This year, the Long Beach Fellowship team is tackling a high-impact domain: health.
Health is one of the areas that governments have of a deep, direct human impact. It’s pretty obvious when your metrics includes things like infant mortality and premature deaths.
Having been a Fellow in 2013, and with most of my work experience in the health policy world (from actuarial and legislative analysis to health reform implementation), I was asked to help support and document some of the lessons of the Long Beach team’s work this year. I’ve also been working with various cities exploring opportunities for Fellowship projects in health, as well as other possibilities for projects in the health space.
It’s easy in health IT to focus on the big “systems integration” projects. For example, Boulder County, Colo. has had successes with a case management system integrated across the range of human service programs provided by the state, and Medicaid systems integrations have been at the top of government health IT lists for years.
But a unified backend is only one piece of government’s infrastructure in health. And for an 11-month Fellowship, it’s not the best focus, both due to the technical challenges of hooking into legacy vendor systems and challenges like HIPAA compliance, the legwork for which can sometimes take years in and of itself.
A place where a CfA Fellowship project can play a profoundly important role is at the front door: you can have the most elegant backend system in the world, but you still always need an interface that works for the people you’re serving. Applying concepts like “human-centered design” and “lean development” — as detailed below — to health and human service programs both confronts an important problem space for these programs, as well as best uses the resources that a Fellowship team brings.
Here are a few areas where I see a health-focused Fellowship project having a large potential impact.
Putting people first
Too many health and human services programs design their “interfaces” — whether a website, waiting room, or form — focused on the logistical details and governing regulations, rather than the people it exists to serve.
Perhaps CfA’s single greatest strength is the commitment to designing for people, not statute. User experience and design thinking are core to CfA’s work. Some example principles I’ve heard in Fellowship projects:
- Meet users where they are
- Speak their language
- Design by data, not assumption
For example, Text4Baby provides educational tips for expecting mothers via text message over the course of their pregnancy. It’s a great example of using technology that has become commodified — SMS — to put the end-user first.
Last year, the Fellowship team in San Francisco also exemplified these principles in their work with the City’s Human Services Agency.
Their app — Promptly — met people where they were. They replaced confusing, legalistic forms sent to people at risk of being disenrolled from food aid, with user-friendly text message reminders.
But the team also had a broader impact at HSA. They took management down to the waiting room. They ran “design thinking” workshops for agency staff (providing practical training in how to think from a “client-first” perspective). And — through their work around making text messaging feasible — they broke down some of the policy barriers standing between staff and better serving their clients.
Hacking eligibility, enrollment, and outreach
One of the largest bottlenecks in health and human services programs is the labyrinthine web of eligibility and enrollment criteria across the many disparate services available to people.
Colorado’s PEAK — the Program Eligibility and Application Kit — is one example of innovation in this area. It’s a unified front door for all benefits available at the state-level, and even allows for medical program eligibility assessment in real-time.
The not-for-profit SingleStop is another interesting example. SingleStop provide eligibility portals custom-tailored to certain groups, for example community college students. A user doesn’t need to know what programs they need; they just enter some basic information and can see what’s available to them.
Outreach for health programs also presents a huge opportunity for creative innovation. From clever uses of social media like the Adorable Care Act to EnrollAmerica’s use of micro-targeting analytics borrowed from the campaign world, this problem area is ripe for experiments using the power of web technology.
Use data in targeted, high-impact ways
Data is rich in the health world, but its best uses target specific decision points with a large potential impact.
The California Department of Public Health put together an easy-to-understand web map showing data on hospital-associated infections.
Significantly, it translated the raw data — difficult to understand for the layman — into markers standing for low, medium, or high incidence. This lets people without any background see, visually, in 30 seconds which hospitals near them are more or less likely to present a level of risk.
Also in California, UCLA’s interactive web tool for its California Health Interview Survey (CHIS) makes it easy for policymakers’ staff, advocates, and others to find real concrete data about the health status and needs of their specific community.
In a policymaking context, having easy access to actionable data can both inform decisions as well as narrow the space for debate. If there is a reliable source that diabetes rates in a city are relatively high while infant mortality rates are relatively low, it can be easier for the many disparate actors involved in policymaking to align on the priorities of what’s best for the community.
Web tools that make data digestable, and which are also targeted at high-impact decision points where there is no current baseline of data is a big potential opportunity for Fellowship projects.
Building to learn
Most Fellowship teams approach problems with a mentality borrowed from an idea called “the lean startup.” The basic idea is that you can learn more about your specific problem space by doing — by creating hypotheses, building just enough to test that a hypothesis concretely, and putting it in front of users early and often — than by purely researching or thinking about things.
In health and human services, many decisions at the policy and program levels are made based on data and research that is too often non-specific, with the hope that it generalizes to the particular context of the community.
You can’t really know how many people will sign up for text message reminders until you do it, and so doing it fast, and on a small scale, gets your that knowledge early enough that you can make the important decisions with much better context. And a CfA Fellowship team is uniquely equipped to bring this approach inside government with the necessary buy-in to get big impacts from such a rapid learning process.
The Affordable Care Act: different challenges, new opportunities
The ACA was a landmark piece of legislation, an attempt to give all Americans access to affordable health insurance. But while the ACA provides financing for many more people to access healthcare services, there are many more pieces to the puzzle of community health improvement.
Increased healthcare access brings with it new challenges, and new opportunities:
- Tools to help people traditionally without insurance navigate a system completely new to them
- With the ACA’s emphasis on prevention, encouraging proactive — rather than reactive — utilization of care
- Supporting the health of those still left behind by the ACA, such as undocumented immigrants
Areas like health insurance literacy and the search process for healthcare providers would be great for a Fellowship team to tackle, both because they’re pressing needs and because human-centered design thinking has rarely been used to tackle this area.
Questions? Comments? Hit us up @codeforamerica.