Nir Altman Of Equiva Health On The Digital Divide and Why & How We Should Close It

An Interview With Monica Sanders

Monica Sanders
Authority Magazine

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Nothing can fully prepare one to be a founder or a CEO. When one takes on these roles, one’s previous experiences can help you to get ready, however by the nature of the roles, one encounters unexpected challenges. Most times there isn’t a go-to formula to solve these challenges. So not sure there are five particular things I wish somebody has told me, however, I’ve repeatedly seen the value of working with a high-quality team and the value of finding joy in the discovery of new ways to help others benefit from digital health technologies.

Digital inequality reinforces existing social disparities, demanding considerable efforts to acknowledge and address this pressing issue. In this interview series, we are talking to business leaders, policymakers, think tanks and experts on this topic to share their insights and stories about “How Companies and Policymakers Are Taking Action and Can Further Contribute to Closing the Digital Divide.” As part of this series, I had the pleasure to interview Nir Altman.

Nir Altman, co-founder and CEO of Equiva, has spent more than a decade pioneering cost-effective approaches to advance digital patient engagement, with a keen focus on helping healthcare organizations create, nurture and retain long-term customer relationships. He’s passionate about supporting initiatives to improve patient and clinician experience, advance health equity, improve health outcomes and drive financial success. In addition to co-founding an award winning non-profit focused on helping individuals use their skills to advance non-profits of their choice, his experiences include leadership roles with Deloitte Consulting and American Express.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about how you grew up?

I grew up in several countries and being exposed to a range of cultures at an early age was an enriching experience.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

‘The Innovator’s Dilemma’ by Clayton Christensen and ‘Good to Great’ by Jim Collins. The first book speaks about the power available to smaller companies in solving complex problems and the second is about the power that can be achieved by highly effective teams.

Do you have a favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life or your work?

“Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.” Albert Einstein

Ok, thank you. Now let’s move to the main focus of our interview. How would you define the Digital Divide? Can you explain or give an example?

At the most basic level, the digital divide is the inequality across various socio-economic groups in the ability to access the internet as well as information and communication technologies, specifically computers, tablets and smartphones.

For many people, the use of the internet and devices like computers is fully ingrained into daily life. For most, the internet makes it easier and less time-consuming to do our jobs, advance our education, run our homes, and manage our lives.

Specific to healthcare, the digital is divide can negatively impact certain populations, including people with lower incomes and those who are medically underserved, uninsured or underinsured.

Someone who lives in a rural area and cannot afford internet service in their home, for example, will likely find it more challenging than a “connected” person to manage a chronic health condition. This person may lack transportation for visits to healthcare providers who may be hours away. With neither connectivity nor a device, they cannot engage in telemedicine visits at home. They don’t have in-home access to online health portals and services, therein precluding them from ready access to health information, test results, online pharmacy services, appointment scheduling and more. Many in this situation delay important care, leading to declines in health status, higher cost care needs and poorer outcomes.

Can you tell our readers a bit about your experience working with initiatives to close the digital divide? Can you share a story with us?

In my decade-plus of experience helping healthcare organizations leverage technology to improve patient engagement, I’ve seen first-hand how the digital divide contributes to disparities in serving populations that are under-resourced and more medically at-risk.

As our mission states, the Equiva team believes that humanity will be better served when every person is connected to the individuals, information, and experiences that support overall well-being. We believe that patients, loved ones, and healthcare professionals deserve a more equitable, less fragmented system where transformative technology yields powerful intelligence that promotes targeted care and wellness.

Note the terms “connected” and “equitable” This is why we branded ourselves “Equiva.” This is all about health equity. And while many within and outside the healthcare industry believe adopting health equity-oriented digital technology is highly complex and costly, we firmly believe — and are showing — that it doesn’t have to be.

We first learned about the Affordable Connectivity Program (ACP) in mid-2022. The FCC launched this $14.2 billion subsidy program in late 2021 to help ensure households can afford the broadband and devices they need for healthcare, school and work. A household is eligible if someone in the home is enrolled in an existing federal subsidy program such as Medicaid, WIC and others.

The FCC and others are encouraging new approaches to bolster ACP enrollment. In healthcare, for example, the ACP offers great promise to help bridge gaps in the digital divide, improve outcomes and reduce costs. Yet a large percentage of people remain unaware of the ACP including clinical and non-clinical professionals in healthcare organizations serving the 91 million Americans enrolled in Medicaid and CHIP programs. We will soon publish a white paper highlighting this topic for population health executives.

Last year, we partnered with a forward-thinking internet service provider, Infiniti Mobile, to create a first-of-its-kind digital health engagement model centered around the ACP. At Equiva, we recently announced the launch of a partnership with Infiniti Mobile. We came together to create a program that could serve as a catalyst in helping hospitals, nursing homes, insurers and other healthcare organizations advance enrollment in the FCC’s Affordable Connectivity Program while also helping these entities engage digitally with individuals for targeted care management and population health programs that advance their health equity initiatives.

We help healthcare organizations understand the ACP, inform their patients about it and promote enrollment. The individuals they bridge to enrollment receive monthly broadband service (up to 20GB provided at no cost via the AC) and a high-quality, cellular-enabled tablet device pre-loaded with healthcare resources and solutions defined by the organization to support targeted population objectives. Costs to the healthcare organization are kept very low. We mail tablets to patient homes and equip entities to give them to patients during in-facility visits.

This may be obvious to you, but it will be helpful to spell this out. Can you articulate to our readers a few reasons why it is so important to create change in this area?

In 2016, the United Nations declared that the ability to access the internet was an essential human right. Our team at Equiva agrees.

The National Institute of Health’s (NIH) Institute on Minority Health and Health Disparities states that: “Many populations in America, whether defined by race, ethnicity, immigrant status, disability, sex, gender, or geography, experience higher rates of certain diseases and more deaths and suffering from them compared with the general population. One of the greatest challenges the healthcare system faces is reducing the profound disparity in the health status of racial and ethnic minorities, rural, low-income, and other underserved populations.”

For example, black infant mortality is 250% higher than white infant mortality. Individuals in rural areas have higher cancer death rates than those in urban areas. And for American Indian and Alaskan Native Tribes, life expectancy is 5.5 years less than others in the US.

Health inequities contribute not only to poor health outcomes but also to increased burdens on the

nation’s economy. The American Public Health Association says that “avoidable costs of health disparities include medical costs related to preventable chronic diseases and the overutilization of healthcare resources.”

Health impacts employment potential and workplace efficiency, they say, and “health disparities result in a large loss of productivity every year.”

According to Deloitte, health inequities account for approximately $320 billion in annual healthcare spending signaling an unsustainable crisis for the industry. If unaddressed, this figure could grow to $1 trillion or more by 2040.

Many healthcare organizations are trying to remedy health inequity, but some are finding it difficult to engage with underserved populations. To achieve health equity, organizations and providers must find new ways to eliminate or reduce barriers to accessing health services, a big piece of that being to reduce the digital divide.

What specific actions has your company or organization taken to address the digital divide, and how do you ensure that your efforts are making a positive impact in the communities you serve?

Now that we have launched our ACP-centric initiative, we’re working to connect with as many healthcare organizations as possible and get this program to as many of their patients and members as possible who could benefit most from it.

A soon-to-go-live customer is a 350-bed urban academic medical center. Inpatients who are identified as Medicaid enrollees and have two or more chronic conditions will soon be asked to enroll in the ACP, be guided on the application, and be sent home from the hospital with a tablet providing ready access to education, resources and tools including telemedicine applications, to support specific care plans. The program has been in place for some time, but challenges exist with relying on the phone as a primary tool to connect with patients. It’s early but the team is optimistic they can reduce both the significant amount of spent trying to locate patients and the program’s drop-off rates. This supports their overall goal of keeping patients on care plans for at least 11 months. It also enables a focus on preventive care which supports better quality of life, reduces readmissions, lowers costs and improves outcomes.

Another example is a non-profit organization, the Cancer Support Community, which provides free education and psychosocial support resources to anyone impacted by a cancer diagnosis via more than 175 network partner sites in the US. They’ve traditionally served clients through brick-and-mortar facilities — but even before the pandemic, adopted a strategy to add remote, digital engagement, especially to reach medically at-risk residents in rural and urban communities. Our ACP program is helping them connect digitally. Our tablets serve as an easy-to-use vehicle for making important cancer resource services readily available anytime. Providing $50 million in free services annually, the Cancer Support Community has positively impacted the lives of millions dealing with an ugly disease. Their team is highly innovative and it’s incredibly rewarding to work with them to serve both those impacted by cancer and the care team members who care for them.

Organizations like these are blazing new trails by becoming a conduit for bringing more people into the ACP. We’re not aware of another program like this in the healthcare sector where we maximize the value of a B-to-B-to-C approach rather than the existing B-to-C model now used by most internet service providers. We work with and listen to our customers and partners who interact daily with patients to make sure our efforts are truly having a positive impact.

We see this as a win/win/win — for the FCC, for healthcare organizations and, most importantly, for the people they serve who are struggling with health issues due to lack of connectivity and devices.

What are some of the challenges that individuals or communities face when trying to bridge the digital divide?

One of the biggest challenges we’re seeing is the lack of awareness of the Affordable Connectivity Program among prospective enrollees and within healthcare organizations. This is also an opportunity.

As stated previously this ACP is a $14.2 billion dollar program that is not currently reaching its full potential and impact. We hope to help change that.

While 48 million households qualify for the ACP, fewer than 16 million enrolled in its first year. Many who could benefit from the program’s provision of no-cost internet and discounted devices are falling through the cracks. A large percentage of people remain unaware of the ACP including individuals in healthcare organizations serving Medicaid enrollees — a large segment of individuals who qualify for ACP enrollment.

The FCC and others are encouraging new approaches to bolster enrollment. Such efforts could include a targeted focus via specific industries, like healthcare.

What role do you see technology companies playing in closing the digital divide, and what steps can they take to ensure that their products and services are accessible to all?

For programs like the ACP to reach their full potential, community organizations, private businesses, and the public sector must all work together to advance initiatives to bridge the digital divide.

We saw an opportunity to bring our organization together with our partner Infiniti Mobile, whose model is solely aligned with the ACP and its precursor, the Lifeline program. Jointly, we’re going far beyond the basics of ACP enrollment by giving healthcare entities a digital platform to quickly, cost-effectively and cohesively deploy care management services to groups who could benefit from them.

My colleague at Infiniti Mobile Jason Welch says it quite well. “Responsible telecommunications providers are longstanding, steadfast supporters of government initiatives to ensure connectivity for low-income Americans,” he says. “Bringing telecommunications together with telehealth in a highly unique way creates a powerful and immense opportunity to address pressing healthcare challenges across underserved communities.”

Tech companies have the opportunity to pursue unique, out-of-the-box solutions that advance and leverage the goals of the ACP program in a way that will benefit under-connected individuals, risk-bearing organizations and the FCC.

Because of investment coming from the federal government, we have funding for great access to infrastructure and digital skills training. In your view, what other policy changes are needed to address the digital divide? How can companies and policymakers work together to implement these changes?

The FCC has done a great job of providing a framework to connect individuals who are experiencing barriers to access. Other stakeholders can come together to further the goals of the ACP, where the FCC has had trouble reaching under-connected individuals.

We are already in Web3.0. What should we be doing as leaders to ensure the next iteration(s) of the Web are green, accessible and beneficial to as many people as possible?

This is less of an immediate concern for healthcare where the adoption of digital engagement solutions has lagged behind other industries. Progress was made, albeit slow, prior to COVID. Think electronic health records. The pandemic drove uber-rapid advances in and uptake of solutions. Think telemedicine visits, for example.

As an industry, healthcare is still working to create a model that emulates a service like online banking. This is challenging because healthcare is such a personal experience and service delivery involves many stakeholders including providers, payors, and suppliers as well as patients themselves (ie, consumers) and their loved ones. Consumerization will continue to evolve and place new demands on — and opportunities for — traditional players in this space such as hospitals and health systems as well as newer entrants such as big box players such as CVS, Walmart, Walgreens and Best Buy.

This is the signature question we ask in most of our interviews. What are your “5 things I wish someone told me when I first started” and why? Please share a story or example for each.

Nothing can fully prepare one to be a founder or a CEO. When one takes on these roles, one’s previous experiences can help you to get ready, however by the nature of the roles, one encounters unexpected challenges. Most times there isn’t a go-to formula to solve these challenges. So not sure there are five particular things I wish somebody has told me, however, I’ve repeatedly seen the value of working with a high-quality team and the value of finding joy in the discovery of new ways to help others benefit from digital health technologies.

What role can individuals play in closing the digital divide, and what steps can they take to support these efforts?

Effectively closing the digital divide will take efforts from a variety of stakeholders, including individuals who are connected as well as those who are not.

Individuals can support efforts by learning about beneficial programs and initiatives, and helping educate friends, family, and others about the potential options that exist to help everyone get connected and stay connected — and to maximize the value of that connectivity to stay informed and engaged.

How can our readers follow you online?

Visit our website at equivahealth.com, follow me on LinkedIn or drop me an email at info@equivahealth.com

This was very meaningful, thank you so much. We wish you only continued success on your great work!

About the Interviewer: Monica Sanders JD, LL.M, is the founder of “The Undivide Project”, an organization dedicated to creating climate resilience in underserved communities using good tech and the power of the Internet. She holds faculty roles at the Georgetown University Law Center and the Tulane University Disaster Resilience Leadership Academy. Professor Sanders also serves on several UN agency working groups. As an attorney, Monica has held senior roles in all three branches of government, private industry, and nonprofits. In her previous life, she was a journalist for seven years and the recipient of several awards, including an Emmy. Now the New Orleans native spends her time in solidarity with and championing change for those on the frontlines of climate change and digital divestment. Learn more about how to join her at: www.theundivideproject.org.

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Monica Sanders
Authority Magazine

Monica Sanders JD, LL.M, is the founder of “The Undivide Project”, an organization dedicated to creating climate resilience in underserved communities.