While the government is spending billions of dollars to modernize healthcare, including addressing a crumbling public health technology infrastructure, a lack of clarity on funding allocation and internal coordination, as well as cultural resistance to change present challenges.
The already vulnerable U.S. public health system has been struck with the cataclysmic impact of COVID-19 and is at risk of failing when the next pandemic or crisis hits without major investments and systemic changes. With the government allocating billions of dollars to healthcare, however, there is a tremendous opportunity to fix one of public health’s biggest problems—a technology infrastructure comprised of aging legacy systems, enormous data silos, lack of interoperability and many other challenges.
Hurdles to success from this funding infusion include a public health culture historically slow to change, resistant to new technologies and with a preference to self-develop systems and platforms. There are also many other complexities – from disparate systems with little ability to exchange and integrate data to health agencies at the state and local levels spending heavily on independent and manual processes – witness the billions being spent on contact tracing based primarily on phones and faxes at all levels with no cohesive architecture. The factors may derail technology project funding, prioritizing, and success, potentially setting public health back further.
Billions allocated to healthcare
In the last year and a half, the federal government has earmarked billions of dollars to the U.S. healthcare system to help it recover from the COVID-19 pandemic. This funding represents a gamechanger for public health, rural healthcare, provider organizations and others. Funding highlights include:
- The CARES Act. Passed by the 116th U.S. Congress and signed into law by President Donald Trump in March 2020, this funding provides $178 billion to hospitals, $127 billion for the Public Health and Social Services Emergency Fund at the Department of Health and Human Services (HHS), $4.3 billion to the CDC and more.
- The American Rescue Plan (ARP). The ARP was passed by the 117th U.S. Congress and signed into law by President Joe Biden in March 2021. It provides $400 billion to expand home care and community-based care for older, disabled adults, $40-$70 billion for COVID-19 vaccination outreach and contact tracing programs, $14-18 billion to upgrade the VA healthcare system and roughly $7-$8 billion each to HHS, CDC, public health agencies, community health centers and rural hospitals.
- White House fiscal year 2022 discretionary funding. In May 2021, the Biden administration outlined health IT funding priorities in a letter to the Committee on Appropriations. The VA stands to collect $113.1 billion for various projects, including $4.8 billion for the VA’s Office of Information Technology and $2.7 billion to continue modernizing its EHR. The CDC has been allocated $8.7 billion for future public health crises, and $65 million goes to rural health broadband.
The CARES Act and the ARP are promising, yet there are many unknowns and ambiguities.
The ARP, which provides significant funding in response to the pandemic for public health, infrastructure and reporting, is vast at 600 pages long with vague program descriptions and allocation amounts. For example, depending on the analyses, the ARP allocates between $14-$18 billion to upgrade the VA systems. Additionally, according to various ARP analyses, $40-$70 billion is earmarked for COVID-19 vaccination outreach and contact tracing programs while another designates $21 billion. Additionally, there are billions of dollars in funds that crossover between these initiatives. All of this begs the question, “Do we have a plan, and how are we going to knit all these infrastructure investments together for real value?” We are at a unique point where the critical question has shifted from “how will we fund this” to “how do we capitalize on these funding opportunities to build a public health technical infrastructure to support our society for the next 30+ years.
Rethinking public health IT strategies
With the ARP funds, the US health system – including private entities and public agencies — have a once in a century opportunity to radically modernize our public health technology. It is critical we work quickly across this health ecosystem to establish health system technology infrastructure to be able to respond to the next crisis. Three essential recommendations to maximize this opportunity include:
- Buy, don’t build. Purchase off-the-shelf applications or partner with proven agile development firms serving similar agencies. Public health must let go of its need to self-develop technology systems and data collection tools, which often take years to develop. Commercial technology can meet – or adapt to – the needs of public health. EHR data now flows through standards base architecture to federal, state and local data repositories. CRM products such as Salesforce and ERP platforms such as Workday can be included in the toolchest. One of the most significant advantages these technologies offer is their speed to market. Just know that 80% percent will be perfect out of the box, while 20% will need refinement.
- Leverage common, standardized available platforms with improved interoperability and data collection capabilities to enable streamlined outreach between public health agencies and community health providers. For example, we work with a large FQHC in Northern California. It reports vaccination data to its private and public health plan partners and the state using two entirely different platforms. The duplicative nature of the reporting process is time–consuming, inefficient and unnecessarily convoluted. Multiply this organization by 5,000 and this is the complexity the industry is wrestling with.
- Forge Private-Public Partnerships. Large health systems have spent the last 15+ years working their way through system adoption, interoperability rules and regulations and major market shifts such as a focus on SDOH and patient experience. There has never been a better time for Public-Private partnerships. In one recent example, five major health systems in Portland, Oregon, came together in collaboration with the state health office to offer mass vaccinations using a single technology platform, with one of the organizations retooling its patient portal to support the endeavor. Another Pivot Point Consulting client, a major academic center in the south, has extended its Epic EHR across the state health department to support their care, service, outreach and reporting.
Today, our public health has unparalleled funding to work with, let’s build a high-functioning system. If we don’t, we put future generations at risk and task them with rebuilding this critical safety net.
Laura Kreofsky, VP, Advisory & Telehealth, Pivot Point Consulting, brings a wealth of expertise to her role leading Pivot Point Consulting’s Advisory practice. Over the past 27 years, she has led health IT planning, implementation and operations in the private and public sectors; working with and for academic medical centers, community hospitals, insurers, public health agencies and international clients. Her areas of focus include IT-enabled business strategy, IT operations and governance and industry regulations and reform