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Improving Equitable Access to HHS Assistance Programs

In an outdoor setting with green-leafed trees in the background, a young child is sitting on a woman’s shoulders. Both are smiling/laughing, and the child has one hand on the woman’s forehead for balance. Strategies and initiatives influencing access, integration and data utilization across health and human services

Improved access to safety net and government and community assistance programs can support healthier outcomes, improve socioeconomic conditions and provide a path to self-sufficiency. Unfortunately, finding and accessing the benefits these programs offer means navigating a complicated and often disconnected network of health, financial, housing and family services. 

In this blog, we will share some of the social and technological challenges inhibiting access to safety net programs and strategies and initiatives states can implement to enhance outcomes for our country’s most vulnerable citizens.

Human Services Technology Challenges

The technology human services programs use varies significantly in age and complexity, ranging from enterprise systems to standalone applications and desktop spreadsheets.

Multiple technology and useability challenges make it difficult for individuals and their cohorts to find programs for which they may be eligible, complete the necessary applications to obtain the services they need today, and navigate the path to long-term self-sufficiency for themselves and their families. 

Fortunately, many agencies are evaluating and pursuing opportunities to modernize their systems.  Ultimately, they are striving to achieve better interoperability across agencies and systems to identify individuals and families who are eligible for multiple assistance programs and more efficiently connect them with the services and resources they need.

Strategic Initiatives

Initiatives improving access, integration and data use and interoperability across HHS are substantially driven by the following:

  • The confluence of healthcare and human services programs and services
  • A transition to a whole person care model supported by expanded access to SDOH data
  • Enhancing recipient experience
  • Improving recipient outcomes and creating paths to self-sufficiency while reducing program and administrative costs
  • Addressing work-life and productivity challenges among the agency workforce, with a focus on social and case workers

What are the potential benefits and improved outcomes that can be achieved by executing on the systems and processes that deliver on these initiatives?

Let’s look at the following graphic:

A chart titled "Key Strategies & Initiatives Driving State Public Assistance Transformation" outlining four key components: a confluence of health care and human services, transition from a case-centric to whole person engagement, improved outcomes/reduced costs, and enhanced experience for recipients and providers.

When government HHS agencies can connect data across healthcare and human services programs, they gain a holistic view of a recipient’s medical, behavioral and socioeconomic well-being. This whole person view enables agencies to achieve the Quadruple Aim for human services.

As illustrated in the above graphic, the Quadruple Aim for human services focuses on safety net and other family and human assistance and services — augmenting the original Institute for Healthcare Improvement (IHI) Triple Aim for healthcare.  The Quadruple Aim for human services presents a framework for improving social/economic outcomes, reducing program/administrative costs while enhancing the recipient experience and ensuring the well-being of case workers/providers.

Achieving these aims is not easy. Technical, operational, legislative/regulatory, cultural and funding challenges are just a few barriers inhibiting modernization efforts and, with them, more equitable access to public assistance programs. In a previous Gainwell blog post, we touched on some of these challenges and outlined the pathway to a more holistic delivery

Here, we want to dive deeper into the technical solutions and services needed to drive equitable access to public assistance programs through the lens of a whole person approach to improving outcomes and self-sufficiency

What Is a Whole Person Approach?

A whole person approach is about addressing challenges at both the individual and community level that may lead someone to need ongoing assistance from HHS programs. It’s an aspirational approach that encompasses a set of coordinated services that holistically address an individual’s physical, mental and socioeconomic well-being. It also seeks to restore and sustain that person’s self-sufficiency. The core principle is about fundamentally helping people — and not just providing point-in-time aid that doesn’t address the often multi-faceted and interrelated set of challenges a person may be facing.  

To improve equitable access to public assistance programs and ultimately deliver on a whole person approach, agencies need targeted, actionable and integrated data on an individual’s socioeconomic, health and human services needs across the public assistance and care continuum ecosystems.

Agencies also need a longitudinal view of the population to understand the larger societal factors that may contribute to a community’s challenges and foster better wellness and self-sufficiency at the individual, family and community level. With robust outcome analytics that provide actionable advice, agencies can determine what tactics and strategies may be most effective, and track and measure progress toward each recipient’s outcomes and self-sufficiency goals.

How Can Agencies Accomplish these Aspirations?

It starts with connecting and aggregating the data across health and human services programs.

In a white paper published by the APHSA National Collaborative for Integration of Health and Human Services Analytics Committee, the organization provided guidance on how to effectively implement successful analytic initiatives and the organizational capacities needed to support them. They also outlined the necessary data levels to identify and inform improvements that will drive equitable access to public assistance programs.

The levels as APHSA defined them are:

1. Population Level Data — This data can be considered as benchmark data and would be useful for a broad population view of assessment trends including program investments, program design and policy at the population level. For example, de-identified data sets may include American Communities Survey, the Youth Risk Behavior Survey or the Behavior Risk Factor Surveillance System.

2. Program Level Data — This data is focused on the services public assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) program offer. It is used to generate evidence that supports the services and expected outcomes for recipients while evaluating program effectiveness, return on investment and social impact. The data could gauge how successful programs are in supporting recipients’ paths to self-sufficiency and other measures of well-being.

3. Individual Recipient and Household Level Data — This is the core recipient data typically collected from eligibility enrollments, community programs, healthcare providers and direct engagement between social/case workers and recipients. When properly analyzed, this data is most useful to improve equitable access to public assistance programs.

Bridging the Digital Divide

As organizations progress in their strategic initiatives to improve access, integration and the more effective utilization and interoperability of data across the enterprise, we must also be cognizant of the digital divide that can serve as a barrier to participation in human services programs.

The National League of Cities defines the digital divide as the gap between individuals who have access to computers, high-speed internet and the skills to use them, and those who do not.

The good news is the digital divide has been narrowed significantly in the past decade. As an example, a recent BCG study shows more than 96% of Medicaid recipients use a smartphone, which is indicative of a high level of access to the internet and electronic communications like text and email. Geographically, these percentages will vary. Rural areas are less likely to have adequate data access coverage than metropolitan areas. Enabling access through conveniently located internet-enabled kiosks can help to close or at least reduce the impact of the digital divide.

We also need to be aware of “digital friction” or the usability of the systems for not only recipients but also their families in accessing case/social services resources. When applicants need access to financial, health and social supports, it often comes during some of the hardest moments of their lives. Access to assistance and services should therefore be intuitive and seamless and not create additional challenges to overcome.

Narrowing the digital divide starts with considering three attributes of system usability:

Simplify — Reduced clicks, plain language, the use of intelligent agents, when possible, to guide users, and the availability of alternate real-person support for users. Pre-populate forms when feasible.

Accessible — Simple navigation for mobile users is a must. Don’t use excessive graphics that “hog” page loads, keep bandwidths in mind (leaner is better). Be sure to include audio options, including telephone voice response.

Respectful — Be thoughtful of usability in design. Age, gender, language and other factors should always be key considerations.

Data Is Key

HHS data integration is essential to delivering on the promise of integrated eligibility in creating equitable access to public assistance programs — enabling organizations to:

  • Address determinants of self-sufficiency (medical, behavioral and socioeconomic wellbeing)
  • Promote access to education, financial stability and connecting people to the right resources in enabling them to stand on their own
  • Help agencies connect recipients and families with the programs they need
  • Provide a comprehensive look at a recipient’s past, present and future care to create actionable advice for sustainable wellness
  • Proactively focus on improved care outcomes, allowing for other important resources that can be reinvested in the greater social good
  • Adopt a holistic, integrated solution to move eligibility and enrollment processes toward recipient-focused care and improved outcomes

Achieving data interoperability not only across healthcare systems but the broader human services and public health landscape is vital to improving equitable access and outcomes for human assistance program recipients.

About the Author

Alan Hansen is Gainwell’s senior principal application architect, responsible for consulting on and providing innovative strategic systems and technology direction for state human services and public health, private sector healthcare and commercial payer leaders.

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