A blended workforce—combining human expertise and digital execution at scale.

An open letter from the Office of the CEO·June 15, 2026

Dear CMS and HHS Leadership,

We are writing to share a clear and actionable perspective based on our years of work supporting federal, state, and local public health and human services organizations.

No state would fund a road construction project without ensuring work crews have modern equipment and materials. We do not expect roads to be built with manual effort alone. We invest in machines, materials, and systems that allow work to be completed at scale, safely, and efficiently.

Public health should be no different.

Today, CMS and HHS largely fund services. Going forward, we must also provide those organizations with the capacity - the machinery - to deliver them.

The most effective path forward is to directly sponsor local community-based organizations (CBOs) and frontline teams with digital workforce infrastructure—modern, direct-to-population engagement capabilities that expand execution capacity, improve outcomes, and create real-time visibility into performance.

We have significant data demonstrating that digital workforces operate alongside human teams—just as machines augment physical labor in infrastructure—performing high-volume engagement work at scale, including:

  • Outreach and follow-up
  • Education and reminders
  • Scheduling and coordination
  • Monitoring and service completion

Expanding digital workforces enable consistent, scalable engagement with all populations while capturing structured, real-time data on every interaction. For the past five years our models have demonstrated that frontline digitally-supported engagement work can be performed at scale, reliably, and at a fraction of the cost of traditional staffing models.

From a policy and financial perspective, this creates a clear opportunity to:

  • Expand execution capacity without linear increases in labor costs
  • Improve the return on existing program investments
  • Reduce inefficiencies tied to missed engagement and incomplete service delivery
  • Fund outcomes, not just intent

The Core Issue

Public health systems are not constrained by funding or strategy. They are constrained by execution capacity. Delivering care requires thousands of individual interactions. Each interaction requires time, and time drives cost. The workforce required to perform this work is finite.

In every other sector, this constraint has been solved by augmenting human effort with machines and modern tools. Public health has not made this transition. This is no longer a theoretical gap—it is a policy risk.

Under emerging federal priorities, including Medicaid modernization through OB3, states are facing increased pressure to demonstrate measurable performance, accountability, and return on investment. Programs will be judged not by intent, but by execution. Without the capacity to consistently perform and verify frontline work, even well-funded programs will struggle to meet these expectations.

We are funding services without funding the ability to deliver them at scale.

Why This Matters Now

Emerging federal and state priorities—including Medicaid modernization under OB3—are increasing pressure to demonstrate performance, accountability, and return on investment. However, most investments continue to prioritize what should be delivered, without addressing how that work is executed at scale. Without strengthening frontline workers' execution capacity, even well-funded programs struggle to produce measurable results.

A Practical Path Forward

Improving outcomes does not require new spending. It requires alignment.

Specifically, it requires:

  • Funding digital workforce support directly within CBO and program budgets
  • Embedding engagement infrastructure as a core component of service delivery
  • Ensuring execution capacity scales with program expectations

When this infrastructure is in place:

  • Outreach becomes visible, not assumed
  • Engagement becomes measurable, not anecdotal
  • Service delivery becomes verifiable, not fragmented

This enables a shift from trust-based funding to evidence-based funding and gives leadership a clear line of sight into whether programs are working.

Policy Implication

As accountability requirements continue to rise, public funding should be tied to:

  • Visible work
  • Measurable engagement
  • Verified service delivery
  • Demonstrated outcomes

And critically, funding must include the execution infrastructure required to deliver on these expectations. We would not expect roads to be built without modern equipment. We should not expect public health outcomes to be delivered without modern execution capacity.

Invitation for Discussion

We believe this is a timely opportunity to strengthen the effectiveness of existing public health and human services investments. As states face increasing pressure to deliver measurable results, we would value your perspective and welcome the opportunity to continue the conversation.

We welcome the opportunity to share data, discuss alignment with current priorities, and explore practical paths forward.

Respectfully,

Tom Hartle

Chief Executive Officer

People.Health

Zach Smith

Chief Product Officer

People.Health

Dr. Phil Levy, MD, MPH

Chief Medical Officer

People.Health