How one big state was able to manage its COVID-19 testing and management program

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During the worst of the pandemic, Florida officials were able to speed test results to resident thanks to automation. The Florida Department of Health signed up Healthy Together, a provider of online disease management software. The work recently received an award from the Advanced Technology Academic Research Center. For details, the Federal Drive with Tom Temin spoke with Healthy Together co-founder Jared Allgood.

Interview transcript:

Tom Temin
I guess last name, like Allgood is good to have with a healthy together type of company. But tell us exactly what the company does.

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Jared Allgood
Sure, you know, at the start of the pandemic, we were contacted by some state governments who are interested in using some of the mobile platform technology that we had built previously, to create a link between the health department and residents in their state, the objective was to try and kind of cut through some of the noise and provide information direct to residents, we started in the state of Utah, and then quickly started having conversations with the state of Florida about ways that we could potentially help their COVID response.

Tom Temin
All right, so it’s software for disease management, but that’s not the medicine work of managing diseases, but sounds like managing information to the public about what’s going on with diseases that are widespread.

Jared Allgood
Yeah. So I mean, prior to the pandemic, you know, nobody really had heard much about contact tracing, but public health departments for years had been managing and tracking diseases and spread. This is the job of epidemiology. And the processes that are used to track the spread of diseases and to encourage people to take action to stop the spread have been well known processes for over a century, I think what COVID did was it overwhelmed the systems that had been in place in every state in the country. And technology, you know, had a place to come in and help kind of augment and speed up those processes. So that, you know, there could be a proper response.

Tom Temin
Give us some examples of the types of information delivery that the platform delivered for Florida.

Jared Allgood
You know, Florida, like every other state was overwhelmed with the number of cases that they were having. And they tried to implement your traditional contact tracing processes. And one of the things that they did, and this was in the news at the time, they hired 4,000 new contact tracers to get on the phone and to speak with people who had tested positive for COVID as a way to collect information about who they may have exposed and also provide information about what they should do to self isolate, and to protect the people around them. That process is very manual about hiring 4,000 new people required a software system to manage those phone calls to collect that data, and ingest that data and put it back into the state system so that they could manage it properly. So the first thing we did in the state of Florida was work with them to stand up an easy to use case management system that would allow somebody who had never done contact tracing before, to effectively manage a contact tracing phone call. But quickly, we realized, as we saw the data coming in, and just how overwhelmed even these 4000 contact traces were that we needed to provide something that would go direct to residents and automate those processes. So we deployed the Healthy Together mobile platform. These are native built mobile apps that are deployed on iOS and on Android. And what we did was primarily first was delivered test results to residents, anybody who was getting tested in the state that data was being provided back to the Florida Department of Health. But there were times where people weren’t getting notified, they wouldn’t get the results for days, or sometimes even you know, over a week. And so what we did was implement a system that would allow us to instantaneously in real time, the moment that data hit the state database, we could notify a resident of Florida that their test results were available. And that was really the introduction for most Floridians to Healthy Together. But once they got their test results, if you were negative, then you know, congratulations, you know, move on with your day. If you were positive, we wanted you to participate in a contact tracing interview. And that case interview could either happen on the phone, or you could do it through the Healthy Together application. And that was the real kind of technological innovation that happened here. By giving people a way to do it on their own, we dramatically sped up the rate at which people would finalize a contact tracing interview, thereby providing the state with the data. In some cases, states were waiting, you know, a week or two to be able to get that information from people with Healthy Together, our average is 2.6 hours from delivering the test result.

Tom Temin
We’re speaking with Jared Allgood. He’s co-founder of healthy together and working with the Florida Department of Health develop this award winning application. So in a sense, you really allowed the old processes as you said were known almost for a century to scale to meet the size of the COVID requirement.

Jared Allgood
That’s exactly right. Nobody in epidemiology had been through a pandemic of this size and this scale. And so the systems that existed were just not up to the task to scale due to the impact of COVID, you know, when you have millions of people contracting a disease that’s disclosable to the state, you need new tools you need to leverage technology to scale to meet that need.

Tom Temin
And is there evidence this helped the rate of disease spreading or the rate of deaths from the disease at all? I mean, was there a health outcome result of all this and not just an information speed up component?

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Jared Allgood
Absolutely, we believe there was, in fact, we were able to run an analysis. And there are some known kind of figures that help you measure the time from being tested to receiving a test result is the time where much of the disease continues to spread. So just the notification aspect of it of letting people know that they were negative, helped people make their own personal choice, the right choice to isolate once they tested positive. And then also the speed to notifying people who were exposed, reduced the number of people who were out in the wild having been exposed, sharing the disease with others. So there is an analysis that we’re able to perform that demonstrated that there was a true health impact. We also had really great scores on health equity as well, we performed a study after the first million people were on Healthy Together in the state of Florida, to see who it was that was using the platform. In a state like Florida, I think 26% of the state of Florida are non-white individuals. But of the first million people unhealthy together. 45% were non-white individuals. So these are typically populations that struggle to interact with government or the government struggles to interact with them, they found that interacting with a native built mobile application that was personalized to them that had their information for them was much more comfortable than getting on the phone and speaking with somebody from the government.

Tom Temin
And you mentioned the idea of case management and case management software has been around for decades, also. Is yours, basically case management with a health flavor, or does it have some scaling capabilities such that it can almost be retail level, as opposed to something that’s highly specialized?

Jared Allgood
Yeah, our platform is highly flexible. So one of the big successes that we had by deploying the health together platform was it we were able to take technology that we had built previously, and repurpose it for specific contact tracing case management around COVID. That can be extended to case management around any disclosable disease. But it can also be extended to case management around Medicaid applications, around child welfare and foster care case management deployable very rapidly, I think the first case management software that we deployed in the state of Florida, we deployed four weeks after signing the contract with the state in a format that for the state felt perfectly customized to what they need. We did something similar with the Healthy Together mobile application. And that platform was deployed was ready for deployment four weeks after we signed the contract with the state of Florida, to be deployed statewide in a state that has over 20 million people. So that’s part of what our expertise is, as a company is being able to take a series of modules in our technology, reconfigure them in custom solutions, and deploy quickly for our government partners.

Tom Temin
Because at the federal level, you’re lucky if it can be deployed in four years after signing the contract. Any federal experience so far?

Jared Allgood
Yeah, so this is what we saw. You know, as we started to deploy solutions at the state level, we recognized two things. One, that technology that states were using was highly antiquated, for the most part. And often it was, you know, homegrown and custom built, it was not a cloud based SaaS solution that can be deployed at scale very quickly. So we wanted to solve that problem beyond certainly beyond into disease management. So we have solutions now for Medicaid, SNAP, WIC, TANF, and other state level programs. At the federal level we recently announced that we’ve integrated with and we have a partnership with the Department of Veterans Affairs, they have a lighthouse program that allowed us to provide veterans who are on the Healthy Together platform, access to their electronic health records through the VA with Healthy Together. The initial deployment allows veterans to get access to their entire immunization record and receive tools and updates and reminders about how to update their immunizations and when they should, but we’ll continue to expand that to support other important health information that will help veterans just keep track of their own health records.

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