A Black History Month Wake-Up Call on Patient Engagement
By Daree Allen Nieves, Healthtech UX Content Designer and Strategist, Ree Writes, LLC
LinkedIn: Daree A.
Health systems that evaluate remote patient monitoring (RPM) solutions unknowingly select vendors whose patient education systematically excludes 40% of their patient population.
According to the CDC, American Diabetes Association, and the Office of Minority Health, Black Americans are 60% more likely to have hypertension, 77% more likely to have diabetes, and 30% more likely to die from heart disease than their white counterparts (CDC, 2023; American Diabetes Association, 2024; Office of Minority Health, 2024). These are the chronic conditions RPM platforms are designed to monitor. Yet research shows significant gaps in device activation and ongoing engagement among Black patients. The vendor’s onboarding experience excludes them before they can start setup.
For health systems, this affects your patient experience problem and your ROI. When 4 out of 10 Black patients disengage, your RPM investment delivers poor outcomes data, fails to demonstrate value, and undermines your organization’s health equity commitments.
Four Red Flags to Watch For When Evaluating RPM Vendors
I’m a Black woman who managed complex care for my late husband with diabetes, kidney failure, cancer, and limb loss in our early 40s, so I’ve experienced firsthand how “colorblind” patient education fails. Now as a healthtech content strategist, I help organizations identify these gaps before signing contracts.
Here are the four critical red flags that signal an RPM vendor’s patient education will fail your Black patients.
Red Flag #1: Reading Level Mismatch
The average RPM patient education is written at an 11th-12th grade reading level. According to the Agency for Healthcare Research and Quality, the average reading level for U.S. adults is 8th-9th grade, with research showing that health literacy level potentially mediates disparities between Black and white patients.
Ask your vendor during demos: “What reading level is your patient onboarding content written at?” If they can’t answer immediately with “6th-8th grade” and provide readability scores, their content will exclude significant portions of your patient population.
Example that loses patients: “Ensure optimal adherence to your prescribed monitoring protocol by documenting systolic and diastolic readings biweekly and reporting significant deviations to your healthcare provider.”
Example that works: “Check your blood pressure twice a day. Write down both numbers, the top number and the bottom number. Call your doctor if the top number is over 140.”
Each version conveys the same information with completely different accessibility.
Red Flag #2: Caregiver Exclusion
According to the National Alliance for Caregiving & AARP, 21% of Black adults are family caregivers, compared to 16% of white adults. Black caregivers report higher intensity caregiving responsibilities, including medication management and care coordination. Meanwhile, most RPM onboarding gives instructions like “Set up your device” as if the patient is operating alone. But it’s often the patient’s daughter, sister, spouse or adult child setting up that device.
Ask your vendor during procurement: “Can family caregivers receive duplicate onboarding communications and access the patient’s app with permission?” If the answer is “We don’t currently support that” or “Patients can share their login,” the vendor hasn’t designed for how Black families actually manage chronic care.
What you should require:
- Caregiver roles built into the onboarding flow
- Duplicate welcome emails (one each for the patient and caregiver)
- App access permissions for family members with patient approval
Red Flag #3: The Trust Deficit
According to research published in the New England Journal of Medicine, 35% of Black Americans have little trust in the healthcare system, with good reasons rooted in not-so-ancient history:
- From 1932 to 1972, the U.S. Public Health Service studied untreated syphilis in Black men, withholding treatment even after penicillin became standard care. The Tuskegee Syphilis Study ended in 1972, which was only 54 years ago.
- Henrietta Lacks’ cells built a multibillion-dollar biotech industry. Her family was never told or compensated.
- Today, according to CDC data, Black women are 3x-4x more likely to die from pregnancy-related causes, even when controlling for income and education (Petersen et al., 2019).
This lived experience shapes how Black patients interact with healthcare technology. Questions like “Who has access to my data?” and “Will I be studied without consent?” reflects their informed skepticism.
Ask your vendor: “Show me your onboarding materials. Where do you explicitly address data privacy, patient control, and opt-out rights?” If the vendor’s materials don’t proactively state “Your data is HIPAA-protected. Only your doctor sees your readings. You decide what gets shared. You can stop at any time,” they’re triggering historical trauma without realizing it.
Red Flag #4: Visual Representation Gaps
When I audit RPM vendor marketing materials, the stock photos overwhelmingly feature white patients and families. The psychological impact makes Black patients think, “This isn’t for people like me.”
Ask your vendor: “Show me examples of your patient-facing materials. Do they reflect the diversity of our patient population?” If their demos, instruction manuals, and app screenshots feature only generic white patients, your Black patients will disengage before they even open the box.
The Financial Impact on Your Organization
These vendor failures don’t just hurt your patients. They cost your health system real money across three stages:
- Stage 1: Initial Investment You’ve allocated budget for RPM deployment: devices, vendor fees, staff training, patient recruitment. But if patients disengage because vendors designed onboarding for a different demographic, you’ve wasted $400-$800 per patient in acquisition costs for every inactive device. Multiply that by 1,000 patients, and you’ve just lost $400,000 to $800,000.
- Stage 2: Outcomes Data Your value-based care contracts require demonstrated outcomes improvements. But when Black patients disengage, your data is biased toward white, affluent patients. You can’t demonstrate equity in outcomes because your vendor’s patient education created inequity in engagement.
- Stage 3: Program Sustainability Your board asks: “Is our RPM program delivering ROI?” When activation rates are 60% instead of 85%, when patient engagement drops off after week two, when readmission rates don’t improve for your most vulnerable populations, the answer is “No.” Programs get defunded. Contracts don’t renew.
The total cost of selecting the wrong vendor is $1.9M to $3.6M in wasted investment per 1,000-patient deployment.
What to Require in Your Next RPM RFP
Health systems increasingly incorporate health equity requirements into RFPs, with at least 21 states including health equity-related provisions in their managed care contracts as of April 2023. Health systems have procurement power. Use it. Here’s what to add to your RFP requirements.
Requirement #1: Health Literacy Standards
“All patient-facing content must be written at 6th-8th grade reading level, verified with readability tools. Vendor must provide readability scores for onboarding emails, app instructions, and help content.”
Requirement #2: Caregiver Support
“Platform must support caregiver roles with separate login credentials, duplicate communications to patient and designated family member, and permission-based access to patient data.”
Requirement #3: Trust-Building Language
“All onboarding materials must explicitly address: data privacy protections, who has access to patient data, how data is used, and how patients can opt out. Vendor must provide examples during proposal review.”
Requirement #4: Cultural Representation
“Vendor must demonstrate visual representation of diverse patient populations in all patient-facing materials, including Black patients and families. Marketing materials used during sales process must match materials shown to patients.”
Requirement #5: Engagement Metrics by Demographics
“Vendor must provide device activation rates and ongoing engagement rates segmented by patient race/ethnicity from existing health system deployments. Vendors without this data will be ranked lower in technical evaluation.”
The Fastest Win: Audit Before You Buy
During your vendor selection process, request these deliverables:
- Week 1: Reading Level Audit Ask finalists to run their three most-used patient onboarding emails through a readability checker and provide the scores. Reject vendors scoring 11th grade or higher.
- Week 2: Caregiver Flow Demo Ask vendors to demonstrate how a family caregiver would get access to help their elderly mother set up her blood pressure monitor. If they can’t show thisworkflow, they don’t have it.
- Week 3: Trust Language Review Ask for screenshots of their data privacy messaging in the patient app. If it’s buried in a terms-of-service agreement or doesn’t exist, move to the next vendor.
- Week 4: Outcomes Data Request Ask for activation rates by patient demographics from their three largest health system deployments. Vendors who say “We don’t track that” are creating equity problems they can’t measure.
This is more than DEI—it’s Clinical Effectiveness
Black History Month is an opportunity to acknowledge not just the historical contributions of Black Americans, but also the ongoing health inequities that shape their experiences with healthcare technology today. For health systems, the business case is clear: When you deploy an RPM platform that excludes your Black patients, you’re not delivering equitable care or meeting your mission. You’re not getting ROI on your technology investment.
Vendors who invest in culturally competent patient education achieve 75%+ activation rates across all demographics, demonstrating measurable outcomes improvements in diverse populations, and earn contract renewals at 2x-3x higher rates. That’s the vendor you want to select. Your patients deserve technology that serves them. Your organization deserves a vendor partner that helps you deliver on your equity commitments. And your CFO deserves to see ROI on the RPM investment.
It’s time to make health equity a non-negotiable RFP requirement.