Reducing the “Time Tax”: Impacts of Biden’s CX Executive Order

President Biden’s December 2021 Executive Order on Transforming Customer Experience and Service Delivery to Rebuild Trust in Government aims to improve customer service delivery and outcomes for the millions of Americans who access government services every day.

In the EO, President Biden designates 35 High Impact Service Providers and charges them with reducing the administrative burden on individuals attempting to access US government services.

In part, this customer experience (CX) directive will result in investment in digital tools (e.g., streamlined websites and mobile apps) and better information sharing between agencies.

Healthcare is one of the most prominent and important customer-facing government services. Unsurprisingly, Biden’s EO is expected to have major impacts on how organizations like the Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA) engage with beneficiaries of healthcare and public benefits through digital services.

Department of Health and Human Services

The President’s CX Executive Order relates to multiple aspects of HHS’ FY2022-2026 draft strategic plan – but most notably its goal to “Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare.”

The Centers for Medicare and Medicaid Services (CMS) is the most impacted by the EO, given its role in providing healthcare coverage and playing a major role in healthcare policy.

Nearly 64 million Americans are currently covered by Medicare, and as of June 2021, a record 31 million Americans were enrolled in healthcare coverage through the ACA Marketplace and state Medicaid expansion.

President Biden has directed the department to streamline and digitize healthcare delivery. Specific mandates were as follows:

• Expand customer support options and create personalized online tools. The goal is to make it easier for users to access Medicare services online related to managing care, receiving support, and saving money on drugs.
• Enact automatic enrollment between benefits programs. Americans reaching retirement (age 65+) will have a more streamlined experience enrolling in both Medicare and Social Security benefits due to mandate to improve collaboration between CMS and SSA.
• Strengthen requirements for measuring maternal health quality. Collecting data on patient demographics (e.g., race, ethnicity), quality of care, and patient experience drives the ability to better analyze and correct inequities in US healthcare.
• Test methods to automate patient access to maternal health records. Expanding access to electronic prenatal, birth, and postpartum records aims to further improve patient experiences in maternity care.
• Develop better guidance for telehealth. The EO demands improved guidance for ensuring telehealth services are compliant with HIPAA rules while improving patient experience and convenience.
• Support streamlining State enrollment processes. Advises State agencies to remove barriers (i.e., face-to-face interview requirements) to ease access to critical benefit programs, through solutions like digital renewal forms.

If HHS and CMS are successful in addressing these directives, this will not only reduce the administrative burden of accessing federal healthcare services for beneficiaries but also create a more equitable and sustainable system overall.

HHS will turn to industry for support, creating new opportunities for FedHealth IT leaders to bring a fresh CX lens to these challenging initiatives.

Expanding customer service options and personalized digital tools may come in many forms but are likely to build on current support activities like Medicare call centers, Healthcare.gov, CMS’ “What’s Covered” app, and more.

Contactor-addressable requirements for both advisory and software development will stem from this directive. The government will look to industry to help answer questions such as:

• How do we customize CX solutions?
• What data and services are most important?
• How do we ease the burden of using digital services for elderly Medicare beneficiaries?
• How do we measure the impact of improving CX tools on healthcare outcomes?

Mandates related to maternal health care quality, data collection, and data access all relate to the Biden-Harris administration’s emphasis on rooting out inequity in healthcare.

These data efforts may lead to new requirements for data analysis, program evaluation, and monitoring that ultimately lead to recommendations on how to drive improved equity.

Finally, at the State & Local level, we may see the federal push for digitization and automation in benefits enrollment lead to higher spending on digital transformation and software solutions for Medicaid, social benefits, and more.

Department of Veterans Affairs

The VA is quite mature in its digital transformation efforts, including digitizing veteran-facing services. After all, the #1 priority of VA’s Office of Information and Technology is to provide exceptional customer experience.

However, this has led to a wide range of disparate support functions, applications, and digital services provided through platforms like MyHealtheVet and over 30 veteran-specific applications on the VA App Store.

Biden’s directives to the VA reflect this notion, focusing on integrating and streamlining existing platforms. Specifically, the VA will:

• Provide a single, integrated, and equitable digital platform on VA.gov with single sign-on. Veterans and service members will be able to use Login.gov accounts to access VA.gov and both VHA and VBA benefits (USAJOBS, SBA, and TSA are currently piloting this software). Eliminating duplicate sign-in options will streamline veterans’ access to online services.
• Pilot a flagship VA mobile app to house all VA digital services. The goal is to consolidate existing VA digital offerings that are currently disaggregated across apps, portals, and websites (e.g., appointment scheduling, telehealth services, prescription refills, etc.) onto one easy-to-use platform.
• Provide more accessible online customer service support. Online customer service features like personalized online chat with a live or virtual agent will enable better on-demand support for veterans and hopefully reduce the “time tax” in accessing VA services.

Given its fairly robust digital ecosystem today, the VA faces the challenge of how best to integrate and improve current solutions based on the President’s order.

Just this month, the agency awarded a $9M task order to Oddball to improve the quality of digital communications with veterans through VANotify and VA.gov. Agile Six received a task order to update the content management system for VA.gov to make the website more user-friendly. These recent awards are indicative of continued emphasis on customer experience at the VA.

The customer experience directives mentioned above will not only require front-end website and app updates, but also examination of why and how the VA delivers these services and what backend program management, data management, and processes are required to drive CX success.

Key VA IT leadership has emphasized that creating these new platforms will require significant investments in enterprise data management and backend support. “I like the idea of ‘time tax’ emphasized in Biden’s executive order,” noted Kshmendra Paul, CDO of the VA at AFCEA’s Health IT Conference in early February. “We should ask for data once, we should manage that data, and once we have it, we can review it in unique ways.”

The VA is certain to look to its trusted health and IT industry partners for both advisory and technology support on these initiatives. Knowledge of key enablers (e.g., login.gov, VA.gov, current VA apps) will be differentiators for companies looking to get involved.

The Way Forward for CX in Health

Biden’s CX EO signifies a reinvigorated focus on improving how citizens engage with the federal government – an exciting moment in digital transformation for federal health.

This goes beyond just attractive websites and apps, with the need for more thoughtful planning, management, and investment in how the government engages with beneficiaries of healthcare and benefits.

Satisfying the EO’s directives – and the broader conversation it ignites about improving citizens’ relationship with government – will not be easy.

HHS and the VA will be looking to best practices and leadership from industry, especially from those most familiar with the challenges and opportunities facing federal health agencies, to catalyze a permanent shift in how government delivers vital health resources to Americans.