Podcast: Andrea Danes, Global Human Services Leader, EY
Andrea Danes is an Executive Director within EY’s Government and Public Sector practice, driving Social Services transformation. Her focus includes leveraging the EY global initiatives to better support vulnerable populations in the US, including approaches to integrated service delivery, intelligent use of data, and user-centered design principles. She maintains over 28 years’ experience in both public and private sectors, program expertise in Medicaid, Child Welfare, and experience across the Social Services program spectrum.
Below are a couple highlights from our interview, but be sure to listen and subscribe to The Patient's Journey podcast, linked at the bottom of the page.
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You’ve been in the government program space for over 28 years, could you tell us a little bit about your current role at EY and how you’re involved in healthcare?
Absolutely. As you said, I have about 28 years of experience in the healthcare space, starting with about 10 years as a state employee in my home state of Illinois. I’ve worked in the Medicaid program and in the child welfare program. I’ve moved to the private sector since 2003 doing technology and consulting work. I love the work, but what makes it the most interesting to me is the personal experience that I’ve had. I grew up with a single mom in government-subsidized housing with free school lunches, so I truly understand how challenging it is for some families to make ends meet. I also have a foster daughter, so the very programs that I’ve worked on as a government employee or consultant are the same programs that I often access on my daughter’s behalf. The process is never simple, and accessing services is often way more difficult than necessary. It’s not the “Amazon” experience, so that’s a huge motivator for me to work with agencies and local governments who are willing to embrace transformation.
And have you seen an acceleration of that transformation since COVID or maybe even prior?
Well, I think there's always been pockets of innovation. There have always been leaders who have stepped into government who wanted to make a difference and want to make a change. What covid really did for us, though, is turn that transformation into a national conversation. All of a sudden our entire nation began to realize, wait, we have a problem with how we administer government programs. They're not designed for this level of volume. They're not designed to optimize the technology. And the experience that you get, again, when you use Amazon is very different than when you have to go through the logistical hoops to get access to government services. So the attention that the pandemic brought into this space is ultimately what's going to be a great catalyst for us to really get some significant change. The other thing I'll mention is the social unrest of the last season and the acknowledgment of inequity and delivery: the push to understand communities at the community level and deliver in a more equitable way is also something that's going to push that transformation.
How has this pandemic has affected social safety nets and problems with accessing social services?
Well, we know we had a significant economic downturn. We've got a lot of people who haven't been able to achieve the income they had the year before due to the pandemic, which sends a lot more people into the queue for government assistance. All these types of support and assistance are given through independently funded programs. So if you need housing assistance or medical assistance, you need to know what kind of assistance is available as well as how to access that assistance on various websites and other channels. It’s all extremely fragmented. Picture needing to get car work done and taking your car to one place to get the oil changed, another to get the tires rotated, and so on. Most of us just want to roll into the dealership and say “hey, fix everything that’s broken”. You don’t get the dealership option with social services.
Another momentum shift that the industry has been having for a while is around the social determinants of health. You can fix individual issues in siloes while neglecting the underlying struggles people deal with. For instance, you can give provide someone with a roof over their head, while neglecting to realize they have a chronic health condition that keeps them from working and prevents them from stable housing. We need to connect these services (such as housing and healthcare) in a way that addresses underlying issues and allows an individual or family to truly move forward.
It’s interesting you bring up the intersection of work and healthcare. In the US, there’s some talk of Medicaid requiring a work requirement. Yet we know it’s very difficult for people to work if they’re not well. Do you feel like we’re putting the cart in front of the horse here, and how do we reverse that?
Well, as a caveat, I want to acknowledge that there’s no simple answer, no magic bullet. A solution requires diligence, leadership, vision, continued forward movement, and momentum.
That being said, data really holds a key to a lot of what you described. When we take care of issues within siloes, it generates a lot of data. By connecting those data silos, we can start to create a clearer picture of what that person or family is challenged with. One of my favorite examples has to do with insulin-dependent diabetics on Medicaid who need to store their insulin in a refrigerator. In order to do that, they first need a house that has a refrigerator. Then they need to be able to pay their utility bill. I don’t think there’s a single state Medicaid program that has sufficient data connection to ensure that patients are getting both housing and utility assistance in order to have a successful diabetes treatment plan. The data is there, it’s just not connected.
What are some practical steps that organizations could take to start supporting populations better?
I'm going to give you a very straightforward first step. I think we have to change part of our language from “No” to “Yes”. In a lot of the conversations I get in with leaders, we're talking about transformation. You’ll have a room full of types of people who really want to make things different, as well as people who aren’t sure if change is a good idea. The latter group always starts talking about how “we can’t do that because of this”, “that won’t work because of this”, etc. The first challenge is to start changing that negative language: “No” is not allowed. Instead of “No”, let’s start using “Yes, if…”. If someone in the room wants to challenge a proposal, they could say “yes, that would work so long as we address these caveats”.
Secondly, I believe that “transformation” is a very big word, a big concept. It can be extremely overwhelming to think about where to start on a transformation journey. Frankly, the only unacceptable answer is to not start at all. You can start with user-centered design, or more integrated data, or better data governance. You could start with better equity conversations or processes into communities. Any of those starting places will make improvements and will continue to push the transformation agenda forward. When you do things like that in small enough pieces and start to achieve successes, people get excited about what transformation can mean and are more willing to continue down that path.
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Show The Patient's Journey, Ep Andrea Danes: Global Human Services Leader, EY - May 17, 2021
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