In a Monday opinion piece in the The New York Times, Dr. Vivek Murthy said that social media is a contributing factor in the mental health crisis among young people.

“It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents. A surgeon general’s warning label, which requires congressional action, would regularly remind parents and adolescents that social media has not been proved safe,” Murthy said. “Evidence from tobacco studies show that warning labels can increase awareness and change behavior.”

Murthy said that the use of just a warning label wouldn’t make social media safe for young people, but would be a part of the steps needed.

Social media use is prevalent among young people, with up to 95% of youth ages 13 to 17 saying that they use a social media platform, and more than a third saying that they use social media “almost constantly,” according to 2022 data from the Pew Research Center.

Last year Murthy warned that there wasn’t enough evidence to show that social media is safe for children and teens. He said at the time that policymakers needed to address the harms of social media the same way they regulate things like car seats, baby formula, medication and other products children use.

To comply with federal regulation, social media companies already ban kids under 13 from signing up for their platforms — but children have been shown to easily get around the bans, both with and without their parents’ consent.

Other measures social platforms have taken to address concerns about children’s mental health can also be easily circumvented. For instance, TikTok introduced a default 60-minute time limit for users under 18. But once the limit is reached, minors can simply enter a passcode to keep watching.

Murthy believes the impact of social media on young people should be a more pressing concern.

“Why is it that we have failed to respond to the harms of social media when they are no less urgent or widespread than those posed by unsafe cars, planes or food? These harms are not a failure of willpower and parenting; they are the consequence of unleashing powerful technology without adequate safety measures, transparency or accountability,” he wrote.

In January the CEOs of Meta, TikTok, X and other social media companies went before the Senate Judiciary Committee to testify as parents worry that they’re not doing enough to protect young people. The executives touted existing safety tools on their platforms and the work they’ve done with nonprofits and law enforcement to protect minors.

Murthy said Monday that Congress needs to implement legislation that will protect young people from online harassment, abuse and exploitation and from exposure to extreme violence and sexual content.

“The measures should prevent platforms from collecting sensitive data from children and should restrict the use of features like push notifications, autoplay and infinite scroll, which prey on developing brains and contribute to excessive use,” Murthy wrote.

The surgeon general is also recommending that companies be required to share all their data on health effects with independent scientists and the public, which they currently don’t do, and allow independent safety audits.

Murthy said schools and parents also need to participate in providing phone-free times and that doctors, nurses and other clinicians should help guide families toward safer practices.

GEHA, a popular Federal Employees Health Benefit plan that covers some 2 million beneficiaries, has some of its services provided by Change Healthcare, the target of the attack by a ransomware hacker group, ALPHV, or Blackcat. UnitedHealth Group, Inc., is the parent company.

Last month, GEHA showed an online message to beneficiaries saying it was having difficulties with one of its vendors, and Federal Times received complaints from some policyholders that they couldn’t access certain account statements.

“This system failure has impeded my ability to receive reimbursement for significant medical expenses incurred during [a] recent trip, despite following all prescribed claim submission procedures,” a federal retiree said in an email March 14.

GEHA later updated its online statement to say that it’s having challenges with member and provider print and mail services, explanation of benefit retrievals, and payment processing for dental providers, out-of-network medical providers and members. Some Flexible Spending Account payments may also be delayed.

“No action is needed from members,” the company said on its website. “GEHA is working diligently to resolve this issue to resume normal access to [explanation of benefits] and payments. GEHA’s internal technology and systems were not directly impacted by the cyberattack on Change Healthcare.”

A spokesperson for GEHA did not respond to Federal Times’ request for further comment by the time of publication.

It’s unclear how soon the issue will be fully resolved given the complexity of the healthcare system and the scale of the attack. UnitedHealth Group said it has already funneled $3.3 billion in temporary funding assistance to help providers, especially smaller practices, weather the outages. The company also said it has not yet seen any evidence of sensitive data being published on the web. The U.S. Department of Health and Human Services is also aware of the issue and has been helping coordinate Medicare continuity for affected providers.

“Many of these providers are concerned about their ability to offer care in the absence of timely payments, but providers persist despite the need for numerous onerous workarounds and cash flow uncertainty,” said Xavier Becerra, the department’s secretary, in a March 10 joint statement with the Department of Labor.

At this stage, the affected company is in the process of restoring services it disconnected in an immediate attempt to mitigate risk when the attack first happened. So far, the company has also developed a temporary workaround for claim submissions. As of mid March, Change Healthcare’s e-payments platform was restored.

GEHA said the hack does not affect policyholders’ ability to receive health benefits, visit providers and get prescriptions.

According to the Cybersecurity and Infrastructure Security Agency, since December, the healthcare sector has been the most victimized by ALPHV/Blackcat actors. Public infrastructure is a common target for enemies of the state to attempt to disable or weaken critical systems that house large sets of personal data or contribute to national security or logistics. According to the FBI’s latest report on internet crimes, 14 of the 16 critical infrastructure sectors, including health care, fell victim to cyber attacks last year.

“Let’s be clear: Cyber threats to our critical infrastructure represent real-world threats to our physical safety,” said FBI Director Christopher Wray before the House lawmakers on Jan. 31.

Change Healthcare processes 15 billion health care transactions each year.

Ahead of the last-minute work on their final fiscal 2024 appropriations package, Republicans and Democrats sparred last week over potential future changes to how the Department of Veterans Affairs’ budget is handled, and whether inaction could tank any planned reforms for its operations.

At issue is the department’s Toxic Exposures Fund, created as part of the 2022 PACT Act to help cover the costs of the sweeping expansion of medical care and disability benefits in the legislation.

The administration has asked for $24.5 billion in TEF money for fiscal 2025, up from $20.2 billion this year. It represents more than 10% of all department mandatory spending, and is projected to continue at that size for years to come.

The fund was at the center of Republican objections to the PACT Act’s passage two years ago and continues to be problematic in crafting veterans legislation because of House rules that require spending offsets.

On several occasions over the last year, Congressional Budget Office planners have said that proposed legislation seemingly unrelated to the toxic exposure benefits could still trigger new mandatory spending related to the TEF. Under House GOP rules, that means that lawmakers must find other savings to counteract those appropriations increases.

House Veterans’ Affairs Committee Chairman Mike Bost, R-Ill., said that problem has stymied a host of panel business this session, sidelining reforms that would help veterans because of the funding implications. He has proposed a plan shifting the money to discretionary accounts and placing caps on the spending.

“If we don’t fix it, the Congressional Budget Office has assured us that this problem will continue to plague the next chairman and future committee members when they try to legislate,” he said at a hearing on the issue on March 21. “That’s a disservice to every single veteran, caregiver and survivor.”

But Democratic lawmakers accused him of working to undermine the fund and the insurance it provides to veterans receiving toxic exposure benefits. They said that changes can be made in chamber rules and scoring practices to get around the budgetary accounting issues, instead of potentially damaging changes to the TEF.

“We made a promise through the PACT Act to our veterans that they will have access to health care for conditions related to toxic exposure,” committee ranking member Mark Takano, D-Calif., said in response to Bost’s plan. “The Cost of War Toxic Exposure Fund is the mechanism through which we are ensuring that promise is kept, for this generation and for future ones as well.”

Takano also accused Republicans of looking to water down or reverse portions of the PACT Act through the proposed changes, a suggestion that drew the ire of multiple GOP members of the panel.

For their part, Republican members blasted Democrats on the committee for refusing to engage with the problem, and accused them of simply leaving the issue for future administrations to solve.

VA officials have so far opposed significant changes to the fund. VA Chief Financial Officer Jon Rychalsk testified before the committee that shifting the appropriations between mandatory and discretionary accounts could have “unintended consequences that may adversely affect veterans.”

But department officials also acknowledged the accounting problems without offering a funding fix.

For now, Bost’s legislation appears stalled in committee. Even if it were to pass out of the House, it is unclear whether Senate officials would act on the issue.

However, with VA spending expected to top $350 billion in total appropriations next year, and with the TEF expected to continue to add to the mandatory spending requirements for the department, Republican lawmakers have promised to continue pressing the issue.

“We are responsible for authorizing programs and services for all veterans so that they can get the care and benefits they have earned,” Bost said. “In order to carry that, we need to get these handcuffs off.”

House and Senate appropriators are expected to finalize plans on the VA budget for fiscal 2025 over the next few months. The new fiscal year starts on Oct. 1.

The new policies allow anyone who has service-connected infertility to use either department’s program, lifting previous requirements that only married, heterosexual couples using their own sperm and eggs could participate.

Now, eligible troops and veterans can access IVF regardless of their martial status or sexual orientation, and they may use donor eggs or sperm ― changing a policy that previously discriminated against those whose infertility affected their ability to produce gametes.

The reforms were spurred on by a lawsuit filed in August by the Yale Law School and the National Organization for Women’s New York chapter.

“We are grateful to the Defense Department and overjoyed for the service members who, through this policy change, will now be able to access the reproductive healthcare so desperately needed in order to build their families,” Sonia Ossorio, executive director of NOW-NYC, said in a statement Monday.

DOD unveiled its new rules Friday, undoing restrictions that limited Tricare coverage of IVF to married couples only.

“We continue to identify ways to lean forward as much as we can in support of equity of access to reproductive health care for our service members,” Kimberly Lahm, who directors oversight of the Pentagon’s health affairs office, said in a statement Monday.

Veterans Affairs followed suit shortly thereafter, amending their policies to include married, same-sex couples and unmarried veterans in their IVF program. Officials there said they expect to begin enrolling newly eligible individuals in IVF programs in coming weeks.

“Raising a family is a wonderful thing, and I’m proud that VA is helping more veterans to have that opportunity,” VA Secretary Denis McDonough said in a statement. “This expansion of care has long been a priority for us, and we are working urgently to make sure that unmarried veterans and veterans in same-sex marriages will have access to IVF in every part of the country as soon as possible.”

But the moves don’t address everything in the original lawsuit, which seeks to open IVF access to all troops and veterans, regardless of whether their fertility issues were caused by illness or injury suffered while serving.

“This is substantial progress,” Donovan Bendana, a Yale Law School student representing NOW-NYC and member of the Reproductive Rights and Justice Project, said in a Monday release. “But the onerous requirement of linking infertility to a specific service injury will deny many service members the opportunity to build a family. This is especially arbitrary in light of the military’s decades-long disinterest in studying women’s health, including the impact of service on fertility.”

NOW-NYC intends to continue with the lawsuit, according to the release, seeking to remove all barriers to IVF for troops and veterans using federal health benefits.

The deployment makes the North Chicago complex the final Defense Department medical site to begin using the new record system, and the first Veterans Affairs site in 21 months to launch the software. VA officials announced a halt to all new site deployments in April 2023 amid growing concerns about staff training and system readiness.

Whether the deployment to Lovell FHCC would go ahead as scheduled this month was in doubt just a few weeks ago, with lawmakers and advocates questioning whether enough fixes had been made to VA processes to ensure patient safety.

But Neil Evans, acting director of VA’s Electronic Health Record Modernization Integration Office, told reporters this week he is confident that patient safety will be improved — not jeopardized — with the launch of the new records system.

“We believe that it is important for us to operate as an integrated system,” he said. “We want to make sure that we are integrated and functioning as a cohesive whole, and making sure this will work as expected. We’re not concerned about unleashing new issues.”

Since President Donald Trump announced plans to put VA and the Defense Department on the same health records system in 2017, the effort has been fraught with software problems, employee frustrations and patient safety concerns.

After deployment to just five sites, VA Secretary Denis McDonough halted all future installations at veterans medical centers until officials were confident that those issues had been corrected.

Several lawmakers have openly questioned whether VA’s $16 billion contract with Oracle Cerner will ever produce a workable system for the department. But McDonough and Oracle officials have insisted the problems can be fixed, given time and focus on the issue.

Meanwhile, the Defense Department’s version of the software — MHS Genesis — has largely been installed with only minor technical setbacks. In a statement, Assistant Secretary of Defense for Health Affairs Lester Martinez-Lopez said deployment of the system to Lovell FHCC “will help DOD and VA deliver on the promise made to those who serve our country to provide seamless care from their first day of active service to the transition to veteran status.”

The Illinois medical center is a joint VA and Defense Department facility which provides care to about 75,000 veterans, service members and family members annually. It is the only joint health care complex of its kind in the nation.

Evans said bringing all of those patients into a single records system will help with coordinating care and provide important insights for VA’s future software deployments.

But in the short term, the move will leave some VA patients in the North Chicago region who use multiple health care sites with two sets of medical records: one in the new Millennium software, and one in VA’s legacy VistA platform.

Those double records have led to problems in the past, particularly with fulfilling pharmacy orders. Evans said officials have made adjustments in recent months and will be closely monitoring the issue going forward.

It also has affected some retail pharmacies across the country.

For the time being, officials ask for patience, “while pharmacies take longer than usual to safely fill prescription needs.”

Until the issue is resolved, military pharmacies will use a manual procedure to fill outpatient prescriptions, health officials said in a Thursday statement to Military Times. Priority goes to urgent prescriptions, followed by routine prescriptions.

“Each military hospital and clinic will continue to offer pharmacy operations based on their local manning and resources,” officials said.

On Wednesday, Change Healthcare disconnected its systems to protect patient information.

“Once we became aware of the outside threat, in the interest of protecting our partners and patients, we took immediate action to disconnect our systems to prevent further impact,” stated Change Healthcare’s status web page.

The latest update said the company expected the disruptions to last at least through Thursday.

The company’s website states that it provides provides “industry-leading analytics, expansive data, and unparalleled connection and data transfer between providers, payers, and consumers.”

Any references that this is caused by a technical issue with MHS Genesis are “inaccurate,” military health officials stated. Genesis is the military’s electronic health record system.

Military pharmacies around the world have been posting notices about the issue and their procedures in response.

“This is impacting pharmacies at [military treatment facilities] enterprise-wide,” read a sign posted at the 19th Medical Group pharmacy at Little Rock Air Force Base, Arkansas, shared on social media Thursday. “We do not know how long it will be down. They are working to resolve it.”

At McConnell Air Force Base, Kansas, the 22nd Medical Group pharmacy posted on social media that it can’t process new prescriptions.

“However, our Pharmacy remains open and will continue to dispense already-completed prescriptions. If you need a new prescription today, please contact your prescribing physician and request that they send the prescription to an alternate pharmacy within the Tricare network.”

At Kadena Air Base in Japan, officials at the medical clinic posted on Facebook Thursday morning: “Due to a systems outage, pharmacy wait times may be longer than normal today.”

The Defense Department has decided to lift previous regulations that only covered in-vitro fertilization for legally married couples using their own sperm and eggs, according to a Dec. 26 court filing in the New York state lawsuit.

A new policy is due out next month that will allow single troops, unmarried couples and any service members using donor sperm or eggs to have their treatment covered, according to a release from Yale Law School, which filed the suit on behalf of National Organization for Women – New York City in August.

Under the revised policy, service members in any relationship status can have IVF covered. They can also use donor sperm or eggs, where previously TRICARE would only cover IVF if the couple seeking treatments provided their own cells, excluding anyone who cannot produce viable sperm or eggs.

“We applaud the Department of Defense for working to expand access to fertility treatments for service members … But this is only the first step,” Sonia Ossorio, NOW-NYC’s executive director, said in a statement. “We will continue to challenge DoD and VA to remove all discriminatory barriers so that each and every service member and veteran who needs this reproductive care can access it.”

Though the government’s filing says that DoD expects to field a new IVF policy in February, the Pentagon was not able to confirm that timeline by Military Times’ deadline on Wednesday.

The Department of Veterans Affairs, also named in the lawsuit, has agreed to review its policies, according to the court filing, which currently only covers heterosexual married couples for such treatment.

The ongoing lawsuit also takes aim at a policy dictating that troops and veterans seeking fertility treatments can only have them covered if their infertility is considered service-linked. Examples include certain chemical exposures or injuries to reproductive organs.

And that coverage only applies to service members experiencing infertility but who can still safely carry a pregnancy, as IVF in conjunction with a gestational carrier, more commonly referred to as a surrogate, is not covered.

“Service members who delay child-rearing and need IVF because of basic demands of military life, like deployments and permanent changes of station, are ineligible for care,” Briana Thompson, a law student intern in the Veterans Legal Services Clinic at Yale Law School and former Air Force officer, said in the Wednesday release. “These stringent requirements are unlawful, out of step with IVF benefits provided to other federal employees, and antithetical to the centrality of the military family to readiness.”

In fiscal 2023, department benefits officials completed nearly 2 million veteran and survivor claims, the most in agency history and up almost 16% from the previous year. During a press call Wednesday, VA Undersecretary for Benefits Joshua Jacobs said through the first three months of fiscal 2024, his staffers are 34% ahead of last year’s pace.

“A key goal for this year is to break last year’s record, and we are on track to do just that for veterans,” he said. “We’re not letting up.”

Jacobs said that prior to Oct. 1, VA benefits employees had processed more than 9,000 claims in a day only three times. Since that date, they’ve surpassed that mark 37 times.

Much of the new success has to do with hiring. Jacobs said that the VA claims workforce is roughly 20% larger than it was in fall 2022, at about 32,000 employees. Officials have set a hiring goal of 4,000 more (12.5%) for the current fiscal year.

“We had a massive hiring effort last year that involved both our human resources functions and also our leadership teams across the country,” he said. “We’ve learned a lot and we are leveraging those lessons to continue improving the way that we do our vetting and our screening and hiring and onboarding and training.”

Despite those successes, however, the total number of backlogged first-time benefits claims in the system — cases that have taken more than four months to complete — earlier this month topped 400,000, the highest that figure has been since June 2014.

That total had been down to around 70,000 cases for several years before the COVID-19 pandemic began in spring 2020.

Disruptions in office work during the pandemic, combined with hundreds of thousands of new cases filed in the wake of the PACT Act passage in 2022, have resulted in a steady rise over the last 16 months. The total caseload in fiscal 2023 was nearly 40% higher than the previous year, meaning the record processing work wasn’t enough to keep up.

Jacobs said he expects the backlog to stabilize in coming months and fall back down to pre-pandemic levels in 2025. Officials expect to release specific projection targets in coming weeks.

The undersecretary also acknowledged that impressive performance statistics are little comfort to veterans who are frustrated waiting for their claims to be finalized.

“We cannot and we will not lose sight of the fact that behind each of these claims is an individual veteran, a family member or a survivor, not a number,” he said. “We’re very mindful that the Veterans Benefits Administration is the first VA touch point for many veterans, which is why we’re also working to build an integrated customer experience for veterans and their families.”

Both initiatives build on the customer experience, or CX, executive order, which stresses the importance of improving confidence in government agencies by “designing and delivering services with a focus on the actual experience of the people whom it is meant to serve.”

As designated high-impact service providers, or HISPs, federal health agencies regard CX as paramount due to the scale and influence of their public-facing services.

Technology is a powerful asset that agencies can utilize to improve digital services. However, to enhance the “actual experiences” of their constituents, and effect meaningful change, it’s essential to understand the customer’s journey and pain points.

Human-centered design, or HCD, is an approach that focuses on customers’ needs, behaviors and experiences. The goal is to create processes and systems that are useful and intuitive by involving the human perspective in all interactions with the federal government.

By emphasizing feedback, agility, and empathy at every stage, HCD can help boost CX at federal health agencies by ensuring that any IT modernization project will result in lasting, meaningful improvements to services that the American public depends on for critical health needs and information.

People, processes and technology

When employees are equipped with the tools and resources they need to perform their job functions with ease, they can deliver better services to citizens in need. In fact, a 2021 report found that organizations with strong employee experience are 2.4x more likely to delight customers.

Therefore, it’s paramount that agency operations and processes evolve alongside technology. Given that employee experiences are directly tied to CX, such adjustments should be informed by the workforce to assure that they are well-received, functional, and advantageous for all parties.

By streamlining processes in accordance with feedback, whether it be from the federal employee or the citizen, agencies can optimize their workflows.

If internal processes don’t complement the new IT solution, digital experiences can become even more arduous for the workforce, which ultimately results in subpar customer experiences. Moreover, without a strategic analysis of the procedure that will support a new IT system, the initiative may get too far down the development line before an issue or bottleneck is identified, and this is when costly rework must occur.

HCD encourages close, consistent communication between all relevant stakeholders early and throughout every step in the process. As such, it would mitigate the likelihood that technology is modernized in a vacuum.

For example, journey maps can examine the steps a customer takes to accomplish a task. Journey maps track the customer’s needs, the “as is” experience, the “to be” experience, and how the customer feels about each step. Input about customer behavior, such as journey maps, combined with guidance from federal employees and contractors are crucial to determine how IT and accompanying processes can be enhanced in an impactful manner.

HCD can be used to address various health agency IT modernization challenges. Often, agencies struggle with organizational silos or barriers. An HCD approach to technology modernization demands that IT personnel understand and account for these barriers and act to reduce the friction they cause.

Understandably, cost and resource constraints are a primary concern for many federal health agencies. However, agencies can better achieve their goal of effective stewardship of taxpayers’ dollars by using HCD to ensure any IT modernization funding is applied in a way that significantly improves CX, based on the first-hand accounts of those customers.

The role of data

Minimal insight into user pain points or obstacles can pose significant challenges for federal health agencies seeking to bolster CX. Fortunately, HCD is devoted to understanding and comprehensively resolving these pain points.

To generate qualitative data on user experiences, agencies can use surveys, focus groups, or call-center conversations. This style of feedback is ideal because it fosters empathic service and two-way discussions. However, given the scale of service required by federal health agencies, other modes of feedback must be incorporated as well.

User experience researchers can review and analyze quantitative data, such as the number of website visitors, the pages they visit, the duration of those visits, errors, abandoned sessions and the actions they take on the website. This information can help federal health IT leaders narrow in on opportunities to improve customer journeys, which enables more effective problem-solving.

Advanced data management platforms can help developers identify actionable insights as they sort through troves of data. Clean, usable and well-governed data, supported by a robust digital infrastructure, can empower health agencies to upgrade their digital services in accordance with HCD principles and meet pressing CX objectives.

To truly embrace HCD requires fundamentally embedding empathy into all CX initiatives and prioritizing sustainable improvements that account for employee and customer experiences alike. Organizational change requires commitment, time and energy to ensure it is lasting.

Given IT modernization initiatives often require partnership from disparate groups, whether from the public or private sector, interoperability is also paramount. Effective data management, standardization and analysis can facilitate easier collaboration between stakeholders to identify and address CX challenges.

When it comes to CX, particularly at federal health agencies, effective service can significantly improve the health and wellness of an individual. The stakes are extremely high because poor service can lead to detrimental health outcomes. As such, it’s imperative that agency leaders, industry experts and academics work together to embed HCD into all digital services and platforms throughout the nation’s federal health agencies.

Rita Breen is Agile and Human-Centered Design Practices Director at National Government Services, an Indianapolis-based provider of specialized services in claims administration, data management, financial management and large scale IT systems.

11:59 p.m. Eastern Time tonight, Dec. 11, is the deadline for service members to enroll in the new Dependent Care Flexible Spending Account. It’s also the sign-up deadline for those eligible for dental and vision coverage under the Federal Employees Dental and Vision Insurance Program, or FEDVIP. Most retirees and their families are eligible for dental and vision coverage under FEDVIP. Families of currently serving members are eligible for the vision coverage under FEDVIP. These currently serving families are eligible for the Tricare Dental Program, which requires separate enrollment.

11:59 p.m. Eastern Time tomorrow, Dec. 12 is the deadline for enrolling in or making changes to your Tricare plan. If you don’t want to make changes, you don’t have to take any action.

The new Dependent Care Flexible Spending Account is available to active duty members, as well as members of the Active Guard Reserve on Title 10 orders. The flexible spending account helps defray the cost of child care and other dependent care by providing tax savings. It’s part of the Federal Flexible Spending Account Program, known as FSAFEDS, which is sponsored by the Office of Personnel Management.

Families can contribute as little as $100, and as much as $5,000 over the year to this account. Eligible expenses include child or adult day care, preschool, summer day camps, and before- or after-school programs.