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E Recommendations Directed to Congress All of the committee’s recommendations for improving the organization and operations of the Department of Health and Human Services (HHS) will benefit from congressional endorsement. Certain recommendations cannot be accomplished effectively, if at all, without corresponding legislative action related to authority and budgetary support. Below are recommendations directed specifically to Congress. recommendations 2 and 4 relate to the funding and oversight of the department, recommendation 3 relates to the effectiveness and efficiency of the health care system, and recommendation 5 relates to the need for greater flexibility in its internal operations and decision making. Recommendation 2: Foster Adaptability and Alignment 2c. The secretary should ensure a more prominent and powerful role for the surgeon general, who, in addition to leading the Commissioned Corps, should be a strong advocate for the health of the American people and work actively to educate Americans on important health issues. The secretary should work with the President and Congress to establish a process for identifying surgeon general candidates for Presidential appointment that gives high priority to qualifications and leadership, and Congress is strongly urged to consider a longer term for this office. 2d. The secretary should work with the President and Congress to establish an appointment process for the department’s senior-level officials that protects the scientific and administrative integrity of major departmental units, promotes progress toward departmental goals, and is based primarily on the candidates’ qualifications and experience. Congress again is strongly urged to consider longer terms for some of 171

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172 HHS IN THE 21ST CENTURY these officials—especially the directors of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), and the commissioner of the Food and Drug Administration (FDA)—which would provide critical continuity in the nation’s public health and scientific endeavors. 2e. The President should make timely appointments and Congress should expedite the confirmation process for key HHS officials, including the secretary, deputy secretary, surgeon general, and the heads of FDA and NIH. Secretarial appointments, such as the director of CDC, should also be expedited. 2h. Congress should allocate sufficient, predictable funding for NIH, CDC, FDA, and AHRQ in order to preserve and enhance these agencies’ scientific missions. Congress should also establish a specific budget line for AHRQ that is independent of appropriations to other HHS agencies. 2i. To address the growing threat of food-borne illnesses, Congress should unify the USDA’s Food Safety and Inspection Service and the food safety activities of FDA within HHS and ensure provision of adequate resources for high-quality inspection, enforcement, and research. Recommendation 3: Increase Effectiveness and Efficiency of the U.S. Health Care System 3a. The secretary should work with Congress to establish a capability for assessing the comparative value—including clinical and cost- effectiveness—of medical interventions and procedures, preventive and treatment technologies, and methods of organizing and delivering care. The assessment of comparative value should begin by leveraging department-wide data sources in conjunction with supportive evidence from providers, payers, and health researchers.a 3b. The secretary should work with Congress to ensure that the department’s programs and reimbursement policies are outcomes based, reflecting best available evidence of value and creating incentives for adoption of best practices, including integration of care, in order to improve quality and efficiency. __________________________________________________ a The committee did not reach consensus on recommendation 3a. Although the majority of the committee supports the language of the recommendation, David Beier, J.D., Senior Vice President of Global Government and Corporate Affairs, Amgen; Kathleen Buto, M.P.A., Vice President, Health Policy, Johnson & Johnson; and Myrl Weinberg, C.A.E., President, National Health Council, did not agree with the majority’s view and provided dissenting opinions, which can be found in Appendix F. They were not able to agree on a common statement.

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APPENDIX E 173 Recommendation 4: Strengthen the HHS and U.S. Public Health and Health Care Workforces 4b. Congress should authorize the department, in cooperation with the Office of Personnel Management, to assemble a package of current and innovative programs and benefits designed to encourage talented, experienced individuals to transition back and forth between government and private-sector service, thereby identifying ways to leverage the best of both. 4c. Congress should provide the secretary with additional authority to reward performance, innovation, and the achievement of results, through bonuses, merit-based pay, recognition awards, or other mechanisms of proven effectiveness. 4f. Congress should give the secretary authority to create new programs that invest in the future generation of biomedical and health services researchers, enabling the continued discovery of new, more effective methods of preventing, treating, and curing disease; promoting health; improving health care delivery and organization; and controlling health system costs. Recommendation 5: Improve Accountability and Decision Making 5. A “new compact” between Congress and the department is essential as HHS works toward achieving its vision for a healthy nation, departmental mission, and key health goals. Under this compact, the secretary would provide Congress and the nation regular, rigorous reports about departmental activities and assume greater accountability for improving performance and obtaining results; in return, Congress should allow the department greater flexibility in its internal operations and decision making. 5b. Congress should authorize the secretary to direct funding from the budgets of all departmental units to support the development of an HHS- wide information system. Funding for such a system would benefit all department units. 5g. Congress should establish a new, strategic initiative fund to enable the secretary to support cross-agency and cross-departmental activities that exhibit innovation in responding to twenty-first century challenges, and to respond quickly to new, unforeseen, or expanding public health threats.

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