Health care and social service providers across Virginia are waiting to see if the General Assembly’s state budget will include continued funding for a technology platform that some of them say has transformed the way they connect clients to critical assistance.
Unite Virginia, which was launched with $10 million in federal CARES Act funding in 2020, today counts 840 organizational users in Virginia, according to Unite Us, the New York-based company that built the network.
Through the system, those users – which include hospital systems, food banks, United Ways and housing assistance nonprofits – can make on-the-spot referrals when they encounter a client who needs the kind of help that a partner agency can provide.
It operates similarly to systems that create shareable electronic medical records but adds information about all of the other factors that influence a client’s health.
Say, for example, that a patient arrives at the emergency room with complications from diabetes. The hospital screener might learn that the patient can’t control the disease because she can’t afford medication, or doesn’t have transportation to get to doctor’s appointments, or lives in a place without reliable access to healthy foods.
Instead of handing the client a brochure with information about how to get help, or making call after call to find the right connection for the client, the screener can use an e-referral system like the one offered by Unite Us to make an instant referral to a food bank or another social service provider, and can then track whether the connection actually gets made. Each contact with the client is stored in the electronic record, allowing service providers to monitor whether clients are getting the kind of assistance they really need or are having the same problems over and over.
It can also help agencies identify service gaps. If the records show that requests for affordable housing services are routinely not getting fulfilled, for instance, it could signal a need for more manpower or money.
The state’s contract with Unite Us runs out in mid-June, according to Dacia Read, associate vice president of regulatory and government affairs at Unite Us. It includes extensions, but they only would take effect if both sides agree on terms.
Then-Gov. Ralph Northam included $16 million in his final budget to continue, and expand, the network over the next biennium, she said. But that funding was slashed in the General Assembly’s versions of the spending plan, with the House of Delegates cutting it out altogether and the state Senate reducing it to $5 million over two years, she said.
Sustaining the current level of service would require $5.5 million a year, Read said.
Budget conferees are expected to release their spending plan within the next few days, in time for a vote on June 1.
Health care and social service providers have a lot of experience in connecting clients to other sources of help, said Tony Keck, chief population health officer at Ballad Health, which has been using Unite Us in Southwest Virginia and Northeast Tennessee. But a centralized way to make and track those referrals can keep clients from getting lost in a sometimes confounding bureaucracy at a time when they’re at their most vulnerable.
“Right now, we know a lot of us are serving a lot of the same people, but we don’t know about it,” Keck said. “And so we don’t have the full picture of the individual sitting in front of us.
“So if somebody goes to a food bank and has food insecurity, it would be good for that group to also know that hey, you also have housing needs, or you have diabetes, or maybe you’ve indicated that you’re suffering from depression. And if we can get a full picture of people, it’s easier for us to make sure that they get to the right services, and to treat them in a way that makes sense.”
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The need for electronic referral systems like Unite Us has grown along with the understanding that a person’s health is determined only in small part by their genetics and the health care they receive. So-called social determinants of health – education, economic stability, housing, transportation – play an even larger role, and addressing those factors can require collaboration among scores of service providers.
Those kinds of partnerships have been building, on both state and regional levels.
In 2018, the Virginia Department of Health and the Virginia Hospital and Healthcare Association launched Partnering for a Healthy Virginia, an initiative to bring together the public and private health sectors to focus on community health needs.
At about the same time, in Ballad’s service area, the STRONG Accountable Care Community assembled health care providers, social services agencies, churches, businesses and others in an attempt to address the social factors that were playing into the region’s poor health.
One of the first initiatives launched by the group, which today counts almost 350 member organizations, was called No Wrong Door.
“It was the idea that no person – no patient, no client, no student, no employee – should ever have to enter the wrong door if they were seeking assistance for themselves or their families,” said Mark Cruise, the initiative’s executive director. “That somebody inside that door could reasonably connect them to the help that they need.”
The group determined that the only way to achieve this goal was to implement a community referral program, so it vetted a number of vendors and decided on Unite Us.
On a parallel track, Partnering for a Healthy Virginia reached the same decision, and the state contributed $10 million in CARES Act money to implement the technology statewide under the Unite Virginia banner.
Since then, the system has rolled out region by region. Unite Virginia worked last year to bring local health districts online and this year is focusing on social services departments, according to Jacque Hale, its Virginia state network director.
United Way of Roanoke Valley started using the system last summer, CEO Abby Hamilton said. The agency, part of a regional population health initiative called Healthy Roanoke Valley, has heard from clients just how hard it can be to navigate the maze of social assistance, she said, so she welcomes any way to streamline the help process, both for providers and for the people they serve.
“There is a recognition that while we as separate entities serve specific clients, it is inevitable that we will cross paths and be serving the same people,” Hamilton said. “So why are we making it so difficult for us to be effective in what we’re doing by not having a system that ties all of this together?”
She said she understands that about 50 organizations in the region have signed on to use the platform so far. Expanding that reach will be key to its success, she said. “The system is also only as effective and as strong as the number of actual programs and users that are in the system utilizing it,” she said. “You can’t really refer to a program that is not part of the system.”
Khristina Morgan, an epidemiologist at the Roanoke City and Alleghany Health Districts, agreed. The agency’s COVID-19 care resource team has been using the platform, but there’s much greater potential for it once more partners are on board, she said.
Carilion Clinic, the region’s largest health care provider, has not yet implemented the platform, Hale said. Carilion spokesman Pete Larkin said Friday that the health system is continuing its discussions with Unite Virginia.
Also critical, Hamilton believes, is making sure that any new technology interacts effectively with existing systems like 211 Virginia, the statewide help hotline, and that the implementation doesn’t become a burden to already short-staffed nonprofits.
No technology is a magic bullet, she said, and she doesn’t know whether Unite Virginia is the “end all and be all.” But the need for a system like it is evident, she said, especially if it can bring state agencies into the loop.
“How transformative would that be?” she said. “And now if you tie it in with hospital systems, and then have partners that are on the community level serving individuals and clients that are also part of those same systems – wow. That really pushes us into a different level of effectiveness, and getting the outcomes that we want.”
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It might be possible for regions to set up their own information-sharing networks. Ballad, which already funds the program on the Tennessee side of its service area, has decided it will continue to pay for the Virginia side if state money doesn’t come through, Keck said.
But it’s unclear how many regions would have the financial wherewithal to do that. The areas that would benefit most from these kinds of connections are probably the least able to support them, said Pamela Irvine, president and CEO of Feeding America Southwest Virginia, whose service area covers 26 counties and is on the Unite Virginia platform.
“Those areas are very challenged,” she said. “I would say that some localities may have resources, but I’m going to tell you a lot of those localities and those communities do not have the resources to launch the program.”
And without state funding, agencies such as the Virginia Department of Health or Virginia Housing likely would be left out of the network. Nor would a decentralized system be able to provide statewide data about service gaps, or effectively track clients who move from region to region – a significant concern, considering that some of the neediest Virginians are also among the most transient, said Eddie Oliver, executive director of the Federation of Virginia Food Banks.
It’s not clear what the General Assembly plans to do. Read said she thinks that a lot of legislators didn’t know about Unite Virginia because it launched during the pandemic and was implemented through an emergency procurement rather than through the usual bidding process. She also suspects that some legislators question whether state money should be spent on the system, and whether additional federal money might be available instead.
“That’s definitely prudent budget work on the behalf of the legislature,” she said. “I think they’re exploring all of their options.” But she’s hopeful that they will look at the ongoing statewide rollout and see that the time and money already invested is worth their support.
A number of General Assembly members from the region either did not respond to questions about Unite Virginia or said they were only vaguely aware of the debate over funding.
Sen. Todd Pillion, R-Washington County, expressed his support for the program in an emailed statement.
“The Unite Virginia e-referral network connects Southwest Virginians to needed community services, reducing reliance on high cost clinical care when health needs can be better addressed by community-based programs,” he said. “The network is accountable and focused on outcomes. The Commonwealth would be well served by keeping this network in place.”
Oliver agreed. “It really has potential to be a game-changer because of its ability to connect so many different service providers in one system,” he said. “Chances are, if someone has a food insecurity need, if they need food assistance, they’re going to need other things, too. Housing assistance, mental health services, whatever it is.”
Vulnerable populations tend to disappear from the radar for lots of different reasons, Keck said: They might have limited phone minutes, or they might work in a job where it’s hard to get time off, or they might not have reliable transportation. Or they might not answer their phone when a help agency calls, fearing that it’s a bill collector.
“When you have somebody in front of you who’s vulnerable, you have to do everything possible to make sure that all of their needs are met, because the chances are you’re not going to see them again for a while,” he said. “And that’s why a system like Unite Us is so important, because you’re trying to make sure that you get these folks connected in as many ways as possible before you lose them again.”
