The American Rescue Plan and public health

The COVID-19 pandemic has exposed cracks in the public health system. Those of us who have worked within public health for years know the limitations caused by funding challenges. But the past year brought broader awareness of the importance of public health. It also inspired a rare and exciting opportunity to modernize systems that have been neglected for too long.

The American Rescue Plan (ARP) was signed into law by President Biden in March 2021. It includes billions of dollars in funding for public health agencies and initiatives. This influx of funding represents a clean starting point, above and beyond agencies’ usual operating budget. 

Officials will be able to make greater investments and act boldly to build the public health systems of the future. Nothing less than the public’s trust in public health is at stake. 

State governments must act swiftly and strategically to improve public health through investment, infrastructure and innovation

1. Investment

ARP funds represent a major opportunity for state governments to make bigger investments in public health. But bold action must start with a sound strategy and an understanding of the resources needed to support it. States need to determine where the dollars will be spent most effectively, and why.

The pandemic has exposed and exacerbated health disparities that have long existed. Public health strategies for the future must address health disparities and social determinants of health (SDOH). 

ARP funding will allow public health departments to focus resources on health equity like never before. They'll have tools ranging from analytics to surveillance to reporting.

States will need to engage in new partnerships and collaborations to support public health. I’m the former state health officer and agency leader for the North Dakota Department of Health. I know public health officials rightfully pride themselves on being health strategists with a clear vision of areas of need and opportunity. I also know that the demands of the past year have resulted in fatigue and left people feeling overwhelmed. 

ARP funds offer a chance to get assistance, rally resources and convene public/private partnerships to build stronger public health systems for tomorrow. 

Public health agencies, hospital systems, payers and providers cannot address something as big and complex as health equity alone. It takes everyone coming together. Partnerships, both traditional and innovative, will be necessary to: 

• Catalyze and accelerate health equity initiatives
• Address systemic health inequities and inculcate SDOH into programs
• Invest in mental health, behavioral health and substance use disorder prevention and treatment programs
• Ensure more affordable insurance coverage through public and private programs
• Modernize public health infrastructure
• Involve local stakeholders, local priorities and local investment

For example, Optum is in the process of building a Center for Health Equity. We’ll partner with state governments to transform Medicaid and HHS performance and improve outcomes by:

• Aligning incentives between payers and providers
• Offering SDOH resources to improve care outcomes 
• Making SDOH services more affordable
• Combating upstream SDOH variables through root-cause analysis

At Optum, we’re ready to help states think strategically about how to build (or rebuild) public health infrastructure, address data needs, augment staffing, and address SDOH and health equity.

2. Infrastructure

A major goal of the ARP is to help states update their public health infrastructure. Data modernization is key for the future. To maintain public trust, states must ensure that public health data is kept safe and secure. At the same time, they must use it effectively and efficiently for public benefit.

Public health infrastructure has suffered from chronic underfunding. Now’s the time to modernize systems and facilitate interoperability — not just for today, but to prepare for the public health challenges of the future.

In Indiana, Optum has supported the state Offices of Medicaid Policy and Planning (OMPP) with data warehousing and analytics services for years. About a year before the pandemic, we were selected to improve the data governance of their analytic system with the goal of “democratizing the data” and allowing access to other agencies as needed. 

The new framework, launched right before the pandemic, supports interoperability. When the pandemic hit, the new framework was immediately put to the test. It proved to be a crucial tool in the state’s pandemic response.

• It enabled state agencies to better monitor testing.
• It provided an accurate daily dashboard.
• It empowered state health leaders to make real-time strategic adjustments to their response.

Updating infrastructure also means investing in public health workflows and readiness. When the COVID-19 crisis began, Optum partnered with the West Virginia Department of Health and Human Resources (DHHR). We supported an integrated eligibility system that processes benefits for medical coverage, food and housing assistance.

This scalable system was able to extend critical benefits quickly in response to policy changes. Within 72 hours, Medicaid and CHIP benefits were extended to more than 77,000 recipients. As COVID-19 vaccines put more pressure on state immunization systems, this kind of scalability will become more urgent. 

Optum has the experience and expertise to design and build the next frontier in public health infrastructure, including:

• Bi-directional data flow between electronic medical records and public health entities 
• Individual identifiers for payers, providers and public health entities
• Data interoperability/data sharing so that multiple care partners have line of sight into patient progress
• Data dashboards to monitor progress and enable real-time adjustments to programs and activities

3. Innovation

Innovation is the thread connecting all the public health initiatives that ARP funding will enable. Many states have been forced to innovate in response to the pandemic (necessity being the mother of invention), and great things have come about. We now need to carry that same innovative urgency and energy throughout 2021 and beyond.

Data integration is the differentiator for the future of public health. Interoperability is like the skeleton that connects systems and makes them hang together. And data integration is like the circulatory system that shuttles crucial nutrients among them. 

Once systems are able to talk to each other, it’s vital that the data they share is of high quality. AI, machine learning, sophisticated algorithms and analytic maturity are key.

Optum excels at advanced analytic maturity. We have the scale of data, the tools and technology, the algorithms, and people skilled in actuary science and analytics. 

Many public health departments have impressive epidemiological data expertise. Yet they could benefit from the analytics, AI, machine learning and predictive modeling tools that Optum has to offer.

Optum recently helped another state rework its overburdened system to accommodate for current and future COVID-19 testing growth. The new, fully automated system was able to:

• Provide highly reliable data 
• Create a repeatable process that enables better reporting and tracking 
• Address inequities exposed by the pandemic
• Unify state and local jurisdictions in their response
• Increase public trust

As public health officials, we understand prevention, health care and the impact of disparities. But those of us who have been in that role know we're not necessarily equipped to go it alone in laying the pipes for data infrastructure, AI or data integration. A partner like Optum has that expertise to help anticipate and prepare for the future of data modernization.

The ARP is an opportunity on a scale we’ve rarely seen before. It can help us make a bigger investment, tackle long-entrenched problems and build the public health infrastructure of tomorrow. 

The level and allocation of investment will be different for each state, based on their current situation. Partnering with Optum can give states a big-picture view of where they are and where they need to go. 

From strategic visioning to advisory services to advanced tools and technology, Optum offers everything states need to take full advantage of the transformative potential of the ARP.

About the author

Mylynn Tufte

Population Health Practice Lead, Optum Advisory Services

With more than 25 years in health care, Mylynn Tufte is the former state health officer for North Dakota. In that role, she led the state’s Department of Health during the COVID-19 public health emergency. She also established health policy and developed and implemented strategic priorities. 

Tufte uses technology to improve health equity, social determinants of health and care for vulnerable populations. She has helped organizations develop and implement innovative solutions that improve health care for diverse populations.

She earned a BSN from Case Western Reserve University, and an MBA and MSIM from Arizona State University.