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What does this mean?

Transforming HHS with Whole Person Service

Tech Services

Service delivery and the individual experience within health and human services (HHS) is often very siloed and fragmented.

Service delivery and the individual experience within health and human services (HHS) is often very siloed and fragmented.

For example, an individual who lost their job may receive cash aid from one social services program, but still have several unmet needs in terms of childcare or elder care assistance that could help them get back to work and begin generating income. It can be difficult for social service providers to identify this gap because they lack a holistic view of the individual’s complete needs or are unable to get to the root problem that led the person to apply for aid in the first place.

Overcoming these challenges and giving social workers, providers and program administrators more visibility into an individual’s needs across the HHS continuum requires a combination of technology, regulatory and cultural changes. It also requires a new approach, especially in the wake of a global pandemic that significantly increased demand for aid and overtaxed health and human services agencies. Whole Person Service is one approach that could help agencies deliver more effective and comprehensive aid.

What is Whole Person Service?

“Whole Person Service is a philosophy or strategy focused on overcoming the barriers that prevent an individual or family from becoming self-sufficient and realizing their potential,” says Dawn Wilder, a 30-year public sector and HHS veteran and an account general manager at Gainwell Technologies, a leading provider of HHS technology solutions.

Whole Person Service is about addressing challenges at both the individual and community level that may lead someone to need ongoing assistance from health and human services programs. It’s an 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 of Whole Person Service 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 need to overcome.

Though social service providers are earnest in their desire to help those who need aid, several barriers often stand in their way. Funding silos are one issue. Many HHS programs are only designed to handle an individual’s immediate needs or only those needs that are within the scope of their particular program. In some cases, a social worker may make a referral to a community organization or another provider, but that’s only if they are able to recognize an individual’s holistic needs in the first place.

“The funding silos make it extremely difficult for organizations to provide this kind of Whole Person Service,” Wilder says. “They’d have to figure out a way to fund the components of all the services that are outside of the specific program funding. The money does not flow in terms of how well you are achieving an outcome. It’s about whether or not you have complied with the specific requirements of that program.”

Along with these funding challenges, there’s another obstacle to achieving Whole Person Service — data integration. In some states, the health department can’t share data with the human services department (and vice versa). This makes coordination between programs more difficult and even potential referrals less impactful because there’s no visibility into how each program is meeting an individual’s needs. Service coordination cannot be accomplished without data sharing.

“The struggle that states face is who can see the data and [the question of] ‘what data sharing agreements do I need to have in place?’” says Brett Barton, a sector general manager at Gainwell. “Then there's the issue of what people think they can share or not and with whom. Data sharing and privacy are complicated areas to navigate, and people may have differing interpretations of regulations.”

The pathway to more holistic HHS delivery

Leveraging advanced technologies, creating a culture of data sharing, and revisiting existing regulations and program silos will help HHS agencies move toward Whole Person Service.

Advanced technology. Agencies will need technologies like the cloud, artificial intelligence (AI) and machine learning (ML) to support their efforts. Wilder says an AI-driven, interactive interview or assessment can serve as an effective tool for initial information gathering that helps social workers and providers better gauge an individual’s holistic needs.

“What we need is a fully interactive interview that, based on what the individual in need says, will assist the worker to ask the next proper set of questions — because we're not talking about things that are easy to ferret out,” Wilder says. “Getting to the root cause of someone's problems can be an extremely difficult task. So, the use of AI in this area is probably on the cutting edge to really understand ‘what questions do I need to ask?’”

Dr. Jung Kim, an analytics and business strategist at Gainwell, says usability also is critical.

“We need to pay attention to the ease-of-use aspect, especially in the self-service context. So when someone approaches an agency on a website, we make it as easy as possible for the person to interact with them, to answer questions, to supply information and, most importantly, to get what they need,” he says.

Robust analytics. To craft an effective Whole Person Service strategy, agencies need robust outcome analytics and the combined data of an individual’s health and human services across multiple programs. They also need a longitudinal view of the population to understand the larger societal factors that may contribute to an individual’s challenges and to foster better wellness and self-sufficiency at the individual and community level. With robust outcome analytics, agencies can figure out what tactics and strategies are most effective, and track and measure progress toward each program recipient’s self-sufficiency goals.

“Whole Person Care coming from Medicaid has demonstrated that Whole Person Service is a good concept — it works. There’s a lot of anecdotal and research evidence out there that addressing the social determinants of health helps significantly,” Kim says. “But the problem is that it can be challenging for an agency to put together a whole person service that includes multiple services and referrals. That’s because we haven’t figured out empirically, and in a data-driven fashion, what works and what doesn’t work effectively.”

Leveraging well-designed data integration to construct a whole person view will help agencies gain insights, drive better outcomes and achieve more effective Whole Person Service.

Regulatory and cultural change. Regulatory changes at the federal and state levels would facilitate Whole Person Service delivery if more emphasis was placed on outcomes rather than strictly compliance.

Federal and state governments need to continue reducing funding silos to give program administrators a bit more flexibility to provide, better track and measure the effectiveness of coordinated services.

Kim says it’s also necessary to build trust among program recipients, social workers, social services providers and other key stakeholders. There must be some measure of trust that individuals can be transparent and get the help they need without exposing themselves to unintended adverse consequences.

With Whole Person Service, Barton says it all boils down to the following goals: empowering individuals with better tools to increase their program engagement; improving population health management; leveraging advanced technologies to integrate data across the HHS ecosystem; creating a strong provider network to address service access issues; conducting outreach to keep program participants, providers and other key stakeholders informed; and focusing on organizational change management.

“It’s more than just technology. How do you create an environment that allows everybody to participate in this whole person approach, versus the traditional silos they've been working in?” Barton says. “If you cannot create organizational change and a change in mindset and behavior, it may fall apart. All of these things need to come together to make Whole Person Service work.”

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