Intro: The following SHSMD Podcast is a production of Dr. Podcasting.com.

Bill Klaproth (host): On this edition of the SHSMD podcast, we talk about Digital Equity and Inclusion in Healthcare with Caroline Franz. Digital equity. You say. Yes. That is what I say because digital equity is a super social determinant of health. So how do we understand this better and come up with strategies to address digital inequity?

 Well, good news. Caroline will be presenting at this year's SHSMD Connections 2023 conference on this very topic. So let's hear more about her session and how to deal with digital inequity, right now.

 This is the SHSMD podcast, rapid insights for healthcare strategy professionals in planning, business development, marketing, communications, and public relations. I'm your host, Bill Klaproth. In this episode, we talk with Caroline Franz, Associate Studio Director at Kaiser Permanente. She is doing a session at this year's 2023 SHSMD Connections annual conference in Chicago. It's called Digital Equity and Inclusion in Healthcare, Designing a Systematic Approach. This is going to be an important session.

Hopefully you can be there Monday, September 11th. All you have to do is sign up, just go to shsmd.org/education/annualconference, and get yourself signed up. Would you do that for me? Thank you very much, Caroline. Welcome to the SHSMD podcast.

Caroline Franz, NCIDQ, MBA, MDes: Thanks Bill. I'm so happy to be here.

Host: Well we are happy to have you here and we are looking forward to having you at SHSMD Connections 2023 in Chicago. Can you give us the cliff notes version of your session?

Caroline Franz, NCIDQ, MBA, MDes: Yeah, so over the last couple of years Kaiser Permanente, we serve 12 million members across the nation. And it became very obvious, you know, with the onset and now the outset of the pandemic, that digital is front and center in everyone's lives and with our population, we realized that we have to go beyond bridging the gaps for those who can't engage fully in the digital world and address barriers for those who can engage, but also are choosing not to because they're uncomfortable. And so it's a strategy that we think is incredibly relevant and important and impacts more than just a person's showing up for healthcare; it impacts all aspects of their life.

Host: So, as you said, digital is front and center. So then this term digital equity, what is digital equity and why is that so important?

Caroline Franz, NCIDQ, MBA, MDes: That's a great question, and this isn't my terminology. It's a term that is out in the world and digital equity is a state in which all have the information technology capacity needed for full participation in our society, our democracy and economy, and the digital inequities can impact all social determinants of health, not just your access to and quality of healthcare.

So it's a pretty prevalent issue that is in enfolding people in or leaving people out.

Host: So digital equity really is important when it comes to social determinants of health. Is that right?

Caroline Franz, NCIDQ, MBA, MDes: Yeah, that's correct. It's actually been called the Super Social Determinant of Health because it does impact so many aspects of a person's life. You know, your education, your work, your family life, your connection to finances, finding a job, your healthcare of course, and so many other things, entertainment, finding partners these days, all of it.

So it's an incredibly important aspect.

Host: So digital equity, the super social determinant of health. I love it. So how do we find out who is living with digital inequity? I mean, can we leverage our own data to understand this?

Caroline Franz, NCIDQ, MBA, MDes: Yeah, Bill absolutely. At Kaiser Permanente, we have a ton of data on our member base. But we sometimes don't know how to leverage that, where to look. And right now we're not actually asking patients about their digital equity or inequity. That's something that we're piloting and starting to roll out so that we can have a better pulse on that.

But while we were doing that, there were a number of ways that we tried to find out who might be facing digital inequities within our member base. And certainly you can draw kind of proxies to where people live. There are infrastructure issues across the United States. You can draw similar lines to other socioeconomic inequities, often people with lower income, different communities and backgrounds and cultures. There's just a lot of alignment with the inherent inequities that exist today in the United States. So, we looked for that. We also did a lot of digging for new information that we didn't have yet; sending out surveys, asking people, figuring out what data outside of Kaiser Permanente was relevant. How could we cross tab that with what we do have and where can we find new insight.

Host: Really interesting. So as you said, you're starting to ask the questions now, trying to find out who has digital inequities. So when you find this information out, do you tie it down to certain zip codes?

Caroline Franz, NCIDQ, MBA, MDes: Yeah, that's a great question. And actually we were able to do that. We have a pretty robust set of data analysts that we are thankful to have a great relationship with, and they specialized in mapping things geographically that we are able to bring them. So we're able to see with our own data sets and that geographic mapping, that it's not necessarily infrastructure that's impacting our KP members.

A neighborhood doesn't have the wiring or whatever it might be to connect physically to the internet, but rather it is an affordability issue for our members. It's simply, the cost of internet and data plans is just pricing out a lot of our patient base. And so that was a great insight that we saw of being able to see, you know, it's still in pretty urban areas. It's all wired and current. So that wasn't the issue, particularly for our members.

Host: So you've mapped it out, you understand the areas where there is digital inequity. So the next question is now what, knowing what you know now, how did you put a strategy together to address it and what is the strategy?

Caroline Franz, NCIDQ, MBA, MDes: Yeah, that's a great question. And as you might imagine, the strategy and vision that we've put forward is quite robust. And it's not something that can take place overnight. And so we've tried to intentionally think of ways to incrementally improve digital equity as we reach for that North Star.

So we're starting with, like I mentioned, adding those kind of digital connection questions to our social health screener. So if you're a KP member, you're usually pretty used to answering questions about what your family life is like. Do you have access to food? Do you need other services?

So this now folded into that set of question so that give us one toe in to know a little bit more about our members so that we might connect them with things in their community. Programs that can help them afford a device, find subsidiaries for the data plan, whatever it might be. So that's one small step.

There's another small step in the strategy that is leveraging our call center to connect people directly to services that are federally provided for better cost of service. So we have a couple of those toe ins, but other big issues that we're looking at, we do a lot of work around policy and how can we show up on the hill to influence nationwide, what it means to think of internet and digital connection as something bigger than just a service people pay for.

And so how does that impact our presence across the US and how we can show up our members and there's other strategic stuff that really begins with how we use the information that we have, how we design programs out in the communities, how we partner with organizations in the communities that we're present in, and start to have a bigger, more collective approach to this issue because it is so pervasive and we want to start to make a difference.

And also, it's a lot of self-reflection too. Of course we have our website, our digital apps, and we're asking our members to meet us oftentimes online. And so we have to be able to help them do that. Right? So there's education across our employees, our physicians of, how can we make that a great experience and how can we still make it something that members are choosing to do?

So it's never going to be something that's forced. We still want to enable that choice, but to make it a fruitful one, when members do choose it.

Host: So Caroline what have the results been so far? How do you measure this? What is success look like for you?

Caroline Franz, NCIDQ, MBA, MDes: That's another great question. And with some of our programs that we've been able to pilot you know, during the pandemic and on the heels of it, we were able to test a pilot that was connecting folks to some federal programs. At the time it was called Lifeline. Then coming out of the pandemic, it was the Affordable Connectivity Program.

And we love running pilots because we can leverage some small concept testing, see and track and evaluate are people taking the call when we say, we've noticed that you have this need, do you have interest in connecting to these programs? And our outreach was incredibly successful.

I think we reached over 7 million of our members in the two markets that we were touching, and we had incredible interest in people saying, yes, I would absolutely like to be connected to this program. Can you help me do that? And that kind of one-on-one connection. And then getting people online, getting them that device.

 And the initial pilot results that we saw there, proved out that we should make this real. And so it's something that we're looking to deploy in all of our markets.

Host: So when you say device, is that a laptop or a phone or a tablet?

Caroline Franz, NCIDQ, MBA, MDes: Oftentimes most people are using a smartphone when it comes to connectivity. But there still are folks that rely a lot on desktop, laptop, tablet, but I'd say, nine out of 10 people today have a smartphone in their pocket. And so that tends to be the more popular way that people are connecting.

Host: So Caroline if another organization wants to follow in your footsteps where should they start?

Caroline Franz, NCIDQ, MBA, MDes: That's a great question too, Bill. And I would say what we did is we started with what we knew or at least who to ask about what we might know. And so we started inside just understanding the data that we had, looking at the numbers, looking at issues and other things that would help paint the picture of who might be connected and who might not be. We also relied on a lot of external data sets that were freely available, through different institutions across the US that started to quantify digital connection and what that looks like. And then we actually find an incredible amount of value in practicing human-centered design, where it's more of a qualitative approach. And so it's talking to, very personally and at length 20 to 30 people that were experiencing digital inequities firsthand. And so you really get to experience what they're experiencing through their firsthand stories, encounters and their feedback on what that's like, how it impacts them, how it impacts their health and other parts of their life.

And so that's something that we believe strongly in and I always recommend is a thing for others to try. Just so you can hear firsthand what that experience is truly like.

Host: Right. And if you want more details on all of this, I know Caroline, you're going to go into a lot more details and specifics during the session. The session is Digital Equity and Inclusion in Healthcare. It's going to be a great session. It's on Monday, September 11th. Caroline, thank you for your time. Before we wrap up, one last question.

Any final thoughts you want to add?

Caroline Franz, NCIDQ, MBA, MDes: Oh gosh. That feels like a loaded question. But I think know, we're just continually trying to work to understand that real lived experience of those who face digital inequities among our membership and beyond. And we're continuing to try and build the evidence around this issue because it's a pretty new issue that we're facing in the world today.

And so the more that we can all come together collectively to push against this, and make sure that if people want to be connected, that they can be, and that we're there to enable that and use it to drive equitable health outcomes across the nation and beyond.

Host: Yeah. Absolutely. Well, thank you again. This has been great talking with you. I know this is going be a great session. Again, it's on Monday, September 11th at SHSMD Connections 2023 in Chicago. Caroline, thank you so much for your time. I really appreciate it.

Caroline Franz, NCIDQ, MBA, MDes: Yep. Thank you.

Host: And once again, that's Caroline Franz. Her session is on Monday, September 11th. Make sure you get to SHSMD Connections, 2023. Well, you haven't signed up yet. What is that what I'm hearing from you? Oh, my goodness, please. Just go to SHSMD.org/education/annualconference. Come on, it's going to be September. It's going to be Chicago. It's going to be gorgeous. And you're going to learn a lot and meet a lot of great people and you can stop by the Dr. Podcasting booth and say hi to me. We'll be doing the SHSMD podcast that you're hearing right now live from the show floor. So come by and say hi, would you do that for me? That would be nice. I'd like to meet you. Uh, my one listener.

No, I'm kidding. We have thousands and thousands of listeners. I mean come on. It's the best healthcare marketing podcast there is people please. Hello. All right. Thank you for listening as always. I'm Bill Klaproth your humble host, and this has been a production of Dr. Podcasting. See ya at SHSMD Connections.

 See ya.