2020
CONFERENCE THOUGHT LEADERSHIP COMPENDIUM
2020
CONFERENCE
TABLE OF CONTENTS 3 Fiscal 2020 Civilian Contracting Hits Record $228 Billion Bloomberg Government 7 The Best They Can Be: Veterans and Active-Duty Military Mental Health Struggles and How Data Can Help Leidos 12 Technology Aids in the Protection of High-Risk Healthcare Recipients and Providers Parsons
Fiscal 2020 Civilian Contracting Hits Record $228 Billion
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Fiscal 2020 Civilian Contracting Hits Record $228 Billion October 2020 The fight against the Covid-19 pandemic drove civilian contract spending across the federal government to a record high of $228 billion in fiscal 2020, which ended on Sept. 30, according to Bloomberg Government data available as of Oct. 6. The double-digit increase of about 17%, or $33.5 billion, over fiscal 2019 spending, dwarfs the single-digit year-over-year increases in recent years. Spending at the departments of Health and Human Services (HHA) and Veterans Affairs (VA) was responsible for a large part of the increase as well as increases at the nation’s nuclear research laboratories run by the Department of Energy (DOE).
Civilian Federal Contracting Jumps 17% in FY 2020 Dollars in billions; by fiscal year
$228 $181
$187
$194
$171
FY 2016
FY 2017
FY 2018
FY 2019
FY 2020
Source: Bloomberg Government Note: Does not include Department of Defense
Select Agencies Drive Growth At HHS, contracting obligations jumped from $26.6 billion in fiscal 2019 to $41.2 billion in fiscal 2020, a leap of about 55%. Spending for ventilators, pandemic response, vaccines, biomedical research, and other efforts to fight Covid-19 was responsible for virtually all of the increase at HHS. The top contractor for HHS in fiscal 2020 was Merck & Co Inc. with $1.9 billion in obligations, providing HHS with vaccines. Moderna Inc., which has not done business with HHS in recent years, also received nearly $1 billion for vaccine development. Overall, HHS contracting increases accounted for about 44% of the total increase in civilian contracting across the government in fiscal 2020.
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The Department of Veterans Affairs increased its contract spending about $4.4 billion in fiscal 2020 over fiscal 2019 — about 15%. The biggest single increase at VA in fiscal 2020 was on the Patient Centered Community contract, which went from $3.0 billion in obligations in fiscal 2019 to $5.6 billion in fiscal 2020. This contract, held by Triwest Healthcare Alliance Corp., allows veteran patients to access care in their local communities under certain conditions. Triwest has received $14.8 billion in total obligations on this contract since fiscal 2013 and it ends in March of 2021. According to the VA, 53,207 veterans have been diagnosed with Covid-19, and 11,400 patients have been admitted to VA facilities, which may indicate that a substantial number utilized the community care program. Overall contracting increases at the VA in fiscal 2020 accounted for about 13% of the total increases for civilian contracting across the government. At the Department of Energy contracting obligations increased $7.1 billion — 25% — in fiscal 2020. The increases were primarily driven by boosts at Sandia National Laboratories, with headquarters in Albuquerque, NM, and the Y-12 National Security Complex at Oakridge, TN. Contract obligations for the operations of both of these labs each increased nearly $2.5 billion for a total of about $5 billion. The contract for operating the Sandia lab is held by a subsidiary of Honeywell International Inc. and the contract for Y-12 is held by Consolidated Nuclear Security LLC. Together these two companies have received nearly $30 billion for the operations of these labs. Although these labs are primarily involved in research related to nuclear weapons, some of the increased spending may be due to Covid-19, both for the increased operational costs of operating with the various health measures being taken at the contractor-operated labs, and the Covid-19-related research being done at both Sandia and Y-12. The spending increases at DOE accounted for about 21% of the overall contracting increase for all civilian agencies. One other agency of note is the Small Business Administration (SBA). Contracting at that agency jumped from about $177 million in fiscal 2019 to more than $1.5 billion in fiscal 2020. This large increase was mostly for a data analysis and loan recommendation services contract held by RER Solutions Inc., which has received $770 million in obligations. This contract was awarded to help the SBA process loans for small business as part of the Economic Injury Disaster Loan program. If Congress passes additional assistance, contracts of this type may increase, though this particular contract is receiving some scrutiny from Congress and the SBA’s own inspector general.
Company Spending As it has since at least 2015, McKesson Corp. led the pack among all civilian contractors in fiscal 2020 with $6.8 billion in contracting, primarily providing the VA with pharmaceuticals. Overall $59.4 billion — 26% — of the $227 billion total in civilian contracting obligations in fiscal 2020 went to small business. The top small business was Moderna with nearly $1 billion for its HHS work. Information technology contracting increased by nearly $3 billion and professional services by $3.8 billion in fiscal 2020. In both cases the top spender was HHS. The Trump administration has sought to reduce spending at most civilian agencies each year but encounters opposition in Congress and proposed cuts never made it into final appropriations bills. Final contracting figures for the Department of Defense for fiscal 2020 will not be available until January 2021 because the Pentagon delays its data release for 90 days for security purposes.
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The best they can be Veterans and active-duty military still struggle with mental health, but data and analytics can help.
By WP BrandStudio AUGUST 19, 2020
Civil War soldiers knew it as “soldier’s heart.” For those in World War I, the condition was called “shell shock.” It’s even mentioned in Shakespeare’s Henry IV. Throughout history and literature, post-traumatic stress disorder has been the de facto poster child of mental health issues in the military. But it’s not the whole story. With time and insight, we’ve learned the mental challenges military members face are both more complex and more common than once thought. In 2018, the suicide rate of active-duty soldiers was 24.8 per 100,000 , up from 21.9 in 2017. Veterans are 1.5 times more likely to die by suicide than non-veterans, after adjusting for differences in age and sex. These troubling statistics have compelled many in and outside the government to take action. In the last decade, the U.S. Departments of Defense and Veterans Affairs have received increased financial and political support for mental health and suicide prevention. The U.S. Senate earlier this year approved landmark bi-partisan legislation that increases rural access to VA counselors and telehealth services, offers alternative therapy options like yoga and acupuncture and bolsters the VA’s mental health workforce.
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Businesses are stepping up as well. Leidos, a science and technology solutions leader, is one of the largest health IT service providers to the VA, continuing the company’s long-standing commitment to military members and their families. From operating counseling programs to optimizing electronic health record systems, Leidos’s work ensures service members get the help they need more efficiently than ever.
Bridging a gap In 2018, the suicide rate of active-duty soldiers was 24.8 per 100,000, up from 21.9 in 2017. Veterans are 1.5 times more likely to die by suicide then non-veterans, after adjusting for differences in age and sex.
Despite these efforts, a persistent gap remains in mental health care. Many active-duty military members don’t take advantage of the programming available to them, and about half of surveyed veterans don’t receive the counseling they need. Why the divide? One reason is a simple lack of awareness. Many service members don’t know about the VA’s mental health resources, where to go,
how to apply—or even that they needed help to begin with. Another is fear of the stigma attached to seeking counseling. While the larger society has made great strides in these areas, encouraging active duty military members to report psychological health issues is still a problem, especially since it can have career consequences, such as loss of security clearance. From their research and experience, the behavioral health experts and clinicians at Leidos have found that early prevention and normalization are two keys to overcoming these barriers. Many of the programs they develop and manage embrace an outreach model, such as the landmark Adolescent Support and Counseling Service, which was started in 1987 to provide counseling for military dependents suffering from substance abuse. In the program’s first 30 years, Leidos has served 20,000 adolescents—statistically one of the most at-risk populations—without a single suicide. By introducing programs like ASACS aimed at adolescents, counselors can help the young people who make up much of the active duty military force (most new recruits are under the age of 25) before mental health issues manifest. And if such problems emerge later in their military careers, whether it’s PTSD or other common disorders such as anxiety or depression, service members are better equipped to seek support.
“As scientists progress and we receive better data, we can actually come up with signature programs at scale.” Michael D. Lumpkin, head of human performance, Leidos
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“It [mental health] is not just a question of exposure to traumatic situations,” said Louis Valente, a Leidos clinical supervisor who served two tours of duty in the Vietnam War with the U.S. Army’s Special Forces. “So much of what a service member brings into the military is from their family of origin. Many Leidos recently launched MHS Genesis, the new electronic health record system for the DoD, a tool that is poised to bring in a new era of more informed ethics and choices and early detection of suicide risk. With even more data at their fingertips, analysts hope to seamlessly connect the dots between studies and the real world.
come from poverty, domestic violence, and substance abuse. Those issues don’t go away by virtue of putting on a uniform. I think we’d come a long way if we follow young inductees through their service in a less invasive capacity.” Valente also credits the overwhelming success of ASACS with providing his team access to the broader military—another important step in erasing the stigma of mental health care. “It bought us an entry into working with
command, which is important when talking about normalization of mental health,” he said. “ We had the opportunity to brief local commanders on developments and risk factors in their specific community. We need to bring that more within the military culture.”
The intersection of data and holistic mental health Data and analytics offer another strategic insight into how we can lower suicide risk and provide the military with the best possible mental health care. By parsing through vast databases of patient information, linking datasets like medical records, personal data and service information, and applying complex modeling and statistical measures, analysts can determine patients most at risk for mental illness, as well as the best and most effective treatment. Thanks to a 50-year relationship with the federal government and 40 years serving the VA, Leidos has become a leader in this space with an unprecedented level of research and data across the continuum of military service, from recruitment to retirement. “As scientists progress and we receive better data, we can actually come up with signature programs at scale,” said Michael D. Lumpkin, head of human performance, who is a former Navy officer and was Assistant Secretary of Defense for Special Operations and Low Intensity Conflict during the Obama administration. “We have to take the individual and make them the best possible individual they can be.”
“We’re looking at the whole continuum–from working with the data in our electronic health record business to the research that our group does to then providing information to clinical decision-makers and providers that can translate to patients.” Kevin Kaiser, Vice President and Division Manager Biobehavioral Research, Leidos
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The Human Performance and Behavioral Health division at Leidos takes it one step further, conducting human subject and data-based research on physical and psychological health in multiple test environments, including virtual reality. Their work, which focuses on the entire deployment cycle, has led to notable discoveries such as how the use of morphine in-theatre to treat significant bodily injury can minimize long-term psychological health issues like PTSD. That finding may have implications for other disorders such as suicide and insomnia. The division currently is running a study on the effectiveness of surf therapy as an intervention for PTSD and depression. “We’re looking at the whole continuum—from working with the data in our electronic health record business to the research that our group does to then providing information to clinical decision-makers and providers that can translate to patients,” said Kevin Encouraging active duty military members to report psychological health issues is still a problem, especially since it can have career consequences, such as loss of security clearance.
Kaiser, vice president and division manager of Biobehavioral Research at
From their research and experience, the behavioral health experts and clinicians at Leidos have found that early prevention and normalization are two keys to overcoming these barriers.
electronic health record system for the DOD, a tool that is poised to bring in
Leidos. Leidos also recently launched Military Health System Genesis, the new a new era of more informed choices and early detection of suicide risk. With even more data at their fingertips, analysts hope to seamlessly connect the dots between studies and the real world. But integrating years of longitudinal data into clinical workflows and
sharing that information among organizations also presents challenges. To bridge this knowledge-sharing gap, the DOD and the VA in April implemented a new capability for sharing electronic health records with community partners. “We have great data on our active-duty military,” Kaiser said. “But once people leave active duty, it’s sometimes very difficult to see what type of things they’re getting treated for and their longer-term health care.” Linking the active-duty and VA datasets offers the power of creating a holistic picture from start to finish. “There are almost 1.5 million people on active duty right now, and not one of those 1.5 million people are the same,” Lumpkin said. “But if we have enough data, we can create programs at scale to support everybody as an individual to optimize their performance, have readiness on the battlefield, and provide them with good lives and a good future. I think it’s a noble goal we need to strive for.”
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This content is paid for by an advertiser and published by WP BrandStudio. The Washington Post newsroom was not involved in the creation of this content. Learn more about WP BrandStudio. SOURCES: U.S. Department of Veterans Affairs Leidos The Washington Post Smithsonian Magazine The National Academies of Sciences, Engineering and Medicine Department of Defense
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SOLUTIONS 12
Technology Aids In The Protection Of High-Risk Healthcare Recipients And Providers. To protect patients, residence, and health workers, healthcare providers and senior living centers are taking extra measures to protect those at high risk of COVID-19. One of these measures is to screen entry into hospitals, senior centers, and other treatment centers. Given the high risks associated with these facilities, it is imperative that access is based on a risk assessment as it relates to any pathogen with distinctive symptoms. Currently, the general state of access control technology is comprised of an individual with a digital thermometer and a clipboard, taking the potential entrants’ temperature and asking risk assessment questions. This laborintensive process exposes the screener to potential COVID-19 risks and is subject to human errors in recording temperature measurements and data retention.
Innovative technology is allowing the screening process to become automated using touchless kiosks with badge printers and cloud based hosted platforms. Kiosk technologies can eliminate or minimize the need for manned entry points thereby allowing the redeployment of resources and minimizing the risk of exposure to the screener and facility. A badge printer provides physical proof at the facility that an individual meets the access risk threat level. Finally, a cloud- based hosted platform provides questionnaire screening that both prevents at risk individuals from entering the facility and expedites entry for those individuals meeting the access risk threat level.
Kiosk Technology Kiosks, which measure body temperature and have the capability to question potential entrants, are replacing the need to have an attendant at every entry point. Touchless kiosk technology is deployed to prevent potential disease transition through surface contact. Kiosks require no physical contact and eliminate both the potential for disease transfer and the need for sanitizing between individuals. Without touchless kiosks, the reverse effect is created: a bottleneck where all individuals are subject to interacting in the same place. Kiosks are deployed with an array of cameras and thermographic imaging devises to measure core body temperature. A common misconception is that skin temperature is the same as core body temperature. As the individual approaches the kiosk, a camera detects the individual and messages the individual to approach or step back to allow the thermographic imaging to be completed. The imaging takes between one and three seconds.
Figure 1: Moving from handheld devices to automated core body temperature thermographic kiosk sensors.
For accurate and repeatable core body temperature measurements, the temperature resolution and integration of the sensor matters. Contactless medical thermometers may use sensors which are as low as 16 temperature pixels. Obtaining the core body temperature requires data from specific regions of the face. If the administrator does not target the correct area, the measurement may miss elevated febrile skin. Taking a temperature reading from the correct location on a face is critical to ensuring reliability. Less technologically advanced kiosks use inexpensive, low resolution sensors to perform core body measurements.
Elenium Sensor Array (100k temperature pixels) XVGA Higher resolution sensors are able to detect more temperature points on a human face to an area of interest like a human tear duct in an area 2-3mm² in size from 0.5 meters away.
DetectWise
Chino Corp., Japan Thermopile Array (2.2k temperature pixels) 48x47 pixels Low cost sensors rated for technically -/+ 0.5 accuracy will not have the capability to return values specific enough to a location on a human face, resulting in high false negative rate.
An accurate technology solution must be able to detect specific regions of interest on a human face. Parsons’ advanced DetectWise kiosk integrates a thermographic image with a high-resolution visual image to accurately locate facial regions of interest like an individual’s tear duct or the area where supraorbital blood vessels are closest to the individual’s external skin surface. This ensures that the core body temperature assessment can differentiate between surface skin temperatures and true core temperature.
Figure 2: Comparison – High Resolution vs. Low Resolution Sensors
In order to provide accuracy to the 0.1 degree C every time, the DetectWise kiosk continually measures surrounding ambient
Figure 3: Detection of specific Facial Regions is Key to an Accurate Solution
Forehead
1-to-1 Framing
Temples
Tear Ducts
High-Res Full-Face Imaging
DetectWise Solutions | Parsons
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Illustration of Supraorbital Blood Vessels
temperature while actively and algorithmically reducing temperature drift, which increases the accuracy of the sensor temperature. The level of monitoring provided by DetectWise assures that drift is always within the 0.1 degree C limit which eliminates the need for periodic manual calibrations required by lower end kiosks.
If the answers are within the risk tolerance the web application, it will provide a QR code with a unique user identifier, date and time stamp. When the individual arrives at their facility the QR code is scanned by the kiosk which will use the unique idenfication to determine the user and marry their core temperature data with the questionnaire that has been filled out on the web. All communication to and from and the DetectWiseTM database web application is encrypted at all times. If the core temperature is within the acceptable limits and the questionnaire was answer within a specified elapsed time a message is returned to the kiosk to display a welcome message and print a badge, if that option is exercised.
To replace the human screener, the kiosk must be able to present all questions in multiple languages and allow a response input. While a touch screen kiosk can meet this simple requirement, it also exposes the possibility of contamination of the touch screen and COVID-19 transmission via surface transfers. To help prevent surface transfer, we have deployed touchless question response mechanisms. This can take the form of voice recognition or a screen cursor which tracks the user’s head and eye movement. Noise cancelling technologies are used with voice recognition to provide a better analysis of a user’s input. Cursor control, which follows the individual’s head and eye movement, has been found to be a preferred entry mechanism for entry points with mid to high levels of background noise. These technologies’ yes and no questions are composed to allow binary responses to collect risk assessments associated with contacts, any COVID-19 testing, other symptoms, and travel as examples. This prevents screeners from interfacing with people entering a facility. Those entering the facility can answer questions without physical interaction with a kiosk.
Figure 4: Sample health Questionnaire/QRC Check-in
An additional function that a human screener performs is the exclusion of individuals who are determined to have an elevated risk profile, through either core body temperature or the answers to the questionnaire. The kiosk screening relies on the integrity of the person entering with additional technical implementations to perform remote elevated risk identification. The implementation of a remote alert sent to a station near an entry point allows human intervention in the event of an elevated risk assessment. The kiosk can utilize a printed “PASS” sticker with a time and date which must always be worn by any individual entering the facility. Barcodes can be printed on the badge for validation within the facility. Finally, the kiosk and associated cloud application can be interfaced to door controls and access controls to block entry in the event of an elevated risk assessment.
If the questionnaire is answered in a manner that would elevate the risk assessment beyond an acceptable threshold or value, a message is displayed to the user that they should NOT come into the facility and provides a configurable direction to call a supervisor and / or COVID hotline. Similarly, if the questions are low risk but the individual arrives at the facility and registers a core body temperature above the threshold the kiosk will report this to the application and the application will respond with a command to display a message blocking entry. In addition to the advantages of entry streamlining and remote detection, the web application technology also provides a means to collect and store data in a secure environment. When a new registration is entered, the applications creates two file storages, a unique identification under which the temperature and questionnaire information is stored and a file which include personal data about the registrant. These two files are bifurcated thereby preventing the storage of potentially PHI. Reports can be run regarding statistics for entry as a global population.
Our DetectWise kiosk meets the stringent requirements to replace or diminish the need for human screeners while keeping our most critical population protected. DetectWise was developed to meet the demands of a COVID environment and is in use today.
Online Cloud Based Hosted Platform While a kiosk at entry points can help reassign human resource and protect staff from exposure, it is this process of scanning people at a location which poses a potential bottle neck during high traffic periods and does not catch potential risk elevated individuals before they arrive at the facility. Parsons DetectWiseTM Cloud Based Hosted Platform provides a technological solution to entry flow rate and prescreening before arrival in addition to an on premises Kiosk. Using a secure web-app individuals who regularly enter the facility; employees, mobile residence, contractors, etc.; can be registered with the DetectWiseTM system. The individual can then log in remotely and answer the risk assessment questionnaire, provided by their place of employment or the facility they would like to visit, using a computer, tablet or smart phone. Parsons | DetectWise Solutions
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Contact us WILLIAM KRULL / Vice President Direct: + 1 404.824.7968 william.krull@parsons.com GUS NASSAR / Director of Product Development, Digital Solutions Direct: +1 734.309.2153 gus.nassar@parsons.com
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