By Henry Giardina, Contributor
At the start of the COVID-19 outbreak in the United States, the Centers for Medicare and Medicaid Services relaxed some of their restrictions on telehealth coverage. With virus transmissions picking up, it became clear by mid-March that healthcare—from behavioral treatment to medication management—was about to find a semi-permanent home online.
Health services geared toward the LGBTQ community were no exception.
In April, telehealth claims spiked 8,000 percent from the previous year as restrictions for onsite-specific care shifted. The waiver of certain concerns of the Health Insurance Portability and Accountability Act (HIPAA)—which was implemented to protect patient information from becoming public—also helped speed telehealth adoptions. HIPAA-adjustments enabled sites like the Los Angeles LGBT Center to quickly implement remote healthcare solutions. By late April, 90 percent of The Center’s scheduled visits—including STI checks, primary care visits, and mental health appointments—occurred via telehealth.
The LA Center isn’t alone in responding quickly to healthcare needs during COVID-19. Recent studies have shown that among the general spike of Americans experiencing COVID-related depression and anxiety, LGBTQ Americans are at an even higher risk. LGBTQ adults are already at twice the risk of experiencing depressive episodes, addiction, and suicidal ideation—for queer and trans youth, those numbers are even starker. Across the country, at the over 200 locations servicing queer clients (like the Ali Forney Center in New York City, Fenway Health in Boston) and at Planned Parenthood centers across the nation, telehealth is experiencing a massive uptick—and for a marginalized population like the LGBTQ community, in particular, it’s clear there’s a demand.
The Need for Telehealth Solutions
Queer people are more vulnerable than ever to the manifold health concerns set loose by the virus. LGBTQ HIV-positive communities, for instance, are at higher risk of contracting COVID-19. In a recent report from the Human Rights Campaign Foundation, of the over 14 million LGBTQ+ adults living in the United States, over five million can be found in jobs that expose them to a higher-than-average risk of COVID-19, including food service jobs, careers in medicine, and those in education.
For queer health clinics that are already strained under the weight of the crisis, the added risk of exposure for a uniquely at-risk community leaves the door open for creative, often virtual, health solutions.
Enter the new wave of apps, start-ups, and digital solutions for remote healthcare. Platforms like QueerDoc and Queerly Health, which connect users with access to hormone replacement therapy (HRT), birth control, and pre-exposure prophylaxis (PrEP), an HIV prevention medication. Start-ups like Plume and Folx—which is currently raising venture backing and has yet to be released—are more community-based: By connecting trans patients with affirming doctors within the queer community, they’re bringing ideas of personal, embodied care to trans people who’ve historically either avoided traditional medical care or suffered the consequences of an antiquated system. While these apps are part of a larger wave of remote healthcare initiatives—platforms like Forward and BetterHelp—their specific focus on queer health needs is both revolutionary and essential.
Plume is currently planning to expand beyond hormone therapy into the primary care and behavioral health realm, envisioning the app’s future to act as more of a community touchpoint than a disembodied HRT subscription. Matthew Wetschler, the CEO and co-founder of Plume, sees the company’s focus as key to its success. “[Healthcare] has been personalizing medicine initially around the genome with sites like 23andme, and [using this information to determine] how drugs are metabolized in certain ways,” he says. “But there are all sorts of clinical care that is actually more about daily life community connection, and we think this is the next wave of where medicine is going. Healthcare has been a one-size-fits-all solution, but all it really fits is white straight people.” For Plume, seeking doctors and employees from within the queer community is a start to correcting that.
Plume requires a WiFi connection and a phone or computer. Membership is $99 per month, including lab work. Similar to the layout of personalized subscription apps like Curology and AmWell, patients can sign on, consult, and be given a customized plan for medications and HRT from the privacy of one’s own home. Using Plume’s partner app Solace, Plume is able to offer guided care through the process of transition, as well as doctor check-ins.
Startups like Plume combine the traditional tech startup model with the promise of a wider reach than has ever been possible before, thanks to the recently lifted telehealth restrictions. Jerrica Kirkley, co-founder and chief medical officer of Plume, worked at community health centers before co-founding Plume. Her experience working alongside individuals who were struggling to cope with “layers upon layers” of oppression within the medical sphere pushed her to develop an alternative health solution.
“We’ve had a massive influx of folks come to the platform since [the outbreak started],” Kirkley says. “Every day we have people who sign up for visits who literally can’t get in contact with their medical providers. [These are] people who have yet to start HRT or get access to it—and we’re certainly reaching people who don’t have the resources available for them, period. COVID or no COVID, whether it’s Florida, Texas, the Midwest, the Southeast, I mean, really, [people in need] are everywhere. There’s just this dearth of providers, and then they come across us.”
The ability to virtually meet with therapists across the country means LGBTQ patients are less constrained by geographical location. Even in 2020, basic elements of queer care, like STI checks, reproductive healthcare, and PrEP access, remain out of reach for LGBTQ people in rural areas. For some institutions, COVID-19 offers an opportunity to rise to meet this challenge. Chris Grasso, Fenway Health’s associate vice president for informatics and data services, for instance, dreams of a “Fenway without walls,” a goal she’s wanted to reach even before COVID necessitated the switch to digital. Fenway’s telehealth offerings now make it easier for people to sign on, connect with a sensitive, respectful doctor, and access medications and services privately, safely, and from any location.
This promising new era of telehealth for patients—queer and straight, alike—is not without its limitations. Sensitive healthcare solutions for non-English-speaking patients are still in short supply due to a lack of bilingual practitioners, and immigrants and undocumented workers within the community are often barred from receiving complete care. Meanwhile, some healthcare providers are struggling to find tech that works. While places like Fenway have already integrated telehealth options into their service, it’s still very much a work-in-progress to find tech that makes the process smooth and intuitive for both doctors and patients. “I’m actively doing research into telehealth platforms,” says Grasso, “but the field is pretty immature in some ways. Many of them have longer-term goals of features where they want to develop, but it’s not there yet.”
Whatever the tech may lack, however, is made up for in radical accessibility. In the very recent past, transgender individuals in rural areas often solely relied on physically visiting the nearest Planned Parenthood center for care. “Now, with telehealth, it’s much easier for them to go ahead, log onto Zoom, and talk one-on-one [with an affirming healthcare professional],” says Samantha Cahen, Planned Parenthood of Southeast and North Florida‘s program director for trans patients. “[There are] no distractions, and we’re able to go ahead and provide the care that they need.”
For many queer patients, getting there is half the battle.