This summer I had the privilege of working with Kapor Capital’s investment team, focused specifically on their healthcare portfolio and their thesis around closing gaps of access and opportunity for low-income communities and communities of color. While there are still some unknowns when it comes to this pandemic, we do know that COVID-19 has accelerated and exacerbated health equity gaps for people of color (POC) in this country. We also know that the healthcare industry as a whole is experiencing massive shifts (one of the most obvious examples being the acceleration of telehealth). Over the past few months I helped KCap understand opportunities that exist for investors and entrepreneurs to close these equity gaps and ultimately improve the health outcomes of our most vulnerable Americans.
Part 1: How has the pandemic affected low-income communities and communities of color?
COVID-19 is accelerating and exacerbating health inequities that existed before this pandemic, leading to higher coronavirus infection and fatality rates for POC in this country. The CDC cites numerous social determinants of health as the reasons behind these numbers: POC are more likely to be essential workers and unable to work from home, increasing their exposure to the virus in their workplace; low-income people and communities of color are more likely to live in crowded housing environments due to job loss and the corresponding risk of eviction and homelessness; comorbidities disproportionately affect POC, as they are more likely to experience chronic conditions like diabetes that leave them immunocompromised and more vulnerable to the virus.
African Americans specifically are dying from COVID-19 at a disproportionate rate to their share of the population in numerous cities and states across the U.S. (https://bit.ly/32SKD2S)
My conversations with investors and health equity experts reinforced the existence of these health inequities. The new insight that emerged, however, was that the new healthcare innovations coming out of this pandemic aren’t being designed with low-income communities and communities of color in mind. There are specific opportunities that investors and entrepreneurs can target to see both measurable returns and impact on the health inequities that have been exacerbated this past year.
Part 2: What healthcare areas can we target to close gaps of access and opportunity?
I identified five different healthcare areas being affected by this pandemic that, if invested in, have the potential to most directly impact low-income and POC in this country.
- Chronic Conditions and Social Determinants of Health (SDOH) — Numerous companies already address chronic disease management (including KCap portfolio companies Bodyport, Devoted Health, emocha, Ginger.io, and Omada Health). While payers have started to reimburse for SDOH like transportation to appointments, there’s a unique opportunity for chronic health companies to address additional SDOH: for example, guiding patients around diet (food choices and diabetes), surfacing environmental risks that could affect (air quality and asthma), or connecting them with stable and non-crowded housing options. Creative business models that help fund some of these SDOH will not only improve health outcomes but also ensure financial sustainability for these tools.
- Retail Health & Patient Accessibility — CVS Health, Walmart and Walgreens are a few of the major players establishing health clinics in or near their stores. In 2017 only about 13% of those locations were in medically underserved communities, areas that have overlap with low-income communities and communities of color. Solutions that expand clinic access, whether via intentional retail locations or in new, creative locations that promote trusted provider relationships will help us meet patients where they’re at to deliver effective and convenient care.
- Behavioral Health — KCap already has investments in mental health (including AnswersNow and Ginger.io), yet the pandemic is making this area more relevant than ever. More than half of Americans say the pandemic has affected their mental health. Access to quality, affordable and culturally-centered mental health care is extremely difficult in the current environment. Companies tackling affordability, utilizing solutions like telehealth to expand access, and working to increase the number of therapists of color (currently ~8% identify as eitherBlack or Hispanic) will all succeed in helping close the gaps in access and opportunity for lower-income Americans and POC.
- Patient Affordability — In 2018, 27% of the Hispanic population and 13.8% of the Black population did not have health insurance. The rising unemployment rate means an increase in patients moving off commercial health plans; even if they have coverage, affordability may still be a challenge. Solutions that provide affordable and quality insurance coverage, or expand access via existing plans (whether commercial or government sponsored) will help low-income individuals and POC to receive the care they need, especially when over 20% of uninsured patients say they forgo care due to cost.
- Telehealth — We’ve seen a rapid and forced adoption of telehealth in the last few months due to coronavirus, but the solutions aren’t being designed with the constraints of KCap’s focus communities in mind. Nearly 1 in 8 Americans live in poverty, and these individuals have lower smartphone ownership, home broadband access, internet usage and digital literacy than the general population. Designing telehealth solutions with these and other constraints in mind (such as language barriers) will ensure that all Americans can access care virtually.
Back in June, I knew KCap and the Kapor Center were already researching health inequities, and I was excited to join a team where I could uncover opportunities for investors and entrepreneurs to move the needle on these outcomes. Professionally, I’ve spent my career at the intersection of technology and impact, working with organizations like Teach for America, Clever (an education tech company) and Slack (often recognized for their groundbreaking work in prison reentry programs) and was excited to join a team whose thesis aligned so closely with my own. This focus was also personal though: I grew up seeing these inequities side by side. One side of my family are immigrants, most of whom came to this country on educational visas and were able to take advantage of well-paying jobs and employer-sponsored healthcare plans. The other side of my family has struggled to gain financial stability as the result of many factors, including untreated chronic conditions like hepatitis, heart disease and hypertension and lack of access to affordable higher education opportunities.
COVID-19 is an opportunity for this country to make choices about what we want the future of our healthcare system and health outcomes to look like. During all of these seismic changes, we can refocus and reexamine health inequities and design solutions that specifically include the communities most affected by these shifts.
If you’re interested in learning more about my insights, think your company is well-positioned to address these challenges, or would like to chat about the intersection of tech, health and impact, feel free to reach out: angeli.agrawal@gmail.com or find me on Twitter @angeliagrawal. I look forward to meeting!
**A quick note on methodology — I interviewed more than 20 investors and health equity experts during the course of this project. I want to acknowledge the help and guidance of many individuals with significant healthcare experience in developing these perspectives. Thank you!