Lack of broadband access is a barrier to health care – and Michigan is aiming to eliminate it

COVID-19 exposed Michigan's digital divide, and its sobering effect on residents' ability to access health care during the pandemic. But efforts are underway to address it.
This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

When the COVID-19 pandemic hit, health care shifted to online modalities practically overnight — and with admirable outcomes. Telehealth helped Michiganders access needed care, and it’s likely to remain a common, convenient, and cost-effective way to connect with providers even after the pandemic has passed.
 
However, when COVID-19 shifted provider appointments – and so much else in life – online, it became clear how deep Michigan’s digital divide has become. According to the Federal Communications Commission, more than 1.2 million households in Michigan struggle with internet connectivity. Gaps in high-speed internet access disproportionately impact Michigan’s communities of color, those in rural areas, and low-income households. 
 
The largest Federally Qualified Health Center in Michigan, Cherry Health provides integrated health services to people in six southwestern Michigan counties. Some live in income-challenged urban neighborhoods, while others populate rural areas. Because many of them faced barriers in keeping face-to-face appointments, Cherry Health launched telemedicine programs prior to the pandemic and dramatically increased their use when COVID-19 hit.
 
During the height of pandemic stay-home orders, Cherry Health providers delivered more than 80% of all care virtually. While those numbers have dropped to 30% in 2021, lack of access to online modalities takes a real toll on the people Cherry Health serves.
 
“Many of our patients have barriers to getting into our office — transportation issues, child care, missing work — so it certainly does save time and is more convenient for people than coming into the office,” says Dr. Leslie Pelkey, Cherry Health’s chief medical officer. “… We’ve found that it’s a really great way to check in on individuals when they have minor health concerns like cold-like symptoms or rashes, and it works well for following up on some chronic medical conditions. And, of course, behavioral health concerns adapt well to telemedicine.”
 
Pelkey describes virtual visits as coming in two flavors: video and audio. Video visits create an actual window into the patient’s home. Providers can ask patients to open their medicine chests and refrigerators to assess potential medication conflicts or food insecurity. A glance inside the home can identify hazards like throw rugs that might cause an older adult to trip and fall.
 
However, an evaluation of Cherry Health’s data found that while 30% of this year’s care took place virtually, 68% of those visits were audio only. Patients reported that barriers to accessing video visits included not having smart devices, lacking broadband connection, and, especially among older patients, digital illiteracy.
 
“With audio [only], it is much more difficult to evaluate any kind of physical concerns,” Pelkey says. “Is the patient pale and lying in bed with their covers pulled up to their chin, or smiling with high energy and able to get up and move around? After launching our telehealth platform, we were very quickly alerted to the tremendous disparity in care for patients without access to video.”
 
Paula Cunningham, AARP Michigan's state director, says COVID-19 “opened the eyes of so many people” to the many barriers many Michiganders face to good health – and the ways broadband access can eliminate them.
 
“The biggest barriers to accessing telehealth are: one, not having a broadband provider; and the other, not knowing how to use it,” she says.
Paula Cunningham.
Cunningham notes that when older adults lack broadband access, they are also at higher risk for experiencing social isolation, which in itself puts people at risk for many physical and mental health problems including heart disease, diabetes, anxiety, depression, and early death — and is estimated to cumulatively cost Medicare an additional $6.7 billion each year. Cunningham notes that broadband-supported devices also make home health care a more viable option.
 
“Accessing health care outside of the home can be very difficult for older adults and people with disabilities,” she says. “It can be very difficult to travel to medical appointments, get their prescriptions, or even get to the store. With broadband access, they can even order groceries online.”
 
Bridging the digital divide
 
Help is on the way for Michiganders for whom broadband access is a barrier to good health. AARP Michigan is launching programs to help train older adults how to use their devices and make the most of their online communities. And meanwhile, the state of Michigan is working to ensure all Michiganders can access the health care and other services they need online. On June 2, Michigan Gov. Gretchen Whitmer established the Michigan High-Speed Internet Office (MIHI) to bridge the digital divide by making high-speed internet more affordable and accessible.
Garlin Gilchrist. 
Housed inside the Michigan Department of Labor and Economic Opportunity (LEO), MIHI’s charge is to develop strategies and coordinate funding to ensure every Michigan home and business has access to an affordable, reliable high-speed connection; smart devices; and the skills to use them.
 
“Our administration’s goal is to make sure everyone in every part of Michigan has full access to the health care services they need, and are able to be their healthiest and best self,” says Michigan Lt. Gov. Garlin Gilchrist. “High-quality, high-speed internet connection at home will contribute to better health outcomes.”
 
For example, accessing care via a smart device was especially helpful for those managing chronic conditions and connecting with mental health providers during the pandemic.
 
“If you are a Michigander living with ALS, there are a small number of ALS centers for treatment and care in the state of Michigan but there are none in the Upper Peninsula,” Gilchrist says. “If you live in the Upper Peninsula, having to make a trip to one of those centers in lower Michigan is very difficult. If instead you could meet with that specialist via a telemedicine experience, you only have to make that trip down to lower Michigan twice a year instead of six, seven, or eight times. That level of accessibility can be a game-changer for folks from all walks of life.”
 Susan Corbin.
According to LEO Acting Director Susan Corbin, having MIHI as a point of access for internet providers, local communities, and individual households will facilitate expanding access to broadband. When the American Recovery Plan and other federal programs release broadband funds to states, Michigan will be ready to direct them where they’re most needed.
 
“During the pandemic we realized how critical it is for every household to have strong connectivity. To us, [lack of access to] it is a barrier that needs to be removed,” Corbin says. “Having broadband access is one of those issues of barrier removal that we talk about. Access to broadband means for a household better housing, options for healthy food, medicine, and other social determinants of health. We believe that having internet access improves quality of life.”
 
Telemedicine is not going away, but increasing access to broadband services and smart devices is an important tool for decreasing Michigan’s health care disparities.
 
“Offering universal and affordable internet access would help reduce this clear disparity in access to digital health care,” Pelkey says. “This would be a great step forward, not just to support telemedicine, but also is critical for education and jobs, which are important social determinants of health and impact health equity as well.”

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Dr. Leslie Pelkey photos by Bud Kibby. Paula Cunningham photos by Roxanne Frith. All other photos courtesy of the subject.