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Telehealth Increases Access to Care for Medi-Cal Patients – Let’s Keep It OPINION

Telehealth may not make for a good Norman Rockwell painting, but it does make for good medicine. It’s an improvement, a step forward that helps us get healthier and close gaps in care.

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Nearly a century ago, a Norman Rockwell painting titled “Doctor and Doll” was published on the cover of the Saturday Evening Post, a popular American cultural magazine.

It depicted an older gentleman wearing a suit, doctor bag at his feet, pressing a stethoscope to the chest of a little girl’s toy doll. A cluttered desk and worn chair sit atop a forgettable rug. It’s an old image of health care in America. A country doctor caring for his neighbors via a “house call.”

Of course, we know it was not that simple. Healthcare was rudimentary compared to today’s standards – that is if you had access to care at all. Average life expectancy reflected that. If you were born white in 1929 you would be lucky to reach your 60s. If you were Black, you weren’t likely to reach your 50s.

While things are far from perfect, at least they have improved. Healthy lifestyles and modern medicine have made living into your 80s commonplace. Significant racial disparities remain, but the gap is closing. And the number of people with health coverage has never been higher.  But while Medi-Cal (the state sponsored coverage for people who have low-incomes) now covers nearly 14 million people, many still lack appropriate access to care.

Access to care is a complex issue, but sometimes it’s as simple as geography. Taking an hours-long bus ride across town to visit the doctor isn’t practical for most people. Add lost wages, a lack of childcare, and the fact that you don’t feel good, and it’s downright impossible.

Solutions available in employer-based health insurance for years, like virtual care through an app or over the telephone, haven’t been an option for people on Medi-Cal.

Until the pandemic.

When the federal and state governments declared emergency last Spring, federally qualified health centers like WellSpace Health were able to provide care virtually via telephone and video, a practice that had been prohibited previously.

Virtual care is wildly successful. Over the past two weeks, 5,015 patients accessed care remotely rather than visiting our health centers. Half of primary care visits and 85% of behavioral health visits were virtual. According to a statewide survey of community health centers, which serve 1 in 5 Californians, there has been a 75% decrease in no-show rates since the implementation of telehealth. A study conducted by the California Pan-Ethnic Health Network reported a significant number of patients from communities of color engaging in telehealth and having a high level of patient satisfaction.

As an internal medicine doctor and the chief medical officer WellSpace Health, it makes sense. Technology has given us the ability to conduct a modern day “house call.” We can go to the patient and break down significant barriers to care. If the patient requires a hands-on assessment or treatment, we can take that step. But frequently, especially in behavioral health, hands-on care is not necessary.

Our ability to provide virtual care under the emergency order will expire soon. Permanent authorization will require action by the Legislature and the governor through the budget process. Assembly Bill (AB) 32 by Assemblymember Cecilia Aguiar-Curry (D- Winters) provides the template for action.

In this budget cycle, the governor must take advantage of a once-in-a-lifetime opportunity to address inequality in our health care delivery system. By adopting the provisions of AB 32 into the FY21-22 final budget, it will guarantee that all Medi-Cal beneficiaries – regardless of where they seek care – can use all telehealth modalities, including telephonic care, indefinitely.

Telehealth may not make for a good Norman Rockwell painting, but it does make for good medicine. It’s an improvement, a step forward that helps us get healthier and close gaps in care.

It even brings back the house call.

Dr. Janine Bera is the chief medical officer for WellSpace Health and chair of the California Primary Care Association Telehealth Clinical Task Force.

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East Oakland Community Clean-up

The office of Councilmember Treva Reid invites you to…

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Oakland Clean Up Flyer

The Oakland Post’s coverage of local news in Alameda County is supported by the Ethnic Media Sustainability Initiative, a program created by California Black Media and Ethnic Media Services to support community newspapers across California.

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Sept. 11, 2001, 20 years later: ‘Remembrance’ held aboard the USS Hornet Sea, Space & Air Museum

The USS Hornet Sea, Space & Air Museum, moored at the City of Alameda, hosted a “Remembrance” ceremony of the events of Sept. 11, 2001, on board the ship on the 20th anniversary, Sept. 11, 2021.

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U.S. Marine Corps Honor Guard, 23rd Marine Regiment: Sgt. Tristan Garivay, Sgt. Michael Her, Cpl. Adrian Chavez and Cpl. Quentavious Leeks. Photo by Russell Moore, USS Hornet Sea, Air & Space Museum, Community Events & Outreach

Quintin Jones, Colonel, USMC, Commanding Officer, 23rd Marine Regiment. Photo by Russell Moore, USS Hornet Sea, Air & Space Museum, Community Events & Outreach

The USS Hornet Sea, Space & Air Museum, moored at the City of Alameda, hosted a “Remembrance” ceremony of the events of Sept. 11, 2001, on board the ship on the 20th anniversary, Sept. 11, 2021.

The ceremony recognized the impact and consequences of the series of airline hijackings and suicide attacks committed on 2001 by 19 militants associated with the Islamic extremist group al-Queda against targets in New York City and Wash., D.C. Nearly 3,000 people died that day and 6,000 were injured.  This was the deadliest terrorist attack on American soil in U.S. history. 

The ceremony aboard the USS Hornet began with the presentation of the colors by the U.S. Marine Corps Honor Guard, 23rd Marine Regiment. (Pictured above.)

Leon Watkins, co-founder of The Walking Ghosts of Black History, was the Master of Ceremonies. He spoke about the extensive death and destruction which triggered the enormous U.S. effort to combat terrorism.

Daniel Costin, a special agent with the Federal Bureau of Investigation, spoke of the lasting impact of 9/11 terrorists attack on first responders. He recounted incidents where first responders rushed into the scenes of the attacks, many at the sacrifice of their own lives. More than 400 police officers and firefighters were killed that day: 343 members of the New York City Fire Department and 71 members of their law enforcement agencies.

Quintin Jones, Colonel, USMC, commanding officer of the 23rd Marine Regiment, spoke about the recovery efforts at the Pentagon following the terrorists’ attack where 125 people perished. He reflected on the actions of three first responders who recovered the U.S. Marine Corps flag from the commandant of the Marine Corps’ office at the Pentagon. This flag was still standing after the attack. It was a symbol of America’s resolve.

At the end of the formal presentations, the Marine Corps Wreath Bearers went to the fantail of the Hornet. After the playing of ‘Taps,’ they tossed a wreath into the San Francisco Bay to give final honors.

The Oakland Post’s coverage of local news in Alameda County is supported by the Ethnic Media Sustainability Initiative, a program created by California Black Media and Ethnic Media Services to support community newspapers across California.

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Many in Black Communities are Choosing Vaccination 

Inequities in health outcomes have always been with us. COVID-19 morbidity and mortality rates among African Americans rival or exceed those in heart disease, diabetes and other illnesses. Blacks sit atop most bad lists and at the bottom of most good lists. 

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Vaccination/Photo Courtesy of Shutterstock

The trail of illness and death left amid the spread of COVID-19 in Black and African American communities should come as no surprise.

Inequities in health outcomes have always been with us. COVID-19 morbidity and mortality rates among African Americans rival or exceed those in heart disease, diabetes and other illnesses. Blacks sit atop most bad lists and at the bottom of most good lists.

COVID-19 vaccinations offer us an opportunity to better balance the scale.

Unfortunately, even with widely available testing, highly effective vaccines, and extraordinary efforts by health departments to educate and encourage people of color to get vaccinated, many Black Californians remain skeptical.

We can only hope that the FDA’s full regulatory approval of the Pfizer vaccine on August 23 for those 16 and up convinces more to get the vaccine.  It’s worth noting that emergency-use authorization also remains in place for the Moderna and Johnson & Johnson shots, as well as Pfizer’s for 12- to 15-year-olds – and that all of these vaccines are safe and effective in protecting against COVID-19 and its highly contagious variants.

Eddie Fairchild and Steph Sanders were skeptical about the COVID-19 vaccine but came to understand why vaccination benefits our entire community.

Fairchild, a Sacramento insurance agent, said he knew of research that found Black and white people are often treated differently for the same health conditions leading to poorer health outcomes.

“I was hesitant,” he said. “I was going to wait and see how it panned out with everyone else.

But when a Black friend in the health care field told him he’d opted to get vaccinated, Fairchild asked him why.

“He said, ‘Risk-reward, and the risk is death.’ At that point I didn’t have to ask him what the reward was.”

With a finance degree and a belief that numbers don’t lie, Fairchild looked at the data. He learned that until 2020 the average number of Americans who died each year was about 2.6 million, but in 2020 that figure was 3.4 million. There was only one possible explanation for the death rate surge, he said.

“COVID is absolutely real,” he said, adding that three of his cousins died from the virus. “Taking all that into consideration, I decided that it’s risky to engage in the world and not be vaccinated. It made sense for me to get it.”

Racial gaps in vaccination have thankfully narrowed in recent weeks. But as of September 1, while Black people account for 6% of the state’s population, they account for 6.6% of COVID-19 deaths, which is 11% higher than the statewide rate, according to state department of public health data. Only about 55% of Black people in California have had at least one dose of the vaccine.

Reasons for the discrepancies run the gamut, from conspiracy theories like Black people are getting a less effective vaccine than whites or that the vaccine will eventually be deadly, to challenges in health care access. 

Mostly, it’s based on a lack of trust in medical and scientific institutions, which have a long history of racism and mistreating Black people.

So even when it comes to good things like vaccines, which are scientifically proven to be good for the community, it always comes back to trust.

Sanders, a Vallejo school principal, was hesitant because of the Tuskegee syphilis studies in which Black men who had the disease were intentionally not treated with penicillin. And he was dubious that an effective vaccine could be developed so quickly. 

In fact, the science and technology enabling development of the COVID-19 vaccines was in development for a more than decade before the virus emerged in 2020. The FDA authorized three vaccines for emergency use after they underwent a rigorous process and were proven through trials to be safe and effective at preventing severe COVID-19, hospitalization, and death.

He decided to get vaccinated when his school board decided last spring to bring students back into classrooms.

Today, he’s a fervent vaccine advocate. He holds “lunch and learn” forums for educators, encouraging vaccination.

“I’m a leader and people are relying on my knowledge,” he said. “I tell them, ‘Don’t make this about you, but about the people you love and care about. It’s about protecting them.’”

There is still a long way to go before Blacks achieve true health equity, but vaccination against a virus that is taking a terrible toll on our communities is a critical step in the right direction.

 

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