal patient data in order to influence the overall course of care? And how can we guarantee that the algorithms informing these recommendations are free of bias and effective for patients of all identities?

3. Socially integrated care
A wave of studies over the past twenty years has revealed the clear influence of lifestyle, economic stability, and social conditions on healthcare outcomes. Yet, today’s supply-driven system continues to be organized around what treatments can be applied and reimbursed in a clinical setting. As we transition towards an outcomes orientation, the future of healthcare is likely to look and feel social as we better incorporate a broad base of social determinants of health (SDoH) into our course of care. From UniteUs, a software platform standardizing how health and social care providers communicate, to Cityblock Health, a full-stack provider for Medicaid populations using a behavioral health-centric approach to address the unmet health and social needs of its patient base, we’re already witnessing accelerating reimbursement of SDoH-oriented solutions at both the payer and health system levels.

In the future, will we see healthcare’s jurisdiction continue to expand beyond traditional CPT billing codes and transition towards value-based care as we better understand the role played by factors like food and financial security on our overall health? Will regulatory efforts at the state and federal levels expand eligibility and the degree of support provided to both patients and their families? And will we see comparable coverage expand beyond major metropolitan areas, which are today commanding increasing attention from VC-backed Medicare Advantage and Medicaid focused startups, to reach the roughly sixty million underserved Americans who live outside of urban centers?

After years of under-appreciating the variability in healthcare offerings and outcomes across patient populations, it is my hope that we can leverage more comprehensive and inclusive insurance coverage, better access to and understanding of data, and a whole-person approach as grounding pillars of an up-leveled course of care. By effectively leveraging such variables, we’ll position our system to realize meaningfully better healthcare outcomes—at lower costs.

We have the tools at our fingertips to drive a paradigm shift. It is our responsibility as policymakers, investors, and innovators to make this structural shift a reality. If you’re ready to help us ignite this change, we’d love to hear from you.

Note: The author of this post is an investor in Evvy.