In this interview with WashingtonExec, ICF’s John Auerbach discusses his new role as senior vice president of the company’s federal health business. Auerbach joins from the Centers for Disease Control and Prevention, where he most recently served as the director of intergovernmental and strategic affairs. He also served as the public health commissioner for the Massachusetts Department of Public Health.
An established industry leader, Auerbach has co-authored many writings that center on social determinants of health, mental health, substance misuse, the health of older adults and more. We caught up with him below.
Can you start by describing your background in health and the federal space?
I bring 30 years of public health experience to my new role at ICF as an executive leader and strategic advisor for the company’s federal health business. I’ve had the good fortune of working at all levels of the governmental public health system ⏤ local, state and federal. And I’ve also worked outside of government: in a community health center, a Washington, D.C., think tank and a university.
Most recently, immediately before joining ICF, I served as the director of intergovernmental and strategic affairs at the Centers for Disease Control and Prevention, leading the agency’s engagement with many governmental agencies and other external partners.
I also oversaw CDC’s health equity advisory group and served as a chief equity officer for the agency’s COVID-19 response. This was my second stint at CDC. In my previous role, I oversaw the agency’s policy office and its state, local, tribal and territorial relations.
For several years, I was the president and CEO of Trust for America’s Health, a nonpartisan organization dedicated to promoting sound public health policy and making disease prevention a national priority through research, reports and communications campaigns. And earlier, I was the public health commissioner for the Massachusetts Department of Public Health, where I developed innovative programs to promote health equity, combat chronic and infectious disease, and supported the successful implementation of the state’s health care reform initiative.
For a decade, I was the City of Boston’s health commissioner, where I came to understand public health at the grassroots, neighborhood level ⏤ where every decision had a visible impact on one’s neighbors, friends and families.
Across these many roles and experiences, I’ve gained a holistic understanding of the depth, complexity and importance of the issues affecting the health and well-being of the public. And, just as importantly, the many angles you can take to address challenges and improve outcomes.
What drew you to this line of work?
I’ve had a lifelong commitment to health and social justice, which started with my own family’s experience. My grandparents were economic and political refugees in the U.S. My grandfather died of untreated pneumonia in his 40s, causing challenges that reverberated through my generation. We understood the impact of poverty, discrimination and the absence of access to health services and conditions that promoted health. I related to the experience of others who also faced these barriers ⏤ and worse — and, as a result, became active in the civil rights movement.
I spent a few years wondering how to best make a difference before being introduced to public health at the community level. Once I found that ⏤ at first, in a tiny community health center ⏤ I was hooked. In every job since, I’ve sought to prioritize efforts that serve those at elevated risk, through no fault of their own. That is very much what public health stands for.
What drew you to this role at ICF?
I loved ICF’s origin as the Inner City Fund, founded by a Tuskegee Airman and others, to better serve underresourced communities. Even though the organization has grown and evolved in ways the founders could never have imagined, it still has that core commitment to fairness and the belief that everyone is entitled to conditions that are beneficial to one’s health and well-being.
After spending my career strengthening public health programs at the federal, state and local levels, I understand the pros and cons of working in government. I was intrigued by the idea of working in the private sector, in a creative environment that could move quickly and effectively to get to the root of a problem, objectively evaluate and learn lessons from the past, and create innovative yet science-informed solutions. ICF is especially skilled at bringing together subject matter and scientific expertise with data analytics and technology solutions to help government agencies drive positive impact and meet their missions. Government can do so many essential things, but it does need the private sector to accomplish some of its goals.
I also appreciated that ICF takes the more holistic view of health and recognizes the role of economic and social influences ⏤ like stable and affordable housing or access to education ⏤ on an individual’s and a community’s health. I have already started to work with our transportation, early education and housing experts. The silos that exist between different government agencies simply don’t exist at ICF.
In my new role, I’m pleased to be part of Jennifer Welham’s team. Jennifer was recently appointed to lead ICF’s health, human services and workforce business. She’s now leading a 2,500-plus person team focused on providing solutions for our U.S. federal health, social programs, security and organizational clients. It’s great to work alongside so many experts in areas that have a profound impact on public health.
What is driving the expansion of ICF’s federal health business?
As federal health agencies seek more data- and technology-driven solutions to improve health outcomes, they are seeking partners like ICF. Not only do we offer technology-forward, data-informed solutions, but we back them with more than four decades of deep subject matter expertise and mission-driven enthusiasm. This is an exciting time for ICF’s federal health business as we grow to meet increased demand.
In recent years, ICF has made several significant technology acquisitions that have enhanced our offerings to federal health clients. Among them is Enterprise Science and Computing (or ESAC), one of the leading specialized providers of advanced health analytics, research data management and bioinformatics solutions.
We also acquired SemanticBits, a premier partner to U.S. federal health agencies that brings a full suite of scalable digital modernization services using open-source frameworks and cloud-native solutions to help manage large data sets. Together, these acquisitions strengthen our offerings to federal health clients and enable us to support larger, more complex projects across federal agencies.
With double-digit growth and record contract awards, our federal health business is a priority area for ICF. I’m looking forward to helping guide our work in emerging federal health markets and identify ways that we can better support agencies with both their short- and long-term goals.
What do you see as the greatest challenges facing federal health agencies today, and how can ICF help address those?
Data utilization is a huge issue facing federal agencies. I saw firsthand at CDC just how important the data modernization process was during the COVID response.
At ICF, we’ve supported many federal civilian agencies with their data modernization efforts, including those with a health focus. A recent example is our work with the Centers for Medicare and Medicaid Services to increase the transparency of nursing facility data. With more than 14,800 skilled nursing facilities throughout the country ⏤ and a lot of industry change from frequently shifting parent companies and acquisitions ⏤ providing this transparency was a tall task.
We worked to overhaul the agency’s data management and user interface systems to help health care officials, researchers and consumers better assess metrics of nursing home quality. Given the importance and difficulties of the decisions that families and their health care providers make about nursing homes, we were pleased to help CMS ensure there was useful information to inform the decision-making process.
I anticipate that we’ll see more projects like this one because access to robust, timely and accurate data at all levels is essential to a cohesive public health system that’s capable of responding effectively to emergencies.
You’ve mentioned behavioral health and climate change impacts as two of the growing threats facing agencies today. What are some ways companies like ICF can make a positive impact?
As I mentioned earlier, ICF holds a more holistic view of health that recognizes the role of economic and social conditions, often referred to as the social determinants of health. This concept is deeply ingrained in our work. It’s a perspective we utilize in our work to improve housing, community development, justice and education. That is, we consider the full range of outcomes that potential actions will have and we offer our clients insights into ways to solve existing problems without creating unintentional new ones.
We’re well suited to work on projects and initiatives related to social determinants of health because we have deep subject matter expertise across a variety of sectors and industries. A great example is the connection between child welfare and climate change. Last summer, the extreme heat events in the Pacific Northwest disproportionately affected under-resourced communities. Not everyone had access to air conditioning in their homes and schools. The rising heat index was resulting in discomfort and inhibiting children’s health and well-being, as well as their ability to focus in educational settings.
On another important topic, we have been engaged for several years in assisting our clients as they work to prevent and, when appropriate, provide services to address behavioral health needs. CDC’s recent Adolescents and School Health report highlighted the urgency of this work with its shocking data on sexual violence and bullying and the subsequent suicidal ideation and depression. This situation requires an understanding of the conditions that contribute to the problem as well as the evidence-based efforts that have been shown to be protective in similar situations. The CDC has provided an invaluable service by collecting, analyzing and sharing the information in its full complexity. That approach sets the stage for effective interventions.
When we incorporate this type of awareness into our work, we can provide better solutions for our clients, and ultimately improve public health outcomes.
How are issues around equity impacting federal health markets today?
Health equity is another key issue at the forefront for federal health agencies. And it’s one that’s been at the heart of ICF’s mission and drive since its early days as an organization. As we look to improve our health system, equity must be a core element of all levels of work.
One example of where an equity-approach matters is the collection and analysis of data. A core belief in the public health sector is that you must be counted to matter. Population data is essential to properly respond with targeted, health-promoting information, outreach and services. But if certain populations are insufficiently or never counted, it isn’t possible to know if they’re more or less likely to be diagnosed with preventable illnesses and injuries and, therefore, their health and well-being may suffer.
With COVID we saw very clearly the danger of having insufficient or delayed data on race and ethnicity. Early on, we were only receiving such data on about 50% of the reported COVID cases. That made it very difficult to document and respond appropriately to the elevated impact in the communities of color. We also saw very clearly that communication and public health initiatives must be built upon trust and that requires authentic and meaningful partnerships based on mutual respect and shared decision-making. ICF had the good fortune of working with Morehouse University on a COVID-related communications initiative that was effective because it put the voice of the community front and center.
Another segment of the population about whom we still have insufficient information is people with disabilities. When I was still at CDC, we began to work to better understand the often-overlooked needs of this growing population in the U.S. But without a fuller understanding of their needs, any action steps are likely to be insufficient.
A recent example of federal efforts to promote equity is the release of a groundbreaking federal report that aims to advance equity for lesbian, gay, bisexual and transgender (LGBTQI+) people. With this report, the federal government provides a guidebook to systematically capturing information on sexual orientation and gender identity to better inform policies and programs that affect the lives of LGBTQI+ people and their families. And the report is not just focused on health — it also examines the experiences of LGBTQI+ people regarding such matters as housing, educational and job opportunities, and safety.
What are some of the emerging federal health markets you are keeping a close eye on?
Workforce is another timely issue for federal agencies, and another area where I hope we’ll continue to see investments. The public health workforce had been losing personnel for the past 15 years. By some estimates, it was down 40,000 jobs since the time of the 2008 recession. The consequences of that became clear during COVID. The pandemic also showed that our health care workers and federal agencies weren’t prepared for a nonstop, long-lasting emergency. After a few years of that intensified stress, many in the health sector are leaving the profession or questioning their ability to work under such difficult circumstances.
Some steps have begun to be taken to address these concerns and rebuild the public health and health care workforce. For example, CDC recently awarded $3.9 billion in grants to states and localities to improve their workforce and infrastructure. We need to see more efforts that support the public health workforce at all levels ⏤ federal, state, local, territorial and tribal ⏤ with sustainable funding and support.
ICF has been pleased to be involved in many efforts to provide federal employees and the workforce of federal grant recipients with supportive training and technical assistance to help them develop and refine their skills ⏤ and get customized assistance when needed ⏤ so they’re better equipped for the challenges ahead.
What kinds of new investments are you monitoring?
Right before the new year, President Biden signed a $1.7 trillion spending bill to keep the government open. There are a number of key investments included in that bill that indicate some of the priorities for federal agencies.
For example, the bill included $3.3 billion for the Assistant Secretary for Preparedness to help strengthen the nation’s preparedness levels for future pandemics.
The bill also contained a few investments into health equity projects, including a 60 percent increase in funding to the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health for initiatives aimed at improving maternal health and reducing the nation’s alarmingly high maternal mortality rate. There are some new investments in services for populations with elevated risks, such as adolescents with behavioral health needs.
And many federal agencies have prioritized the improvement of their data systems to ensure that they can operate as efficiently and effectively as possible ⏤ and meet the public’s needs. Those investments are sometimes tied to specific programs and sometimes part of a systemwide initiative. But virtually all the agencies realize they must have modernized data systems.