The Integration Imperative: Creating Space for Better Outcomes

By Max Entman, CEO, Altarum

When money gets tight in public health, the instinct is to narrow: smaller contracts, one clean deliverable at a time. For most of the past two decades, that was a reasonable instinct. It is harder to defend now.

AI has changed what a small team can take on, enough that connecting the work often makes better use of a shrinking budget than breaking it into separate buys. The reflex to narrow and the opportunity to do more are now pulling in opposite directions.

You can see that instinct play out when you look at the way the work usually gets bought. An agency with a hard problem assembles support one piece at a time and hopes the pieces connect. Often the connections are left to chance. That approach made more sense when the work itself was harder to connect.

Meeting this moment takes both urgency and imagination: urgency because the budget pressure is real and immediate, and imagination because the answer isn't how to buy the same pieces more cheaply; it's how the pieces fit together.

The Lego-Brick Problem

An agency gets survey research from one organization to understand a population. It brings in a second to provide technical assistance based on those results. A third handles the communications to build awareness. A fourth builds the IT system to track all of it. Each piece may be perfectly good on its own. But you're buying the Lego set one brick at a time, and nobody owns how the bricks fit together. 

Now picture the same work integrated. The point isn't that everyone does more at once. It's that the organization solving the problem can see how the pieces fit together: Research informs implementation, implementation reveals new questions, data shows what's working, and those insights get acted on while the work is still underway.

The agency also gets a more complete picture of the problem. That makes it easier to identify what's working sooner and expand successful approaches instead of waiting until the next cycle to act. 

Expertise Determines the Outcome

AI is expanding what a small expert team can accomplish. Agencies can increasingly automate routine processes and shorten the time from information to insight. That matters.

But public health work takes place in complex, highly regulated environments serving populations with complex needs. The challenge is not simply gathering more information. It is knowing what to do with it.

Technology can expand capacity, but it's no substitute for people who understand epidemiology, program implementation, health economics, and the realities of delivering services at scale in a tightly regulated environment. 

Expertise is what connects information to reality. It's how you know whether an approach that looks promising will work for the populations you're trying to serve.

That expertise also cannot live in isolation. Public health challenges rarely fit within a single discipline or program area. Talk to the community and a different part comes into view. And some barriers only become clear once a program is being implemented, when they never showed up in the data. When those perspectives come together, the picture of the problem gets fuller, and the answer is often one that no single group would reach on its own.

Leadership and the Opportunity to Innovate

This is not a new conversation. We've been hearing versions of this argument since the first IBM personal computer. Some skepticism is healthy.

Public health leaders have worked for years to help people better understand how different pieces of the puzzle fit together. There is no quick fix. Public health structures vary across states and agencies, and progress still depends on leadership and a commitment to sharing information across programs and partners.

Better information sharing isn't a new idea. What's changed is the opportunity to use new tools to identify connections and areas of overlap more quickly and at a larger scale than was previously possible.

But realizing that potential still depends on leadership and a willingness to challenge old assumptions and old instincts.

The foundation already exists. Agencies and partner organizations have spent years building stronger connections across programs and funding streams. The opportunity now is not to invent integration. It is to accelerate it.

That starts with creating space for new approaches.

The imperative here isn't reorganizing how work gets bought. It's the chance—and increasingly, the need—to ask for solutions that drive better health outcomes, and to question the status quo now that the tools and the pressures have both changed.

Agency leaders can define the outcomes that matter and create room for new approaches. The goal isn't innovation for its own sake. It's identifying solutions that work, measuring their impact, and expanding them when they deliver results.

Define the Outcome, Not the Steps

There is real value in asking partners for novel approaches built around the outcomes at the core of the mission. One piece of a problem rarely moves the needle as far as leaders want it to. Stronger solutions tend to pull together different kinds of expertise and a real understanding of the people being served, which is where a fuller picture of the problem comes from, and usually a better answer to it.

The greatest impact does not come from specifying every step in advance. It comes when leaders step back and encourage partners to bring new approaches, grounded in expertise and data, and don't over-prescribe how they get there. Expect evidence that an approach is working, but give partners room to determine how they get there.

What brings me optimism is the chance to put emerging AI tools together with deep public health expertise. Neither does the job alone. The tools can move quickly through data, but they are no substitute for people who understand what it takes to deliver services at scale, in a tightly regulated environment, for populations with complicated needs. Used well, the tools help those experts get to a faster read on what's working and put resources where they'll do the most good. That pairing is what we're building toward with Altarum's Health Data & AI Center of Excellence, and it's the substance of a lot of our conversations with agencies right now.