The innovation paradox: Those who most need it can't get it

Access to care and access to Internet are becoming more synonymous. Depending on where you live, that's a concern.

When the Apple Watch was released, much hype surrounded the potential capabilities and functions of this new device. Those in healthcare were eager to see what this new wearable could contribute to the industry and how a smartwatch might affect patient care. Heart rate monitor, glucose tracking, a built-in pedometer — the opportunities seemed endless and promised a healthier population.

Until we look at who is buying and using the Apple Watch: by and large, people who are already healthy and don't need to monitor their heart rates day in and day out.

Herein lies the paradox of consumer-focused innovation: While the healthcare industry is bullish on developing new technologies and offerings that are meant to improve healthcare quality and wellness, those using such offerings don't really need them. And, the ones who do are often unable to access them.

A recent Wired article discussed this idea in the context of telemedicine. "The rural communities that could benefit most from [telemedicine] also have the least access to fast and reliable Internet — an obvious prerequisite," reads the article.

Hospitals and health systems are increasingly adopting telemedicine, offering remote video consultations for patients at home or connecting with specialists from academic medical centers for bedside care support. Patients are also open to the idea of receiving care this way: 74 percent of U.S. consumers would use telehealth services, according to a 2015 American Hospital Association survey.

But like the Wired article suggests, these offerings are moot if individuals don't have a broadband connection.

Wired cites the Federal Communication Commissions' 2015 Broadband Progress Report, which found 55 million Americans do not have access to broadband-speed Internet access, half of which live in rural America.

Rural providers, too, are left without connectivity, though less severely. According to a Health Affairs blog, just 1 percent of small providers do not have any broadband connectivity, but 7 percent of small providers in rural areas lack adequate access.

For families to use of telemedicine, they first need Internet access, and then they need Internet access that is strong enough.

Compound that with the fact that people living in rural communities often have more healthcare needs than their urban-dwelling contemporaries. According to the National Rural Health Association, rural residents tend to be poorer, with a per capita income $7,417 lower than urban residents.

In general, the health of rural America tends to lag that of the rest of the country. The NRHA reports hypertension is more prevalent in rural areas than in urban areas, at 128.8 per 1,000 individuals versus 101.3 per 1,000 individuals, respectively. Rural residents are also more reliant on food stamps. For fiscal year 2015, the average individual receiving Supplemental Nutrition Assistance Program benefits receives a monthly stipend of $127.14. Healthier foods tend to be pricier, and with less than $130 a month to spend on groceries, SNAP recipients don't always have the options or resources to buy non-processed, fresh foods.

Again, those who are more in need of care, telemedicine and Apple Watches are also those whose access is the most restricted.

Even clinic-based telemedicine offerings like those at CVS Health and Walgreens, which don't rely on individuals having broadband Internet connection, may fall out of reach.

CVS Health and Walgreens have actively pursued telemedicine services for their customers. CVS recently announced partnerships with three commonly used telemedicine providers — American Well, Doctor on Demand and Teladoc — to pilot new programs. Walgreens Boots Alliance is slowly expanding telemedicine coverage to 25 states using MDLive's platform. For minor ailments, these services are a convenient way for consumers to pop in, receive treatment and head out.

Unless you live in, for example, Decorah, Iowa, a small town near the northern border of the state with approximately 8,000 residents. The nearest CVS to Decorah is 62 miles away in Waterloo. The nearest Walgreens is 37 miles away in Prairie du Chien, Wis., according to each retail clinic's Store Locator tool. Not exactly a convenient care option.

To be fair, the government is making efforts to expand care to rural areas and even bolster broadband access and speed to these areas. The FCC's rural healthcare program allots $400 million a year in subsidies for the Rural Health Care Program, which seeks to ensure eligible healthcare providers have access to telecommunications and broadband services, but a Health Affairs report found total FFC spending under this program in 2014 only reached $65 million.

Reliable Internet access at home isn't always a given for these consumers, and they don't always have access to other convenient options like retail clinics, either. Innovation tends to become synonymous with convenience, but convenience means something different to a city-dweller than to somebody in a town like Decorah.

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