Shattering Healthcare Barriers for Vulnerable Patient Populations

In the United States, disparities exist in access to healthcare. To improve outcomes for vulnerable patient populations, healthcare providers must focus on shattering these barriers by embracing disruptive innovation.

Vulnerable Patient Populations

According to The American Journal of Managed Care, vulnerable populations may include racial and ethnic minorities, economically disadvantaged populations, and people with chronic health conditions. The elderly, the very young, and LGBTQ+ populations may also be vulnerable.

In vulnerable patient populations, social factors such as instable housing, culture and language, financial insecurity, or any combination of other intersecting factors can exacerbate the challenge of receiving appropriate healthcare.

The pandemic has highlighted how racial disparities can affect outcomes. According to the Kaiser Family Foundation (KFF), American Indian and Alaska Native, Black, and Hispanic populations have experienced higher rates of illness and death caused by the COVID-19 pandemic.

The Four Types of Healthcare Barriers

While the patient’s unique situation presents one type of barrier, there are many others. A 2019 Cambridge study¹ identified four key categories of barriers that limit ideal care: (1) system barriers, (2) clinic barriers, (3) patient barriers, and (4) provider barriers.

Below are examples of each:

• System barrier: Discharging patients without first scheduling follow-up appointment, allowing patients to fall through the cracks.
• Clinic barrier: Long wait times and lack of availability of appointment times that work within patients’ schedules.
• Patient barrier: No transportation to attend clinic appointments.
• Provider barrier: Provider does not consider patient’s cultural background while determining treatment and protocols.

 A Closer Look at Patient Barriers to Care

While vulnerable patients face a variety of barriers to care, below are some of the most common obstacles:

• Resources: People may avoid or delay care due to a lack of money or health insurance. Gallup found that 18% of U.S. adults could not afford quality healthcare. Among Black adults, 29% could not afford care.
• Physical Access: People may avoid or delay care because they have difficulty getting to the healthcare facility. The American Hospital Association says that 3.6 million people in the U.S. miss out on care each year because of transportation issues. Additionally, people who live in areas without local access to care and people who are incarcerated may have difficulty obtaining the care they need.
• Communication: People may not receive the care they need because of language and literacy barriers or because they lack access to information or online systems.
• Politics: Undocumented immigrants and refugees may avoid care due to a lack of resources or because they are worried about their status in the country.
• Disabilities: People with physical or cognitive disabilities may have increased difficulty accessing care.
• Biases: Biases could include racism, religious discrimination, and LGBTQ+ discrimination, as well as stigmas against sex workers, obesity, drug use, or HIV status. Patients may not receive the care they need because of biases that the care providers have, or they may avoid care because of negative experiences involving biases that they have had in the past.

Embracing Disruption to Help Vulnerable Patients

Healthcare organizations may say they care about helping vulnerable patients, but are they taking steps to change the status quo? Are they devoting resources to shattering barriers?

To achieve real improvement, small changes may not be sufficient. We need disruptive innovation. Coined by Clayton Christensen, disruptive innovation “allows a whole new population of consumers at the bottom of a market access to a product or service.” While organizations often focus on sophisticated services or products that only consumers at the top of a market can access, disruptive innovators focus on simple applications at the bottom of the market.

Applied to healthcare, disruptive innovation can help organizations reach patients who struggle to access care. However, people are often resistant to change. The Diffusion of Innovation theory, developed by Everett Rogers, explains how innovations spread and can be used to help accelerate adoption. According to the model, four key factors impact the diffusion of innovations:

• The innovation itself.
• The communication channels used to share the idea.
• The amount of time needed to get people to accept the new idea.
• The social system and how it interacts with the new idea.

Conducting Honest Assessments

Before you can achieve real change, you need to conduct some honest assessments.
A SWOT analysis can help you evaluate your organization. A SWOT analysis looks at the following:

• Strengths: What advantages and resources do you have?
• Weaknesses: What are your limitations?
• Opportunities: How is the industry changing and what new technology can help you?
• Threats: What obstacles do you face?

Consider the following areas:

• Spending: Does your spending reflect your mission statement?
• Internal Processes: What are your core competencies? What isn’t working?
• Learning: What can you do better?
• Patients: What do your patients want and need?

It’s also important to assess your implicit biases. This requires an honest evaluation in order to identify the biases that may filter how patients are treated. The Harvard Implicit Association Test is a good place to start.
Achieving Real Change

Real change can be achieved, but it requires focus on four key areas:

• Process: Think about how and why you do what you do. View change as a marathon, not a sprint.
• Power: Think about the type of leadership your organization has in place.
• Personnel: Think about the skills and credentials of your workforce.
• Position: Think about your organization’s trajectory.

Keep in mind that efforts to implement substantial change may meet resistance. People often fear change, and this fear may also exist at the organizational level. Organizations may be afraid of failure, or they may worry about what they may lose in terms of money, control, and personnel in the process. Change involves uncertainty, and people often fear the unknown. Overcoming these challenges will require a mindset shift.
The Opportunity for Change Is Here

Right now, the opportunity for change is great. The pandemic has forced many changes. People may talk about trying to return to normal, but instead of going back to the way things used to be, we can use this period of turmoil and disruption to create true innovation and progress.

This article was based, in part, on the Coverys presentation, “Pivot: Embracing Disruptive Innovation to Shatter Barriers for Vulnerable Patient Populations,” presented by Jenelle E. Arnao, MS, CPHRM.

References: 
1: Johannes B, Graaf D, Blatt B, George D, Gonzalo JD. (2019), A multi-site exploration of barriers faced by vulnerable patient populations: a qualitative analysis exploring the needs of patients for targeted interventions in new models of care delivery.