Increased Efficiency in Government Performance
How advancements in technology, program evaluation, and research are driving improved outcomes
Prepared by DLH
The rise of the Federal budget in recent decades has been accompanied by increased expectations from legislators, administrators, and taxpayers. An aging population and economic volatility are among the factors that require Federal programs to serve more beneficiaries than ever, and agencies are expected to meet this increased demand without sacrificing service levels. The work is vital. Federal programs secure our nation from attack, provide health care to millions of Americans, serve as incubators for scientific advancement, ensure equal access to quality education, and much more.
Government spending, meanwhile, is subject to intense scrutiny from political leaders, the media, and watchdogs in-and-out of government. While other entities less-susceptible to public pressure might be tempted to reduce services in such daunting circumstances, government organizations and partners must take the utmost care to ensure standards are met and regulations are complied with. Fortunately, trends in technology, performance evaluation, and research enable the Federal government to meet these increased challenges, delivering services at reduced costs while maintaining and improving quality. Below, we use DLH’s experiences across a wide-array of government health and human service initiatives to illustrate the opportunities available to government programs that are willing to transform.
The results are stark. Across the board, Federal programs that invest in innovation are more efficient and more effective. That leads to better outcomes, and it leads to better lives for the million of Americans the Federal government serves on a daily basis.
Technology
When the average American thinks of the Federal government, it’s unlikely that state-of-the-art information technology systems come to mind. Following a run of unfavorable press stories regarding outdated IT infrastructure and cybersecurity lapses, Congress passed legislation in 2017 calling for an overhaul of government IT systems. The Modernizing Government Technology Act requires Federal agencies to improve their cybersecurity systems and leverage the latest innovations in digital, mobile, and cloud technology to increase efficiency and outcomes.
The bill codified an evolution that was already underway. Technology and data analytics had, and continue to be, an indispensable tool across all levels of government. Federal agencies require massive amounts of qualitative and quantitative data collection and analysis for projects of all scopes and sizes. From study design, to data modeling, provisioning and aggregation, all the way to predictive analysis and impactful real-time dashboard reporting, government now utilizes data analytics to evaluate results, increase efficiency, and drive improved outcomes.
The Federal government’s core driving data management needs have been consistent over recent years - with cornerstones such as accessibility, sharing, privacy and security. But to support these needs in a scalable fashion, allowing continuous integration of the latest tools and technologies, many agencies required investment in system modernization. That increased investment in IT architecture is driving the required digital transformation, which provides two key advantages: flexibility – the ability to adapt to user needs and roll out new system capabilities, and scalability – support for an increasing user base, data volume management, and complexity.
Capably providing support and accessibility for large user bases is key for modern government systems. Real-time complex business decisions are predicated on access to large and diverse data sets. Easy data integration, consolidation, and dissemination are vital, and new systems must enable data mashups, dashboards, and data browsing services that support distributed and mobile users with real-time access.
DLH has supported a state health care com- mission by developing, maintaining, and trans- forming their medical case database. Its claims and encounter data inform decision-making and improve access in a rapidly changing environment by providing access, cost, and quality data to policymakers, purchasers, providers, and the public. By managing data collection, extraction, auditing, and aggregation from 30+ carriers submitting tens of millions of claim records, the client was able to develop data flows and processing guidelines that have enabled data alignment and facilitated the submission of high-quality data, processed through efficient Extract, Transform, Load (ETL) processes into a multi-dimensional warehouse. Undoubtedly, this is a good example of an organization that has embraced an innovation roadmap.
Agencies that are successful in claiming ‘da- ta-driven’ decision making and CQI, achieve a true enterprise-wide adoption of their data management framework and tool-enabled automation. With top-of-the-line enterprise IT architectures in place, government entities can take advantage of the rapid advancements in analytics technology. Analysis has evolved from mere data reporting and user-driven exploration -- describing what happened -- to diagnostic analysis of why something happened. Current advances offer solutions that can reliably forecast using predictive analytics and optimization based on AI/ML-based automation. Successful AI/ML solution deployments are critically dependent on scalable and reliable data pipe- lines powered by advanced IT secure cloud infrastructures. Those agencies which have been willing to dive head first into innovation and transformation, are now able to explore the potential of their untapped data.
Performance Evaluation
Increasingly sophisticated data analysis lends itself directly to superior performance evaluation across government. Simply put, government programs with defined measurement and analysis processes perform better. Without analytical reflection, inefficient processes can persist. That hurts outcomes. To make large, systemic progress against any array of social, health, or environmental challenges—substance abuse, natural disaster recovery, healthcare quality improvement, or public health pandemics, to name a few — the Federal government increasingly applies evidence-based processes and tools which reliably represent program activities and outcomes. DLH provides performance evaluation services to a large Federal pro- gram that serves children and families. Ensuring that an ecosystem of programs, policies, and services are coordinated and responsive to the needs of the program’s beneficiaries is vital.
Thorough analysis and evaluation has taught agency leadership that building capacity through multi-system collaborations and interagency coordination is the best path forward to ensuring efficiency and effectiveness. Traditionally, public child welfare systems, like many similar systems throughout the Federal government, have operated in silos that allow for very limited interactions and relationships amongst Federal data owners. This approach produces significant obstacles for data sharing, accessibility and real-time decision making. Our analysis shows that when systems are integrated, they improve agency performance, thereby successfully meeting their goals, and creating a long-lasting environment of data sharing and integration that ultimately fuels the data-driven positive outcomes for their beneficiaries.
Monitoring and compliance is a natural out- growth of any holistic program evaluation. The use of an independent agent in monitoring and compliance provides an objective way to detect the early warning signs of potential areas of risk and ensures business integrity and accountability. Much like an annual physical, monitoring and compliance regularly takes the pulse of what’s going on to make informed decisions on improving program outcomes. The process answers important questions that communicate whether a pro- gram is meeting its objectives and goals.
Accurately and efficiently capturing those answers provides valuable insights on program performance by serving as indicators of the vital signs of program health.
Effective and innovative monitoring and compliance encourages action, enhances any concurrent evaluation activities, and incorporates user-friendly technology to provide valuable insights, saving time, money, and efforts. Recent U.S. Government Accountability Office (GAO) recommendations have pointed to disaster recovery, opioid use disorder, and Veterans health as domains that could benefit from monitoring and compliance. GAO’s calls for monitoring and compliance urge program oversight, the establishment of performance measures, and development of effective tracking systems to drive critical program efforts to meet their goals and objectives.
Recent years have seen Federal partners adapting monitoring and compliance to incorporate technological advancements and connectivity to optimize program activities and increase transparency and accountability. A framework for monitoring and compliance can ensure key components are present for a high-performing process and useful out- comes. Such a framework includes four main components: 1) mature processes, evidence based, tailored and scalable data collection; 2) adaptability in using technology, optimized
through incremental innovation; 3) expertise in managing complex programs, and 4) access to a strong network of relevant domain subject matter experts. High-per- forming monitoring and compliance efforts yield consistent and reliable program information that allow program leaders to focus on analysis and action. This framework provides a flexible structure to guide the monitoring and compliance process and functions effectively across Federal pro- grams to address various social, health, and environmental challenges.
Research
Scientific research is another area in which innovation is driving improved government outcomes. DLH has supported government health research agencies for over 40 years as they strive to improve the quality, cost, safety, and utilization of health care services. The breadth of this work illustrates the numerous steps agencies across government are taking to bolster their research capabilities. Database management, analytic file development and documentation, data analysis and dissemination, web-based application development and website maintenance, and technical support are all key components of DLH’s research framework.
In one example, the creation of online interactive query systems for Federal-State-Industry partnerships informed researchers, medical professionals, and policymakers on hospital utilization, as well as the cost and quality of health care, and health insurance. In another case, policy analysis assisted Congress in understanding the performance of the U.S. health care system, its strengths, and areas needing improvement. Across government, highly trained specialists, statisticians, communicators, and operations experts delve deep into policy analysis, evaluating public and private solutions to vital challenges. This analysis considers all factors, costs, and benefits, and determines what evidence-based solutions give agencies and organizations the best opportunities to accomplish their goals. DLH manages data, conducts analyses, and publishes manuscripts and briefs for numerous clients using data from insurance claims, electronic health records, national surveys, population-based studies, and many other sources. Many of these analyses examine trends in disease prevalence and health care costs and utilization, risk factors leading to poor health outcomes, access to care and quality of care.
Scientific surveys are a key tool in the research paradigm. Multi-modal instruments provide customers with the flexibility to change questions on a frequent basis, while databases of samples and response data are created and stored for analysis.
Vendors work with government customers to understand the survey tools’ intent and ensure the tools’ evaluation and framework are appropriately designed, ensuring the survey is developed with internal and external scientific validity. Government can run studies on the impact of the current modeling and surveys to ensure outcomes are being met. DLH has designed and implemented 80,000 - 100,000 repeated and modified multi-modal, multi-lingual survey (CAWI, CATI, mobile, paper) per year across numerous projects. Subject areas spanned from environmental studies to health outcomes.
These surveys can be used to track custom- er experience. This is important, as ensuring satisfaction improves outcomes. DLH analysis of a Federal military health program determined that speedy, responsive person- al contact with beneficiaries helps yield trust and cooperation. Forward-looking Federal programs are developing new channels of service delivery such as mobile service and social media for proactive two-way communication.
Moving Forward
The Federal government provides services to millions of Americans everyday. Taxpayers and political leaders have high expectations, and despite limited resources, Federal agencies carry out their vital missions in health, defense, science, welfare, and more. Innovation drives improved outcomes throughout government. When agencies, organizations, and initiatives are willing to invest now to achieve more efficient operations down the line, output increases and cost savings add up. Technology, performance evaluation, and scientific research are just three of the many areas in which a transformative evolution in thinking and investment has begun to maximize government performance. Beyond numbers on a spreadsheet, that increased productivity has real results for real people. Increased government efficiency provides for better out- comes in health, security, economics, or any of the areas in which Americans look to the Federal government. As Federal partners, it’s on all of us to keep innovation moving forward.
This article was featured in the 2020 PSC Annual Conference Thought Leadership Compendium. See the full PDF version here.