Digital has been imperative to the delivery of health, human service, and labour programmes, allowing many innovations to be rolled out quickly post–COVID-19 while building the foundation for future initiatives.
Over the past two decades, health and human services (HHS) and labour agencies across the United States have made advances in digital service delivery. Starting in the 2000s, when they integrated their formerly siloed systems, agencies have moved on to self-service initiatives, omnichannel strategies, and increasing levels of automation in a steady—albeit uneven—march toward truly digital service delivery (see figure below). Some agencies have made significant progress; others are still in the early stages of transformation. The COVID-19 pandemic has accelerated the arrival of a truly digital social safety net.
HHS and labour agencies responded to the pandemic with the sort of rapid change we rarely see in government. They quickly rolled out a variety of large-scale digital innovations, such as telehealth services, telework for employees and virtual court hearings. But the digital infrastructure, digital workforce and citizen-facing connectivity that enabled these successes have implications far beyond the pandemic. They are paving the way for digital service delivery for years to come.
Here we examine some examples of leading HHS agencies that redesigned their service delivery systems in response to the unprecedented public health and natural disasters of the past year, laying the groundwork for greater long-term resiliency.
Wind back the clock to spring 2020 when everything shuttered under lockdown.
In an effort to ensure vulnerable populations could continue to receive medically necessary behavioural health services with minimal interruption, Pennsylvania’s Department of Human Services’ Office of Mental Health and Substance Abuse Services (OMHSAS) temporarily suspended a number of requirements governing the use of telehealth for behavioural health services.1According to individual and family surveys conducted by OMHSAS, telehealth usage skyrocketed—from 10% pre–COVID-19 to 88% during the pandemic.
For many Pennsylvanians who received behavioural health services, the shift to telehealth was a welcome one. Virtual service delivery removed a number of barriers that previously prevented individuals and families from receiving services: travel time, transportation to and from appointments, work conflicts, scheduling issues, and child-care and other caregiving responsibilities. Many families benefitted from improved access, while the agency experienced fewer cancelled or rescheduled appointments.
For others, the immediate suspension of in-person services erected new barriers—chief among them, technology and limited internet access. The shift to online also meant individuals and families receiving services had to contend with limited quiet locations, on top of privacy concerns.
For certain populations, including those with intellectual disabilities, autism diagnoses, and other more complex needs, the telehealth experience has been mixed. In situations where telehealth was not effective, some individuals went from receiving 40-plus hours of services down to zero until in-person services resumed, creating both regression in behaviours and challenging, sometimes dangerous, situations for families. In extreme cases, the inability to provide these services in person can result in residential placements that are more costly, increase exposure to COVID-19, and are often less successful in keeping individuals in their homes and communities over the long term.
As government agencies grapple with physical-return-to-work decisions, the lessons learned from Pennsylvania’s immediate shift to telehealth to mitigate transmission of COVID-19 are informing OMHSAS’s path forward. In order to continue providing in-person services during the pandemic, OMHSAS has disseminated guidance on implementing precautions to protect staff, providers and those receiving services when in-person services are more appropriate. Providers have designed new protocols and reconfigured office layouts, while reserving telehealth and curbside services for nonspecialised populations needing less-intensive services.
Like Pennsylvania’s OMHSAS, New Mexico’s Human Services Department (NM HSD) is striving to keep programmes and services physically accessible while also improving its virtual channels. This approach lets the agency better serve the many clients who have come to prefer virtual and contactless service delivery.
Pre–COVID-19, nearly half of NM HSD’s daily client interactions were in person. As of October 2020, that figure stood at 11%. Since the start of the pandemic, NM HSD’s online portal has seen a 19% increase in traffic per month, with an overwhelming majority of that traffic coming from mobile devices. The volume of calls into NM HSD’s customer service centre every month has more than doubled.
Responding to the immediate shift in channel preference, with an eye toward accommodating future shifts in demand, NM HSD has developed an online platform called ServiceConnect. This tool allows clients to request services and gives them real-time visibility into wait times so that they can select their preferred delivery channels. ServiceConnect works with the department’s existing technologies to seamlessly connect clients to its online portal, contact centre, curbside services, pop-up locations, and (when available again) in-lobby operations. The platform also lets NM HSD set up remote service locations with community partners, further increasing access and creating new collaborations. Because the department is able to anticipate shifts in client traffic, NM HSD can optimise its staffing, enhancing safety and convenience for clients by minimising their length of stay.
NM HSD’s investments in new business processes and technology put it in a better position to honour citizens’ service delivery preferences as they evolve, and to collaborate more closely with community partners. All this will pave the way for a smoother, more equitable recovery.
Among the 30 named storms that battered the Gulf and East Coasts during the 2020 Atlantic hurricane season, five impacted the state of Louisiana. Faced with this record number of natural disasters on top of the pandemic, Louisiana responded by retooling its Disaster Supplemental Nutrition Assistance Program (D-SNAP) system.
Louisiana’s Department of Children and Families Services (LA DCFS) first moved to activate D-SNAP in September, as it prepared for the aftermath of Hurricane Laura. To minimise the impact of COVID-19, LA DCFS needed to make the application and disbursement of D-SNAP benefits virtual. Interviews were to be conducted by phone with identity verification, and disaster electronic benefit transfer cards and notices of decision mailed directly to applicants so that they didn’t have to pick them up in person.
With assistance from Louisiana’s Office of Technology Services, LA DCFS redesigned its new, never-before-used D-SNAP system, creating the state’s first fully virtual D-SNAP process in less than two weeks. Individuals and families who needed emergency food assistance could apply and be certified for benefits remotely. Since the virtual system’s stand-up, it has received around 81,000 virtual applications from 34 impacted parishes, with close to 65,000 cases certified and roughly US$50 million in benefits issued.
Over the longer term, virtual service delivery will help Louisiana respond faster when disasters strike. It will also save the state money on building leases, equipment rentals, and employee reimbursements; reduce employee fatigue as they deal with disasters; and offer technology that other programmes can reuse for their own purposes.
When the global pandemic hit, everything changed. Digital was no longer a “nice to have” but an imperative. Consider digital service delivery’s most compelling features: its ability to serve efficiently, scale cheaply and adapt quickly. The disruption of the pandemic has made these features more vital than ever, both to meet the current moment and to lay the groundwork for greater resiliency in the future.
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