The future of a technology modernization program, meant to help the government understand if the billions of tax dollars it spends on community health centers are in fact making Americans healthy, now looks uncertain.
The layoffs at the Department of Health and Human Services included dozens of employees at the Health Resources and Services Administration who were working on the technology upgrade, which has been years in the making and was set to launch next month. As many as 1,200 of the roughly 1,400 health centers were set to go live with the upgrade on May 31 — a milestone that is unlikely to be met, given the number of critical federal staff who were fired.
“People are ready to do this and they’re ready to do it right now, so not doing it seems like a big waste of investment,” said Julia Skapik, a primary care physician at Neighborhood Health of Virginia and a former official at the National Association of Community Health Centers, where she helped coordinate between the government, industry, and community health centers for the project.
The program required the federal government to work with health IT vendors and community health centers in what had been hailed as a cooperative triumph. Besides saving community health centers from having to spend countless hours meticulously cobbling together data by hand, the modernization was designed to help HRSA understand at a more granular level the health of the 31 million Americans who visit these centers.
“Someone from one of the vendors told me, ‘We have spent so much money and effort doing this and are we just going to not do it now? That’s ridiculous; the investments are already made and everyone is sitting, waiting to go live; why would we stop now? That doesn’t make any sense,’” Skapik said.
The project, called UDS+, was set to modernize the legacy Uniform Data System that HRSA grantees, like federally qualified health centers, use to prove that they’re spending the government’s money effectively. The centers report certain measures and outcomes to the government, like patients’ demographic details, how many people had diabetes, and how many of them had their blood sugar under control.
Right now, typing this data into an Excel spreadsheet and sending it to the government is painstakingly manual and costs health centers extra money. The centers sometimes need to hire extra people to sift through their data and figure out how many 2-year-olds or 3-year-olds the health center serves, for example. With the modernization effort, health centers would be able to send much more specific data at the push of a button. But former employees say that the years of effort that have gone into engaging with community health centers, building trust, and getting everyone ready for the program would be wasted if the team isn’t saved.
“I mean, my God, if efficiency and modernization and — what do they call it? — not-waste and not-abuse is the effort, this was the case example of a project that would deliver all of that,” said a former HRSA employee who spoke to STAT on condition of anonymity out of fear of being targeted. The program “was going to revolutionize” how the government could direct resources to places where it was most needed and reduce the burden on health centers by leveraging health technology, said the former employee.
But axing this specific team poses problems for saving the years of work and millions of dollars that went into the program. “As soon as the word of [the] RIF got out, one of the major regions […] pulled out. The minute they heard that we’ve been RIFed, they said ‘We’re not giving data,’” said the former HRSA employee. Now, this person said, health centers don’t know whether they trust the people they are giving their patient-level data to, where it goes, or how it’s going to be used. “We were there to mitigate all of those concerns. We were there to sign data use agreements and [say], ‘If this is not making sense, let’s change it. What works for you? How can we meet you where you are?’ It took us two years to build that relationship.”
The Office of Strategic Business Operations at HRSA had just under 70 employees before it was eliminated, said a former employee, with about 20 people working on various aspects of UDS+. That entire office has been eliminated as part of the HHS cuts. Since 2022, the office had been working with the Office of the National Coordinator, now known as the Assistant Secretary for Technology Policy, on the modernization project. Four days after the RIF notices went out, 13 employees received letters asking them to come back to finish the project.
HHS did not respond to a request for comment about the future of the technology modernization program. While some workers’ jobs have been restored, there’s not a clear team to hand over the work to, especially a team that has the trust of the community. “If we don’t have anybody to transfer this work to, they might as well kill it. Because, I mean, we don’t want to put anybody through the work that is not going to finish,” said another former HRSA employee.
This year’s May 30 deadline was just a test of the system, which would be phased in over the next few years until the digital process replaced the old manual one. It’s unclear what’s going to happen to the program in the long term. “It doesn’t end on May 30. It doesn’t just have these automatic systems that are set up in place,” said a second former HRSA employee.
Funding community health centers is intended to reduce money the government spends on Medicare and Medicaid because the centers provide “more cost-effective patient care than the care that patients would otherwise receive,” a recent Congressional Business Office report said. Those estimates are only possible because of the data that is reported through the current UDS system.
However, that data is only at the aggregate level, which means that the government can tell how many homeless people a center is serving and how many veterans, but it doesn’t have the patient-level data to determine, for example, how many of them are homeless veterans, and how their outcomes compare to their non-homeless counterparts, said the second former HRSA employee. Skapik added that the way data is currently collected means only the government has access to the data, and physicians don’t have the data at the time they’re treating patients, which could change under the modernization initiative.
Andrew Hamilton co-chaired the UDS+ Test Cooperative steering committee, a coalition of providers, health center networks, and health IT vendors that ensured HRSA’s plans made sense for the entire community. Though these community health centers traditionally have fewer tech resources than other health systems, the program was widely adopted because the community health center IT vendors took on a lot of the work, he said.
Without the HRSA team to continue coordinating the providers and industry in concert with HRSA’s goals, that unique partnership may be in jeopardy. “I am concerned that with the significant reduction in force, do they have enough resources to support all of the moving parts that are going to be required to keep …track to leverage and implement a program of this size?” said Hamilton, who is also chief information officer for AllianceChicago, a health center network.
“This is one of those hard-to-find, but actually surprisingly usual, examples of government working with industry to solve a problem, leveraging standards, and then being able to scale and deploy an entirely modern and technologically contemporary program,” said an employee at ASTP who asked to speak on background for fear of retribution. “And it just gets thrown out with the bathwater.”
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