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Startups Pair Black Patients, Doctors, But Insurers Wary of Bias

July 15, 2020, 9:50 AM

Black communities have faced racist medical treatment for centuries, prompting distrust in healthcare professionals.

Cervical cancer patient Henrietta Lacks’ cells have been used in research for decades even though she never gave consent. In the infamous Tuskegee experiment, hundreds of poor Black men were denied access to adequate syphilis treatments or lied to about their treatment so researchers could study the disease’s progress over four decades.

But it’s not easy for Black patients who feel more comfortable with Black doctors to find them. Only about 5% of active physicians are Black, according to the latest available data, and insurers have avoided using race and ethnicity filters on their online provider lists out of fear they could open the door for discrimination.

That’s led several Black entrepreneurs to create platforms such Health In Her HUE, Therapy for Black Girls, and Hued Co. that are trying to make those connections at a time the Covid-19 pandemic is disproportionately impacting minority communities.

“I’ve personally seen within my networks from Howard University and from New York that people are always asking for referrals to Black gynecologists, Black therapists, and so many more,” said Ashlee Wisdom, founder and CEO of Health In Her HUE. “So, I’ve recognized that that was a gap in digital solutions.”

Some recent studies show that patients who share racial characteristics with their treating physicians saw greater treatment outcomes.

For example, Stanford researchers matched Black male patients in Oakland, Calif., to Black and non-black doctors in the area. The men were 29% more likely to engage with Black doctors and the Black doctors were 35% more likely to take detailed notes about Black patients than non-Black doctors, according to the 2018 study results.

The American Medical Association also “values the importance and impact of race concordance between patient and physician as one proven approach to help bridge the gap in racial health disparities,” according to AMA President Susan R. Bailey.

Serena’s Shoutout

Health In Her HUE garnered Twitter buzz over the last few months, with Black women urging providers in their state to join the app. It got a major boost when tennis superstar Serena Williams endorsed it in an interview in the May issue of Vogue magazine.

In choosing it as a cause for her nonprofit Vital Voices, which invests in women leaders who drive global change, Williams cited Wisdom’s commitment to Black women’s health and her own experiences from near-fatal childbirth complications in 2018.

“Her platform is committed to the health and well-being of Black women, and with everything that I’ve gone through with health care, I know how important that is,” Williams told Vogue.

Wisdom is using her public health and research background to work solely on Health In Her HUE after being laid off earlier this month from her job in healthcare consulting.

Providers that participate in the app are responsible for listing their company information, including location, website, best point of contact, specialty, and the insurance they accept. Health in Her HUE also allows doctors and patients to read relevant content that addresses the needs of Black women.

The app is still in early stages, Wisdom said, but at this point, patients and doctors can create profiles to engage with the content and one another.

There are other apps that connect patients with doctors, but Wisdom noticed one thing was missing—a race and ethnicity component.

“I’ve seen and love a few tech platforms that are similar such as DocDoc. But, there wasn’t a focus on race and there is a need for that component,” Wisdom said.

Wary of Bias

Most insurers, including Blue Cross Blue Shield, Aetna, and Cigna, allow patients to search online for doctors based on geographical location, specialty, and languages spoken. These provider directories may also feature photos of the doctors that are available.

But they don’t filter for race and ethnicity. Insurers say doing that could open the door for patients to discriminate against doctors of color.

“We do want patients to be comfortable with their doctor, as well as in finding their doctor,” Kristine Grow, a spokeswoman for the health insurance trade group, America’s Health Insurance Plans, said.

“One thing we want to be very cautious of is we don’t want to unintentionally have new policies that are proposed that could have the best of intentions but could actually open up new opportunities for discrimination. We want to ensure that there’s an environment of non-discrimination that provides opportunities for all qualified doctors and providers.”

Insurers have to be cautious about how and why patients are matched with specific doctors, according to Neil Sullivan, counsel with a focus on healthcare and insurance law for Greenbaum, Rowe, Smith, & Davis LLP in New Jersey.

“If patient-physician matching means providing information to a vulnerable population, it probably wouldn’t be discriminatory,” Sullivan said.

“If matching means that I’m going to target a Black population, for example, and encourage the use of certain practice groups, then you may see that as a good thing, but that may be something that’s considered as discriminatory or reverse discriminatory.”

Wisdom said she’s aware of the health insurance industry’s concerns about race filters and hopes her app will bridge that gap until the insurance industry can include the element.

Increased Demand Around Pandemic

The benefits of connecting Black patients and doctors outweigh any legal risks, said Ndidiamaka Amutah-Onukagha, an associate professor of public health and community medicine and chair of the diversity, equity, and anti-racism committee at Tufts University School of Medicine, said.

“Just diversifying the medical field is going to uplift and polish the egregious behavior we’ve seen. The medical field and healthcare profession has been allowed to run amok for a long time because people of color are not in positions of power,” she said.

Deaths from Covid-19 have disproportionately hit Black communities all over the U.S. For example, Black residents in Washington, D.C., constitute 74% of total Covid-19 deaths, despite accounting for nearly 45% of the city’s population as of early July according to the district’s latest reported data.

Those numbers as well as anecdotal stories like Rana Zoe Mungin’s—a 30-year-old Brooklyn teacher who died in May after twice being denied treatment for coronavirus symptoms —have prompted some Black women to prioritize finding providers they feel they can trust, Wisdom said.

“I do believe Covid-19 magnified those concerns as Black people saw their communities, friends and loved ones disproportionately affected,” she said.

To contact the reporter on this story: Ayanna Alexander in Washington at aalexander@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.com; Bernie Kohn at bkohn@bloomberglaw.com

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