Health and human services
Transforming delivery of care and our collective well-being
Charting the evolving landscape of population health
Healthcare and population health play a pivotal role in society. Both have undergone significant shifts since the beginning of the COVID-19 pandemic with evolving efforts to build more resilient healthcare and public health infrastructure for the future. It is crucial to understand the dynamic trends in healthcare and population health that contribute to holistic well-being, especially in a world where rapid social, infrastructure, and environmental changes will continue to affect our communities. Other challenges that are shaping the evolving landscape of health and human services include: growing behavioral and mental health crisis, workforce shortages and gaps in public health infrastructure, and disparities in access to care, especially for those in our most vulnerable communities.
As we navigate this uncertain future, it is imperative for organizations in the healthcare and population health ecosystem to understand, track, and influence evolutions in healthcare practices, innovative technologies, and social advancements. Active engagement with the evolving landscape of health and human services is necessary to enable quality of life for populations and the resilience of our interconnected world.
As we look ahead, we see five cross-cutting trends shaping the future of healthcare and population health. Understanding these trends will enable organizations to move from a reactive position to become proactive leaders of positive change:
Information technology (IT) modernization to connect and empower: Transforming data to drive efficiencies and foster connection across small businesses, government partners, and communities
Patient-centric care: Collaborating to provide personalized care focused on social determinants of health (SDOH) and equitable practices
Workforce resiliency: Investing in a robust workforce to keep pace with demand
Cybersecurity as patient safety: Mitigating fraud and cybersecurity threats to our public health and healthcare systems
Analytics and AI: Leveraging data analytics to improve patient outcomes, streamline processes, and enhance decision-making
1. IT modernization to connect and empower: Transforming data to drive efficiencies and foster connection across small businesses, government partners, and communities
IT modernization plays a pivotal role in enhancing efficiency and promoting connectivity within state health and human service organizations, and with the federal government. Upgrading technological infrastructure enables agencies to streamline operations, reduce bottlenecks, and deliver services to the public more effectively. Modernizing IT systems facilitates real-time data-sharing and data analytics. Collectively, these investments enable agencies to identify trends, allocate resources, and respond swiftly to emerging public health and social service challenges.
IT modernization includes mobile applications and online portals which empower citizens to access health and human services and information easily and foster a sense of connection and engagement. In September 2023, the Office of Management and Budget issued its long-awaited guidance on how agencies should more fully implement the 21st Century Integrated Digital Experience Act (IDEA). Fueled by the IDEA’s mandate to prioritize user-centric, digital-first service delivery, the U.S. Department of Health and Human Services (HHS) has already rolled out improved digital experiences accessible to millions of people. Two examples include:
The department redesigned its Medicare Plan Finder to make it easier for people enrolled in Medicare to compare plan options online, resulting in increased user satisfaction scores.
The Veterans Affairs (VA) Health and Benefits mobile app enables blind Veterans to review VA benefit decisions using assistive technology, providing Veterans with improved accessibility to manage their health care and benefits.
At the state level, a growing number of state Health Information Exchanges (HIE) and Health Data Utilities (HDU) are adopting modern analytics and data warehouse platforms improving how electronic transfer of clinical information is synthesized across disparate health information systems and then exchanged across care and service settings. One leading example is from Maryland’s HIE and HDU called Chesapeake Regional Information Systems for our Patients (CRISP).
Their adoption of a modern data analytics platform, orchestration layer, and use of data engineering practices has transformed how CRISP serves its stakeholders. Its new platform—CRISP Insights—easily and securely handles datasets of 400+ billion records and 30+ unique data sources to produce clean reports for further analysis. As a result, teams have the power to explore how different populations are affected by everything from overdoses and regular seasonal flu to pre-diabetes. Local communities across the state now benefit from some of the most reliable, insightful healthcare information in the United States.
As more organizations across the healthcare and population health ecosystem automate administrative processes, such as eligibility determination for child support and other social assistance programs, they can also reduce manual workloads, minimize errors, and expedite service delivery through connected systems and information.
IT modernization serves as a cornerstone and catalyst for transforming state health and human services, ushering in a new era of efficiency, collaboration, and effectiveness with improved health outcomes for the community.
Suddenly, we can build a full view of a person which can be used by epidemiologists or a reporting suite in research studies. And we can link hundreds of thousands of records and link files in specific ways that are 100% accurate. We couldn’t dream of doing that a year ago. It’s like we’re in a different league now.
2. Patient-centric care: Collaboration to provide personalized care focused on social determinants of health and equitable practices
Patient-centric care reflects a paradigm shift in healthcare towards a more holistic and patient-focused approach. It places the patient at the center of healthcare, recognizing their individual needs, preferences, and values. By doing so, it not only improves the patient experience, but also contributes to better health outcomes and more effective use of healthcare and social service resources.
For an individual, navigating the landscape of your state’s health ecosystem can be challenging, especially when it comes to social services, where the intricacies of service referrals and program eligibility determinations come into play. Care teams often struggle with a lack of visibility into available services, their locations, operational hours, and whether an individual meets the criteria for eligibility. While centralized lists may exist for care teams, they frequently suffer from inaccuracies or outdated information. This is especially true for care teams that provide services to vulnerable populations.
For example, patients facing housing instability or homelessness often rely on regional Continuums-of-Care (CoC) comprised of numerous providers working collaboratively to coordinate assistance for individuals in crisis. Real-time access to information regarding available shelters or social services within these continuums enables care teams to respond promptly, connecting individuals with the appropriate shelter and supportive services.
In the context of patient-centric care, it is crucial for state health and human services agencies and organizations to remain attuned to the challenges faced by unhoused individuals in their journey from emergency shelter to permanent housing and self-sufficiency. For example, housing instability has a negative impact on physical health and hinders access to healthcare and is associated with higher rates of morbidity and mortality, and increased healthcare costs. From the perspective of SDOH, housing can be considered a form of healthcare.
This renewed emphasis on SDOH springs from a pressing need to address the root causes of health issues and the healthcare system's pivot towards whole-person care. It is igniting community-based efforts and fostering cross-sector partnerships focused on measuring and tackling health-related social needs (HRSNs). HRSNs encompass critical issues like income instability, housing insecurity, and food insecurity and are intertwined with SDOH.
As patient-centric care is emphasized alongside SDOH as a driver of health outcomes, we are better positioned to foster a healthier population and establish a more sustainable and cost-effective healthcare system.
Defining social determinants of health:
We’re hearing calls for a renewed focus on SDOH and their role in shaping health outcomes and equitable access. This focus is raising awareness of the nonmedical factors that influence health outcomes, such as the conditions where people are born, live, learn, work, and worship.
At the community-level, we’re building greater awareness of how food and housing insecurity and limited access to jobs and learning opportunities put people at greater risk of heart disease, stroke, depression, and diabetes, and impact access to care.
3. Workforce resiliency: Investing in a robust workforce to keep pace with the demand for healthcare services
In the US, the governmental public health workforce is a complex network of more than 3,000 state, local, tribal, and territorial (SLTT) public health agencies that have been chronically understaffed and under-resourced even before the pandemic started. Our health and human service agencies and the network of providers they rely on to perform foundational health services are facing significant workforce and skill gaps threatening their ability to deliver essential care to our communities.
People also rely on our public health workforce to respond to emerging threats. As we all witnessed during the COVID-19 pandemic, our public health professionals were our first responders during a global crisis. Their heroic efforts included long hours and working in staffing shortages for months. These were significant contributing factors to staff departing the SLTT workforce at alarming rates during the pandemic.
According to the US DHS Office of the Assistant Secretary for Planning and Evaluation (ASPE), the size of the state and local public health workforce decreased in the decade leading up to the COVID-19 pandemic. Now that the public health emergency has ended, ASPE reports that challenges remain with hiring and retaining a diverse workforce. Some of the biggest challenges are burnout or high workload, lack of advancement opportunities or low salaries, and inflexible hiring mechanisms. The impact is that our communities do not have enough providers or facilities to meet their health care and social service needs, especially in our rural communities, and for our most vulnerable populations.
As we look ahead, we expect to see continued investment by agencies to recruit, train, and retain skilled workers in critical areas as we build a more robust, diverse, and resilient health workforce for the future. Recruiting and training health and social service providers starts as early as high school. It is important to get 16- and 17-year-old students excited about the field and trained for certain careers directly out of high school. For students continuing to higher education, attracting these students to a community with targeted and personalized messaging can help fill its applicant pool.
After recruiting and training, licensing of the public health and social services professionals is a top concern for many local and state governments. Having a highly manual process with long wait times to obtain a license or renewal could make the difference in keeping a potential recruit. We’re seeing more agencies across all levels of government adopt automated workflows with document repositories and integrated omnichannel communication that provide a more seamless experience for the licensing professional, as well as the government employee processing applications.
As state health and human services agencies take a comprehensive approach to build a robust, diverse, and resilient health workforce for the future, they can consider how modern data and technology capabilities can vet and assign workers for licensure, experience, geographic location, and safety.
The solutions put in place in response to the pandemic’s staffing surges provide a sustainable model for the future. We’ve seen state health agencies overhaul their entire system for assigning tens of thousands of healthcare workers to cases in a matter of months during the pandemic.
By embracing solutions, like secure cloud-based customer relationship management (CRM) solutions, agencies and providers can more quickly match health workers to patients or jobs, automate case management workflows, and make the licensing process more seamless for new healthcare professionals entering the workforce.
Lastly, the availability of quality, unbiased, and ethical providers in communities where they live, and work is fundamental to achieving health equity. Ideally, providers need to be physically located and accessible for the populations they serve and with appropriate SDOH training. We also expect to see policies and programs that call for greater integration of mental health into primary care, especially as the nationwide release of SAMHSA’s 988 Suicide and Crisis Lifeline continues to get implemented across states in the US.
4. Cyber safety is patient safety: Mitigating against fraud and cybersecurity threats to our public health systems
In the context of healthcare and population health, cybersecurity refers to the defensive measures and activities that prevent exploitation or misuse of the cyber infrastructure, such as medical devices, laboratory systems and networks, hospital and treatment center systems, patient databases, hardware components, and software.
Cyber threats to public health agencies, public assistance programs, and commercial healthcare organizations are increasing in frequency and sophistication, as bad actors develop new tools and methods and a more mature understanding of the value of health and patient data. A 93% increase in cyber incidents has been reported by the U.S. HHS Office for Civil Rights in the past four years alone.
These breaches have resulted in considerable harm to patients, providers, and public health systems. Estimates of the number of individuals affected by recent healthcare data breaches range from 20 to 50 million individuals, with costs of these data breaches increasing over 40% in the last two years across commercial and public healthcare organizations.
Large government programs, such as Medicare, disaster assistance, and unemployment benefits, remain the biggest targets of fraudsters. State agencies may be more vulnerable to such fraud due to the breadth of programs and dependence on online application portals. Several impacted state and local departments of public health have had to take websites offline for weeks following ransomware, malware, or other network breaches, disrupting routine and emergency health services. As our healthcare ecosystems become more digitally connected, with the goal of facilitating the secure and interoperable movement of data, these connections introduce new vulnerabilities into our system.
These unrelenting attacks not only put individuals’ data at risk, but they threaten the delivery of essential public health services, including emergency responses by SLTT public health organizations. The U.S. HHS is building off the National Cybersecurity Strategy to establish cybersecurity regulations and provide guidance to SLTT organizations on how they can enhance cyber resiliency and protect our critical health infrastructure and sensitive health data from malicious actors.
We now live in a world where the orchestration/integration layer in complex IT systems is just as important as the care provider or government employee’s user interface or the person’s patient portal. As health and human service agencies work to mitigate growing cyber threats, we recommend establishing robust data governance policies and threat assessments to uncover vulnerabilities in enterprise technology and connectivity points.
Another example of how government is mitigating fraud related to assistance program benefits is the SNAP program’s fraud prevention initiatives. The program is leveraging technological solutions to combat issues like card skimming.
The advancements in modern data analytics, AI, and ML make it possible to more accurately and proactively pinpoint potential or actual fraud and design investigation tools to identify and take action on bad actors.
The success of our healthcare systems and broader initiatives for a digital-first government hinges on our ability to effectively protect data and systems from cyber threats. By working together, public health departments and private health providers can safeguard our vital resources and ensure a secure and resilient future for our healthcare infrastructure.
5. Data analytics and artificial intelligence (AI): Leveraging data analytics to improve patient outcomes, streamline processes, and enhance decision-making
Proficiency in deciphering and harnessing data-driven insights plays a pivotal role in enabling enduring positive changes in the realm of healthcare. The dynamic interplay between data analytics and AI not only streamlines and automates operational workflows, but also cultivates healthcare systems that prioritize equity and enhance patient outcomes.
The integration of predictive analytics holds the key to early identification of potential health issues, paving the way for proactive interventions and personalized treatment plans that embrace a more patient-centric care model. The seamless integration of data from local, state, and federal health and human services agencies will enhance population data, ultimately contributing to superior population health outcomes.
The incorporation of AI enhances connectivity between communities and technology, thereby driving efficiencies for improved healthcare services. AI capabilities focused on healthcare trends and diverse population needs and impacts, allow for tailored and targeted interventions while minimizing redundant efforts. Equitable AI algorithms emerge as a crucial tool in addressing healthcare disparities, ensuring that marginalized populations receive the necessary attention and resources.
A particularly promising facet of AI in healthcare is generative AI (GenAI). By learning from extensive datasets, GenAI creates innovative content on a large scale, encompassing text, images, audio, and more with remarkable speed. Its applications extend to tasks such as email generation, data extraction, research and coding, and technical assistance, among others.
Embracing cutting-edge technologies like responsible AI that ingests and learns from trusted data sources holds the potential to revolutionize the delivery of social, health, and human services by health professionals and agencies.
As we look ahead to 2024 and beyond, we expect rapid improvement in how patients can access their personal healthcare records through the release of the Trusted Exchange Framework and Common Agreement (TEFCA). TEFCA, a nationwide data exchange, will greatly accelerate the opportunity for data interoperability within and across states.
The TEFCA was just released in December 2023 by the US Department of Health and Human Services (HHS) through the Office of the National Coordinator for Health Information Technology (ONC). This nationwide data exchange creates the standards for data interoperability so that patients can have increased access to their records. Healthcare providers and plans will also be able to improve their secure exchange of electronic health information.
As we adopt advanced analytics and more interoperable delivery approaches and systems, our patients, providers, payers, and researchers can more securely exchange and use health information, not only for better care coordination and innovation but also to promote better health outcomes for all.
Slalom contributors: Marie Todd, Matt Bennett, Olga Tadesse, Tia Brown, Jon Riley, Monique Martin, Ceren Oney
