When Louisiana’s lockdown began, the phones lit up. They dialed 211, 311, 911. They called friends, families, doctors and total strangers. They connected the scared, the confused, the unhoused and the vulnerable to testing, to information, to shelter — in short, to help.
Coronavirus exposed a chasm in access to healthcare faced by the most vulnerable populations in one of the nation’s poorest states. The pandemic’s weight strained the bones of Louisiana’s brittle healthcare system, which took on one of the worst outbreaks in the country. We already knew the underlying disconnections — race, income, location, age — that have persisted even as hundreds of thousands more Louisianans now have health insurance through the state’s 2016 Medicaid expansion. What we didn’t know, perhaps, is that a tool for bridging those well-documented gaps was already in the pockets of millions: phones.
Over the last few months, we set out to document how coronavirus and the state’s lockdowns affected access to healthcare. What we found were people working the phones to keep Louisiana connected, safe and healthy in ways that offer lessons beyond the pandemic. Our series, Lifeline: Covid tells their story.
Put to the test, phones showed up. State and city governments promoted easy-to-remember, three-digit call codes, like 211, to connect residents with accurate information and disaster assistance. On the other end of the line, call specialists managed overloaded queues of worried patients looking for Covid tests and formed de facto triage lines for meager testing supplies. They reached deep into rural Louisiana and kept opioid addicts in touch with care from miles away. They connected millions of people, suddenly and indefinitely severed from the supply lines of care, with the services they needed.
“This is a scary and unknown time — when people call, they are looking for a counselor, they’re looking for a friend, they are looking for triage,” says Kisharra Angelety, project coordinator with the Acadiana regional provider for 211, Louisiana’s social service and information line. “They need that Step A, Step B, Step C and that reassurance it’s going to be OK.”
This is as much a phenomenon of policy as a sea change in behavior. Telemedicine exploded for the first time ever, boosted to wide adoption by sweeping changes to Medicaid and Medicare regulations. In January and February of this year, Medicaid recorded 3,000 telemedicine visits. In April, Medicaid reimbursed 264,000 telemed claims, according to preliminary data collected by researchers at Tulane University.
And early returns suggest that many of those visits happened over the phone without any kind of video component. Policy changes opened up the telemedicine playbook that had, in effect, previously been limited by expensive devices, skeptical providers and onerous location requirements. Emergency changes from the state and federal governments gave Louisiana the flexibility to cover phone visits for mental health and substance abuse, including new intakes. Some of Louisiana’s most at-risk residents were able to access care conveniently, for the first time in their lives.
Health economists and clinicians are still rifling through the data, but early returns underscore something health researchers have pointed out for over a decade: Simplicity is the key to access.
“What researchers have found, in the 10-12 years health literacy research has been studied, the biggest lesson is [that] the more simple and clear the process can be, the more likely someone will use it,” says Kat Penna, a researcher at UL Lafayette who studies how patients navigate healthcare.
For many, the American healthcare system is an intimidating labyrinth. Barriers of language, finance and convenience blunted the effect of more people having health insurance, a fact on plain display in the striking demographic breakdowns in Louisiana’s coronavirus case counts and fatalities. Comprising a disproportionate share of Louisiana’s essential workforce, Black Louisianans were on the frontline of Covid’s worst effects. Those infected with the virus waited longer to get help and died at higher rates than their white counterparts, an early study at Ochsner Medical Center found. They avoided the emergency department waiting rooms that had become their de facto primary care providers. And suffered for it. Many were insured.
“Why did we assume that because you have insurance, everything that you need to be perfectly well is going to be taken care of automatically?” asks Dr. Eboni Price-Haywood, a practicing internist at Ochsner Medical Center in New Orleans, author of that study.
Lifeline examines how coronavirus forced open access points that have largely been overlooked in healthcare innovation. That story unfolds in five chapters:
- Calls to action — How 211 became an instant connection to health and social services, while creating a powerful feedback loop to target unmet needs.
- Lifeline — Acadiana’s 211 call data from March to September reveal the evolving impacts of the Covid-19 pandemic and the diversity of one community’s disaster response.
- Calling home — How advocates created a short-term housing solution in local hotels, where phone-equipped navigators connected people with benefits like Medicaid, SNAP or their federal stimulus checks.
- Hang on— People suffering from opioid addiction in rural Louisiana stuck with their treatment plans by staying in touch with their providers by phone — and kept their appointments at higher rates.
- Lost in translation — COVID-19 disproportionately impacted Louisiana’s Spanish-speaking population. Targeted outreach could help break down language barriers and encourage those who are too afraid to ask for help.
Buzzword thinking often looks at healthcare access as a problem solved by new technology. But a deeper look reveals an idea more powerful because of its simplicity: To expand the reach of our healthcare system, you need to meet people where they are.
If we can learn anything from the scramble of the coronavirus pandemic, it’s that the most basic human reaction in times of crisis is to call for help. Lifeline: Covid reveals what can happen when those calls are answered.
Read the first installment Calls to Action here.
Lifeline: COVID is supported by founding sponsor LHC Group, supporting sponsor Oschner Lafayette General and Solutions Journalism Network